Previous Perinatal Death Research Articles

Adverse birth outcome among women who gave birth at the University of Gondar comprehensive specialized hospital, Northwest Ethiopia

BackgroundIn Ethiopia, various maternal and child health interventions, including comprehensive and basic obstetric cares were conducted to curb high neonatal and infant morbidity and mortality. As such, adverse birth outcome has been a public health concern in the country. Thus, this study aimed to assess the burden and associated factors with adverse birth outcomes among women who gave birth at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.MethodsA health facility-based cross-sectional study was employed from 30 March to 01 May 2021 at the University of Gondar Comprehensive Specialized Hospital. A total of 455 women were interviewed using a structured questionnaire. A binary logistic regression model was fitted Adjusted Odds Ratio (AOR) with 95%CI and p-value < 0.05 were used to declare factors significantly associated with adverse birth outcomes.ResultsIn this study, 28% of women had adverse birth outcomes (8.4% stillbirths, 22.9% preterm births, and 10.11% low birth weights). Women aged 20–34) (AOR: 0.32, 95%CI: 0.14, 0.76), rural dwellers (AOR: 2.7, 95%CI: 1.06, 6.32), lack of ANC visits (AOR: 4.10, 95%CI: 1.55, 10.85), APH (AOR: 3.0, 95%CI: 1.27, 7.10) and fever (AOR: 7.80, 95%CI: 3.57, 17.02) were associated to stillbirths. Multiple pregnancy (AOR:7.30, 95%CI:1.75, 20.47), rural dwellers (AOR:4.60, 95%CI:1.36, 15.52), preterm births (AOR: 8.60, 95% CI: 3.88, 19.23), previous perinatal death (AOR:2.90, 95%CI:1.35, 6.24), fever (AOR:2.7,95%CI:1.17 ,6.23) and premature rupture of membrane (AOR:2.60, 95% CI:1.02, 6.57) were affecting low birth weights. In addition, previous antepartum hemorrhage (AOR: 2.40, 95%CI: 1.37, 4.10) and fever (AOR: 3.8, 95%CI: 2.13, 6.89) were also factors contributing to preterm births.ConclusionAdverse birth outcomes continue to pose a significant public health concern. Such high rates of adverse birth outcomes, such as preterm birth, low birth weight, and birth defects, can have serious and long-lasting effects on the health and well-being of both infants and their families, and the community at large. As such, public health efforts are crucial in addressing and mitigating the risk factors associated with adverse birth outcomes. This may involve implementing interventions and policies to improve maternal health, access to prenatal care and nutritional support, and reducing exposure to environmental risks.

Potential Factors Associated with Stillbirth among Babies Born in Hospitals of North Shoa, Oromia, Ethiopia, 2021 Based on Cross-sectional Study Design

Introduction: Fetal death is one of the common adverse pregnancy outcomes. More than 7178 deaths at 28 weeks of gestation occur every day, making 2.6 million fetal deaths worldwide. The majority of these deaths occurred in developing countries, and 98% occurred in low and middle-income countries. To address the problem of stillbirth, the magnitude and determinants of stillbirth must be understood to help intervention be given to reduce fetal stillbirth. This study was facilitated by obtaining basic data on the factors influencing stillbirth. This will facilitate the development of better public health interventions to reduce these preventable fetal deaths and improve maternal health. Objective: This study aimed to assess the determinant factors of still-birth among babies born in hospitals in the North Shoa zone, Oromia, Ethiopia. Methods: The study was conducted among 348 babies born in the hospital of North Shoa Zone. Study subjects were selected by systematic sampling method from the list of babies born in hospitals in a three-month study period. Data were collected by using a pretested and structured questionnaire. Data were edited, cleaned, coded, entered, and analyzed using SPSS-21 statistical software. Bivariate and multivariate analysis was employed. Results: Potential factors were having regular antenatal care, congenital malformation, and having a history of perinatal death, were significantly associated with the stillbirth. Conclusion: The risk of stillbirth was associated with both modifiable and non-modifiable factors. Therefore, encouraging regular ANC to follow up, minimizing the formation of congenital malformation, and increasing birth in the history of previous perinatal death prevent the risk of potential stillbirth.

Types and Distribution of Fetal Congenital Anomaly and their Maternal Characteristics in High Risk Pregnancy Unit of Dhaka Medical College Hospital, Bangladesh

Introduction: Congenital anomaly is one of the important causes of perinatal mortality and morbidity. Proper information regarding its prevalence, distribution as well as risk factors can help policy makers to take appropriate steps for prevention. Materials and Methods: A hospital record based observational study was done in Obstetric department of Dhaka Medical College Hospital, Bangladesh during the year of 2020. The aim of the study is to evaluate the pattern of anomaly found in admitted patients in Maternal Fetal Medicine unit, along with the maternal demographic profile and associated diseases. After taking ethical clearance and permission from department detailed information was collected and analysis was done. Results: In the year 2020 total 6012 delivery was occurred and 4.42% of them were anomalous baby. The maternal characteristics showed that mean maternal age was 26.24(±5.25) years. 20.7% of mother had previous history of abortion, 7.7% has previous perinatal death and 3.3% have previous anomalous baby. 5.49% mother had Diabetic disorders and 4.39% had congenital heart disease. Associated poly hydramnios was found in 17.7% and oligohydramnios was found in 12.1% of cases. The distribution pattern of anomalies according to system involved showed that 41.7% was Central Nervous System anomaly, 8.7% was Renal anomaly, 6.5% was Musculoskeletal anomaly, 4.4% was Gastrointestinal anomaly,6.6% had body wall defect , 10.9 % was Non immune Hydrops, 3.3% was Syndromic baby and 13.1% had multiple congenital anomaly. Conclusion: It is a tertiary hospital based study. So it may not reflect the actual picture of population. So community based study is needed for further advancement.

A risk-prediction model using parameters of maternal body composition to identify gestational diabetes mellitus in early pregnancy.

Accurate early risk-prediction for gestational diabetes mellitus (GDM) would target intervention and prevention in women at the highest risk. We evaluated maternal risk-factors and parameters of body-composition to develop a prediction model for GDM in early gestation. A prospective observational study was undertaken. Pregnant women aged between 18 and 50y of age with gestational age between 10 and 16 weeks were included in the study. Women aged ≤18y, twin-pregnancies, known foetal anomaly or pre-existing condition affecting oedema status were excluded. 8-point-skinfold thickness (SFT), mid-upper-arm-circumference (MUAC), waist, hip, weight and ultrasound measurements of subcutaneous (SAT) and visceral abdominal-adipose (VAT) were measured. Oral-glucose-tolerance-test (OGTT) for GDM diagnosis was undertaken at 28 weeks gestation. Binomial logistic-regression models were used to predict GDM. ROC-analysis determined discrimination and concordance of model and individual variables. 188 women underwent OGTT at ~28 weeks gestation. 20 women developed GDM. BMI (24.7kgm-2 (±6.1), 29.9kgm-2 (±7.8), p=0.022), abdominal SAT(1.32cm (CI 1.31, 1.53), 1.99cm (CI 1.64, 2.31), p=0.027), abdominal VAT(0.78cm (CI 0.8, 0.96), 1.41cm (CI 1.11, 1.65), p=0.002), truncal SFT (84.8mm (CI 88.2, 101.6), 130.4mm (CI 105.1, 140.1), p=0.010), waist (79.8cm (CI 80.3, 84.1), 90.3cm (CI 85.9, 96.2), p=0.006) and gluteal hip (94.3cm (CI 93.9, 98.0), 108.6cm (CI 99.9, 111.6), p=0.023) were higher in GDM vs. non-GDM. After screening variables for inclusion into the multivariate model, family history of diabetes, previous perinatal death, overall insulin resistant condition, abdominal SAT and VAT, 8-point SFT, MUAC and weight were included. The combined multivariate prediction model achieved an excellent level of discrimination, with an AUC of 0.860 (CI 0.774, 0.945) for GDM. An early gestation risk prediction model, incorporating known risk-factors, and parameters of body-composition, accurately identify pregnant women in their first-trimester who developed GDM later on in gestation. This methodology could be used clinically to identify at-risk pregnancies, and target specific treatment through referred services to those mothers who would most benefit.

Determinants of perinatal mortality in public secondary health facilities, Abuja Municipal Area Council, Federal Capital Territory, Abuja, Nigeria.

Introductionin Nigeria, perinatal mortality rate remains high among births at the health facility. Births occur majorly at the secondary healthcare level in Abuja Municipal Area Council (AMAC) of the Federal Capital Territory (FCT). Identifying factors influencing perinatal deaths in this setting would inform interventions on perinatal deaths reduction. We assessed perinatal mortality and its determinants in public secondary health facilities in AMAC.Methodsdelivery and neonatal data from two selected public secondary health facilities between 2013 and 2016 were reviewed and we extracted maternal socio-demographics, obstetrics and neonatal data from hospital delivery, newborns´ admissions and discharge registers. Data were analyzed using descriptive statistics and Cox proportional hazard models (α = 5%).Resultsperinatal mortality rate was 129.5 per 1000 births. Asphyxia 475 (34.0%), neonatal infection 279 (20.0%) and prematurity 242 (17.3%) accounted for majority of the 1,398 perinatal deaths. Unbooked status [aHR = 1.8 (95% CI 1.4 - 2.2)], antepartum haemorrhage [aHR = 2.8 (95% CI 1.2 - 6.7)], previous perinatal death [aHR = 2.3 (95% CI 1.7 - 3.1)] and maternal age ≥ 35 years [aHR= 1.4 (95% CI 1.0 - 1.8)] were associated with increased risk of perinatal death.Conclusionperinatal mortality in the studied hospitals was high. Determinants of perinatal death were unbooked antenatal care (ANC) status, antepartum haemorrhage, previous perinatal death and high maternal age. Reducing perinatal deaths would require improving antenatal care attendance with healthcare staff identifying and targeting women at risk of pregnancy complications.

Perinatal outcomes in a subsequent pregnancy among women who have experienced recurrent miscarriage: a retrospective cohort study.

Is a history of three or more miscarriages associated with adverse perinatal outcomes in a subsequent pregnancy? Recurrent miscarriage is associated with an increased risk of adverse perinatal outcomes, including preterm birth, very preterm birth and perinatal death, in a subsequent pregnancy. Published data are conflicting with some studies reporting an increase in adverse perinatal outcomes in association with prior recurrent miscarriage while others report little or no increase. Large-scale population-based studies have been lacking. We performed a retrospective cohort study of 30 053 women with a singleton pregnancy who booked for antenatal care and delivery between January 2008 and July 2011. All women who attended a university affiliated hospital in Ireland had a detailed obstetric history taken, recording the outcome of all previous pregnancies. We compared the obstetric and perinatal outcomes of 2030 women (6.8%) who had a history of three or more miscarriages (recurrent miscarriage) with the outcomes of 28 023 women (93.2%) who did not. Logistic regression analyses were performed, adjusting for potential confounding factors. Women with a history of recurrent miscarriage were more likely to be obese, to have undergone assisted conception, to have had a previous perinatal death, and to be delivered by scheduled Caesarean section. Recurrent miscarriage was associated with an increased incidence of preterm birth (<37 weeks gestation, 8.1 versus 5.5%, adjOR 1.54; 95% CI 1.29-1.84), very preterm birth (<32 weeks gestation, 2.2 versus 1.2%, adjOR 1.80; 95% CI 1.28-2.53), and perinatal death (1.2 versus 0.5%, adjOR 2.66; 95% CI 1.70-4.14). The results were similar for both primary and secondary recurrent miscarriage. This is a retrospective cohort study and while regression analyses adjusted for potential confounding factors, residual confounding may persist. The strict definition of recurrent miscarriage is three consecutive miscarriages and while each woman in the study group had three or more miscarriages, they were only confirmed to be consecutive in the primary RM group. The affected women have not been categorized according to aetiology of recurrent miscarriage and it may be that adverse outcomes differ according to aetiological subgroup. This study highlights the need for specialist obstetric care for women who have had three or more previous miscarriages, particularly in relation to the risk of preterm delivery. There was no specific funding obtained for this study and there are no conflict of interests.

Correlates of poor perinatal outcomes in non-hospital births in the context of weak health system: the Nigerian experience.

BackgroundNigeria’s high perinatal mortality rate (PNMR) could be most effectively reduced by targeting factors that are associated with increased newborn deaths. Low access to skilled birth attendants (SBAs) and weak health system are recognized factors associated with high PNMR but other socio-demographic and reproductive factors could have significant influences as well. Identification of the major factors associated with high PNMR would be required in designing interventions to improve perinatal outcomes.MethodsFor this cross-sectional study, data from the Nigeria Demographic and Health Survey 2008 were used to estimate the PNMR of non-hospital births in identified socio-demographic and reproductive situations that are known to influence PNMR. The estimated PNMR were compared using logistic regression analysis.ResultsThe PNMR was 36 per 1000 live births. North central region had the lowest PNMR while the south east region had the highest rate (odds ratio 1.59; 95% CI: 1.03, 2.45). Other correlates of high PNMR were belonging to the poorest wealth quintile (odds ratio 1.87; 95% CI: 1.30, 2.70), maternal age group 15–19 years (odds ratio 1.59; 95% CI: 1.05, 2.22), multiple birth (odds ratio 3.12; 95% CI: 2.11, 4.59), history of previous perinatal death (odds ratio 3.31; 95% CI: 2.73, 4.02), birth interval shorter than 18 months (odds ratio 1.65; 95% CI: 1.26, 2.17) and having a small birth size (odds ratio 2.56; 95% CI 1.79, 3.69). Birth attendant, place of birth, parity, maternal education and rural/urban residence had no association with PNMR.ConclusionsReproductive factors that require midwifery skills were found to contribute most to PNMR. We recommend general strengthening of the health system, recruitment of SBAs and retraining of available birth attendants with emphasis on identification and referral of complicated cases. Family planning should be a core MCH activity to address the issues of teenage pregnancy and short pregnancy intervals.

Parents’ experiences and expectations of care in pregnancy after stillbirth or neonatal death: a metasynthesis

Pregnancy after perinatal death is characterised by elevated stress and anxiety, increasing the risk of adverse short-term and long-term outcomes. This metasynthesis aimed to improve understanding of parents' experiences of maternity care in pregnancy after stillbirth or neonatal death. Six electronic databases were searched using predefined search terms. English language studies using qualitative methods to explore the experiences of parents in pregnancy after perinatal loss, were included subject to quality appraisal framework. Searches were initiated in December 2011 and finalised in March 2013. Studies were synthesised using an interpretive approach derived from meta-ethnography. Fourteen studies were included in the synthesis, graded A (no or few flaws, high trustworthiness; n = 5), B (some flaws, unlikely to affect trustworthiness; n = 5) and C (some flaws, possible impact on trustworthiness; n = 4). Three main themes were identified; co-existence of emotions, helpful and unhelpful coping activities and seeking reasssurance through interactions. Parents' experiences of pregnancy are profoundly altered by previous perinatal death; conflicted emotions, extreme anxiety, isolation and a lack of trust in a good outcome are commonly reported. Emotional and psychological support improves parents' experiences of subsequent pregnancy, but the absence of an evidence base may limit consistent delivery of optimal care within current services.

Psychosocial impact of perinatal loss among Muslim women

BackgroundWomen of reproductive age are vulnerable to psychosocial problems, but these have remained largely unexplored in Muslim women in developing countries. The aim of this study was to explore and describe psychosocial impact and social support following perinatal loss among Muslim women.MethodsA qualitative study was conducted in a specialist centre among Muslim mothers who had experienced perinatal loss. Purposive sampling to achieve maximum variation among Muslims in relation to age, parity and previous perinatal death was used. Data was collected by focus group discussion and in-depth unstructured interview until the saturation point met. Sixteen mothers who had recent perinatal loss of wanted pregnancy, had received antenatal follow up from public or private health clinics, and had delivery in our centre participated for the study. All of them had experienced psychological difficulties including feelings of confusion, emptiness and anxiety over facing another pregnancy.ResultsTwo out of sixteen showed anger and one felt guilt. They reported experiencing a lack of communication and privacy in the hospital during the period of grief. Family members and friends play an important role in providing support. The majority agreed that the decision makers were husbands and families instead of themselves. The respondents felt that repetitive reminder of whatever happened was a test from God improved their sense of self-worth. They appreciated this reminder especially when it came from husband, family or friends closed to them.ConclusionMuslim mothers who had experienced perinatal loss showed some level of adverse psychosocial impact which affected their feelings. Husbands and family members were the main decision makers for Muslim women. Health care providers should provide psychosocial support during antenatal, delivery and postnatal care. On-going support involving husband should be available where needed.

Recent Changes in Maternal Characteristics by Socioeconomic Status

ObjectiveTo describe changes in maternal characteristics by socioeconomic status, in order to provide a context for recent changes in the frequency of obstetric procedures and outcomes, and information for health planning purposes. MethodsAll NS residents who delivered between 1988 and 2007 were included in the study. Information on maternal characteristics was obtained from the Nova Scotia Atlee Perinatal Database, and socioeconomic status information was obtained through a confidential link with federal income tax T1 Family Files (1988 to 2003). ResultsTotal births to women <20 years of age were high (31.5% in 2003) and increased in the lowest family income group between 1988 and 2003, while rates were low (0.7% in 2003) and decreased in the highest family income group. Total births to women ≥d35 years increased by 136% (95% CI 122, 150) between 1988–89 and 2006–07. Births to women with a weight ≥390kg also increased, while those to smokers decreased in all socioeconomic groups. The proportion of births to multiparous women with a previous low birth weight infant did not change (–5 %, 95% CI –14, 6), although births to women with a previous perinatal death declined by 52% (95% CI –60,–42). ConclusionLarge secular changes have occurred in maternal characteristics over the past two decades, and the magnitude of these changes has differed by socioeconomic status.

A risk assessment for pregnancy using the World Health Organization classifying form in primary health-care facilities in Enugu, Nigeria

We present a cross-sectional survey of the pattern of high-risk pregnancies in randomly selected primary health-care facilities in Enugu, Nigeria, using the World Health Organization's classifying form. None of the 10 maternity homes studied had a standard risk screening tool. The age of the 299 women studied ranged from 16 to 42 years with a mean of 27.8 +/- 6.7 years. Eighty-eight (29.4%) of them were nulliparous, 160 (53.5%) were multiparous and 51 (17.1%) grandmultiparous. One hundred and twenty (40.1%) respondents were in the high-risk category. Rhesus D-negative blood group parturients (42, 35.0%), previous perinatal deaths (29.2%) and multiple pregnancies (9.2%) were the most common risk factors. The prevalence of high-risk pregnancies significantly increased with maternal age and parity and was not influenced by an improved maternal educational attainment. The institution of screening for high-risk pregnancies is vital at the primary health-care level and must be emphasized and must be regularly audited.

Maternal and Paternal Thrombophilia: Risk Factors for Perinatal Mortality

Maternal thrombophilia is an accepted risk factor for perinatal death, having been associated with pregnancy-related thrombosis and preeclampsia, intrauterine growth restriction, placental abruption, recurrent miscarriage, and late fetal loss. Up to two thirds of these vascular complications can be related to some form of inherited or acquired thrombophilia. It is not clear whether paternal factors contribute to thrombophilia-related perinatal mortality. The investigators examined data from a prospective registry of perinatal mortality in The Netherlands. Seventy-four women with a previous perinatal death and 54 of their male partners were assessed, along with 71 women having uneventful pregnancies and 66 of their partners. Cases and control subjects did not differ with respect to age or oral contraceptive use. Compared with control women, case women had significant higher rates of antithrombin deficiency (12% vs. 0%), elevated factor VIII activity (43% vs. 17%), and increased activated protein C (APC) resistance (32% vs. 6%). Total protein S antigen also was increased in case women. There were no significant group differences in the prevalence of deficient protein C activity, hyperhomocysteinemia, factor V G1691A (F V Leiden) mutation, prothrombin mutation, or the MTHFR C677T mutation. The overall prevalence of one or more thrombophilic factors was 70% in case women and 30% in control women. Male cases had significantly increased APC resistance compared with the male control group (22% vs. 0%). Of 54 couples with past perinatal mortality, 30 (55%) had more than one thrombophilic abnormality compared with 10 (17%) of control couples. The prevalence of thrombophilia is about doubled not only in mothers, but also in fathers having a history of perinatal mortality, suggesting that it is a risk factor.

Preterm Delivery and the Severity of Violence During Pregnancy

Violence has been chronicled in from 6% to 20% of pregnancies, depending partly on how it is defined. The possibility of serious consequences from prenatal violence prompted a prospective cohort study enrolling women who,during a 2-year period in 1994-1996, took part in a maternity care coordination program. Three times the women were asked if they had been hit, slapped, kicked, or hort during the current pregnancy. All those revolting violence were counseled and offered domestic violence shelter and services. Of 550 participants, 13.5% reported violence, which was rated as severe in half the cases (hitting, kicking, injury by a weapon, abdominal injury) and moderate in the remaining half (threats, slapping, shoving, sexual abuse). Hitting and kicking were the commonest forms of violence, and most often the violator was a partner or ex-partner. Although the face and head were the most common targets, many women reported abdominal injury. The average number of violent incidents reported was 1.5. Younger women, the unmarried, and those with little education more often reported severe physical violence. The same was the case for primiparas and African American women. In addition, women reporting severe physical violence were significantly likelier to have a previous perinatal death or preterm birth or to have used alcohol in the current pregnancy. The apparent relationship between severe violence and preterm labor or delivery, very low birth weight, low Apgar scores, and neonatal intensive care persisted after controlling for age, race, a previous poor birth outcome, and alcohol use. Seven of 13 women reporting prenatal violence directed at the abdomen delivered before term, and 5 had a low birth-weight infant. Prenatal physical abuse clearly is associated with preterm delivery, especially when directed at the abdomen. The findings point to a need to routinely screen for such violence. Women subjected to violence should be closely watched for preterm labor.

The effect of various infertility treatments on the risk of preterm birth.

The high incidence of preterm birth (<37 weeks gestation) is a major concern in assisted reproductive technology. The objective of this study was to compare the risk of preterm birth from singleton pregnancies following either low technology treatment (intrauterine insemination and donor insemination) or high technology treatment (IVF, ICSI and gamete intra-Fallopian transfer) with that of naturally conceived pregnancies. Three cohorts of pregnancies resulting from either low or high technology treatment or from natural conception were included in the study. A number of potential risk factors were adjusted for. The incidence of very preterm birth (<32 weeks of gestation) was not significantly increased in the low technology treatment group (1.0 versus 1.3% in controls) but was significantly higher in the high technology treatment group (5.2%, P < 0.001). In spontaneous, elective Caesarean section (CS) and induced delivery onset, the risk of preterm birth increased gradually from the controls to the low technology treatment group to the high technology treatment group, while for an emergency CS the risk of preterm birth was very high in both treatment groups. The overall incidence of preterm birth increased significantly from the controls to the low technology treatment group and to the high technology treatment group. Logistic regression analysis showed that younger and older age, previous perinatal death and emergency CS were associated with an increased risk, while a previous live birth reduced the risk. The length of the infertile period did not seem to affect the risk in any of the treatment groups.

Incidence, obstetric risk factors and pregnancy outcome of preterm placental abruption: a retrospective analysis

Objective: To determine obstetric risk factors for the occurrence of preterm placental abruption and to investigate its subsequent perinatal outcome.Study design: A retrospective comparisonof all singleton preterm deliveries complicated with placental abruption, between the years 1990-1998, to all singleton preterm deliveries without placental abruption, in the Soroka University Medical Center.Results: Placental abruption complicated 300 (5.1%) of all preterm deliveries (n = 5934). A back-step multivariable analysis found the following factors to be independently correlatedwith the occurrence of preterm placental abruption: grandmultiparity (more than five deliveries), early gestational age, severe pregnancy-induced hypertension, previous second-trimester bleeding and non-vertexpresentation. These pregnancies had a significantly lower rate of preterm premature rupture of membranes than preterm pregnancies without placental abruption. Pregnancies complicated with preterm placentalabruption had significantly higher rates of cord prolapse, non-reassuring fetal heart rate patterns, congenital malformations, Cesarean deliveries, perinatal mortality, Apgar scores lower than 7 at 5 min,postpartum anemia and delayed discharge from the hospital than did preterm deliveries without placental abruption. In order to assess whether the increased risk for perinatal mortality was due to the placentalabruption, or due to its significant association with other risk factors, a multivariable analysis was constructed with perinatal mortality as the outcome variable. Placental abruption (OR 3.0, 95% CI 2.1-4.1)as well as cord prolapse, previous perinatal death, low birth weight and congenital malformations were found to be independent risk factors for perinatal mortality.Conclusion: Preterm placentalabruption is an unpredictable severe complication associated with significant perinatal morbidity and mortality. Factors found to be independently associated with placental abruption were grandmultiparity,severe pregnancy-induced hypertension, malpresentation, earlier gestational age and a history of second-trimester vaginal bleeding.

Hydramnios and small for gestational age: prevalence and clinical significance

To investigate the clinical significance of combined obstetrical pathology of small for gestational age and hydramnios as a predictor of peripartum complications, intrapartum morbidity and poor neonatal outcome. The study population consisted of 152 small for gestational age neonates with hydramnios out of 67,806 singleton deliveries during the study period (0.22%). We compared the 152 small for gestational age neonates with hydramnios (hydramnios/small for gestational age) to a sample of 1% of the appropriate for gestational age neonates with normal amniotic fluid (normal amniotic fluid/appropriate for gestational age) (582 cases). Analyses were conducted for the entire cohort as well as for the cohort in which all cases with congenital malformations were excluded. There was a significantly higher rate of congenital anomalies in the hydramnios/small for gestational age group compared with the normal amniotic fluid/appropriate for gestational age group (25% vs. 2.4%, p<0.001). There were significantly more previous perinatal deaths, infertility treatments and diabetes type B-R among the hydramnios/small for gestational age group. These findings remained significant after exclusion of the neonates with congenital malformations. The rates of labor dystocia, placental abruptio, abnormal presentations, prolapse of cord and cesarean sections were significantly higher in the hydramnios/ small for gestational age group compared with normal amniotic fluid/appropriate for gestational age group (5.9/2.4%, p<0.05; 5.9/0.7%, p<0.001; 14.5/3.2%, p<0.001; 2/0.2%, p<0.01; 24.3/8.2%,p<0.001; respectively). Rates of ante partum death and post partum death as well as low 1 and 5 minute Apgar scores were significantly higher in the hydramnios/small for gestational age group (9.9/0.3%; 14.5/0.3%; 12.8/2.1%; 11.7/0.6%, p<0.001, respectively). The combination of small for gestational age and hydramnios is a risk factor for peripartum complications and perinatal mortality even in the absence of congenital malformations.

Obstetric care in southern Tanzania: does it reach those in need?

To assess whether antenatal care achieves identification and timely referral of high-risk pregnancies in southern Tanzania. We compared the risk profiles of pregnant women in general with those attending obstetric care and investigated the reasons for seeking care. The risk profile of inpatients was drawn up through interviews with maternity cases and analysis of their antenatal records at the regional referral hospital (n = 415); population-based data on the prevalence of specific risk factors were obtained from entries in antenatal care registers (n = 1630) and from literature. A significant risk selection towards obstetric referral level care was observed only for previous caesarean section (prevalence hospital 6.7%, all pregnancies 1.5%, P < 0.005) and for nulliparity (hospital 42.8%, all pregnancies 25.0%, P < 0.005). No significant differences were observed for other risk factors such as previous perinatal death, height < 150 cm, multiple gestation and breech presentation. Prevalence of the risk factors age > 34 years and grand multiparity was significantly lower among hospital users. Coverage of obstetric care was below 50% for all risk factors except previous caesarean section (91.5%). Despite pursuing the risk approach and very good coverage, antenatal care in Tanzania has only limited effect on extending obstetric care to high-risk mothers. A critical review of the present screening and counselling practices, including a more focused and client-centred application of risk assessment, is warranted.

Risk factors for perinatal death in Cape Verde

Risk factors for perinatal death in the Cape Verde islands were assessed among 104 bereaved mothers and 292 mothers of surviving infants in an area-based case-control study in 1992-93. Prospectively gathered information on risk factors was obtained from medical records supplemented with post-partum interviews and anthropometric measurements of mothers and infants. No autopsies were performed. Multiple logistic regression analysis was applied. Out of 23 alleged maternal and two alleged infant risk factors, the following seven proved significantly and independently correlated with perinatal death: first pregnancy (odds ratio [OR] = 2.9); previous hypertensive disease (OR = 4.2); previous perinatal death (OR = 4.6); pre-eclampsia (OR = 7.0); non-cephalic fetal presentation (OR = 17.1); male infant (OR = 2.1) and maternal post-partum fever (OR = 3.1). The perinatal mortality rate was calculated as 37-46/1000 total births. A reduction in the mortality rate warrants antenatal and obstetric care with emphasis on primiparous women; improved detection and treatment of hypertensive disorders and genital infections; and improved intrapartum fetal observation and resuscitation routines.

Epidemiology of syphilis in pregnancy in rural South Africa: opportunities for control.

The paper describes the epidemiology, risk factors and impact on pregnancy outcome of syphilis in pregnant women in rural South Africa. Prevalence was determined from laboratory records. A case-control study of 200 women (50 cases with syphilis) was done to investigate possible risk factors. To determine the impact on pregnancy outcome, and to evaluate the effect of treatment, a retrospective cohort was constructed. Overall prevalence of syphilis was 6.5%; it was highest in the urban antenatal clinic (9%). The odds ratios for syphilis in women gravidity 3-5 compared to gravidity 6 was 3.2 and 2.3 compared to women with gravidity 2 or less. For women with a previous birth, those with a previous perinatal death were 3.2 times more likely to have syphilis after adjusting for other risk factors. Pregnancy outcome was available for 187 women. The adjusted odds ratio of an adverse pregnancy outcome in women with syphilis was 11.8. All still births occurred in women with syphilis. The prevalence of syphilis is high in this rural area and screening should be applied to all women. Although screening was comprehensive, less than half of the detected cases were fully treated and a poor perinatal outcome ensued. On-site testing for syphilis at the time of booking would allow treatment to start immediately.

Polyhydramnios is an independent risk factor for perinatal mortality and intrapartum morbidity in preterm delivery

To investigate the clinical significance of polyhydramnios as a predictor of perinatal death and intrapartum morbidity in patients with preterm delivery. Study design: The study population consisted of 4211 patients with singleton gestation, intact membranes and preterm delivery (<37 weeks). Two groups were identified and compared according to the sonographic assessment of the amniotic fluid volume: increased and normal amniotic fluid. Analyses were conducted for the entire cohort as well as for the cohort excluding from each group all cases with congenital malformations. Logistic regression was used to assess the unique contribution of polyhydramnios to mortality and morbidity in the presence of other known risk factors. Results: The prevalence of polyhydramnios among women who delivered preterm was 5% (210/4211) including and 3.7% (142/3818) excluding the cases of congenital malformations, respectively. Polyhydramnios was associated with a higher rate of diabetes, large for gestational age neonates, fetal malpresentation at delivery, previous perinatal death and with a lower Apgar score at 1 and 5 min. Polyhydramnios was an independent predictor of perinatal mortality and intrapartum morbidity. When adjusted for well recognized risk factors for perinatal mortality and intrapartum morbidity (e.g. diabetes, severe pregnancy induced hypertension, multiparity, congenital malformation, previous perinatal death, low gestational age at delivery), the presence of polyhydramnios significantly increased the rate of perinatal mortality (odds ratio (OR) 5.8; 95% confidence interval (CI) 3.68–9.11) and of intrapartum morbidity (OR 2.8; 95% CI 1.94–4.03). Conclusion: In the setting of preterm delivery, polyhydramnios is an independent risk factor for perinatal mortality and intrapartum complications even in the absence of congenital malformation and other conditions traditionally associated with increased perinatal mortality and morbidity.