Reduction In Stillbirths Research Articles

Role of contaminated water for stillbirths in pregnant women

Untreated infection may cause stillbirth by several mechanisms, including direct fetal infection, placental damage and severe maternal illness. Many bacteria, viruses, and protozoa have been associated with stillbirth. Every country has to develop and implement a plan to improve maternal and neonatal health that includes a reduction in stillbirths, and to count stillbirths in their vital statistics and other health outcome surveillance systems. We also ask for increased investment in stillbirth-related research, and especially research aimed at identifying and addressing barriers to the aversion of stillbirths within the maternal and neonatal health systems of low-income and middle-income countries. Screening, prevention and treatment of maternal infections are important to reduce stillbirth risk.

Impact of smoke-free legislation on perinatal and infant mortality: a national quasi-experimental study.

Smoke-free legislation is associated with improved early-life outcomes; however its impact on perinatal survival is unclear. We linked individual-level data with death certificates for all registered singletons births in England (1995–2011). We used interrupted time series logistic regression analysis to study changes in key adverse perinatal events following the July 2007 national, comprehensive smoke-free legislation. We studied 52,163 stillbirths and 10,238,950 live-births. Smoke-free legislation was associated with an immediate 7.8% (95%CI 3.5–11.8; p < 0.001) reduction in stillbirth, a 3.9% (95%CI 2.6–5.1; p < 0.001) reduction in low birth weight, and a 7.6% (95%CI 3.4–11.7; p = 0.001) reduction in neonatal mortality. No significant impact on SIDS was observed. Using a counterfactual scenario, we estimated that in the first four years following smoke-free legislation, 991 stillbirths, 5,470 cases of low birth weight, and 430 neonatal deaths were prevented. In conclusion, smoke-free legislation in England was associated with clinically important reductions in severe adverse perinatal outcomes.

Institutional deliveries and perinatal and neonatal mortality in Southern and Central India.

BackgroundSkilled birth attendance and institutional delivery have been advocated for reducing maternal, perinatal and neonatal mortality (PMR and NMR). India has successfully implemented various strategies to promote skilled attendance and incentivize institutional deliveries in the last 5 years.ObjectivesThe study evaluates the trends in institutional delivery, PMR, NMR, and their risk factors in two Eunice Kennedy Shriver NICHD Global Network for Women’s and Children’s Health Research sites, in Belgaum and Nagpur, India, between January 2010 and December 2013.Design/methodsDescriptive data stratified by level of delivery care and key risk factors were analyzed for 36 geographic clusters providing 48 months of data from a prospective, population-based surveillance system that registers all pregnant permanent residents in the study area, and their pregnancy outcomes irrespective of where they deliver. Log binomial models with generalized estimating equations to control for correlation of clustered observations were used to test the trends significanceResults64,803 deliveries were recorded in Belgaum and 39,081 in Nagpur. Institutional deliveries increased from 92.6% to 96.1% in Belgaum and from 89.5% to 98.6% in Nagpur (both p<0.0001); hospital rates increased from 63.4% to 71.0% (p=0.002) and from 63.1% to 72.0% (p<0.0001), respectively. PMR declined from 41.3 to 34.6 (p=0.008) deaths per 1,000 births in Belgaum and from 47.4 to 40.8 (p=0.09) in Nagpur. Stillbirths also declined, from 22.5 to 16.3 per 1,000 births in Belgaum and from 29.3 to 21.1 in Nagpur (both p=0.002). NMR remained unchanged.ConclusionsSignificant increases in institutional deliveries, particularly in hospitals, were accompanied by reductions in stillbirths and PMR, but not by NMR.

Proceedings of the Stillbirth Summit 2014.

Stillbirth is a devastating pregnancy outcome that occurs once in every 160 pregnancies in the United States, [1] with similar rates in other developed nations around the world. Despite advances in medical knowledge and technology, there have been slow trends in stillbirth reduction in most high income countries over the past two decades relative to other declines in infant mortality [2]. Contributing to this lack of progress is the minimal amount of research activities dedicated to stillbirth etiologies and prevention methods. As a follow-up to Stillbirth Summit 2011, Star Legacy Foundation hosted Stillbirth Summit 2014 in Minneapolis, MN (USA) June 19-21, 2014. The goals of the summit were to support current and emerging stillbirth research, promote collaboration among interested parties, and to encourage dialogue regarding the complex factors affecting stillbirth incidence and care. In attendance were researchers, health care professionals, stillbirth advocates, and bereaved families. The following oral papers offer an overview of the research presented and discussed at this event.

The placenta and adverse pregnancy outcomes – opening the black box?

A healthy placenta is critical for a healthy pregnancy. Conversely, abnormal placental structure and function is seen in conditions which are associated with stillbirth including: fetal growth restriction, preeclampsia, placental abruption and obstetric cholestasis. Abnormalities can be seen ranging from a reduction in placental size in stillbirth to microscopic changes in placental villous architecture [1]. Placental examination is advocated after stillbirth by respected guidelines [2-4]; this recommendation is based upon the frequency of abnormalities seen in placentas after stillbirth [5,6], the reduction in unexplained stillbirths when placental histological examination is performed and the cost-effectiveness per abnormality detected [1,7]. The placenta has previously been referred to as a “diary of pregnancy” and it is tempting to compare examination of the placenta after stillbirth with the “black-box” flight data recorder used after aircraft accidents. To be certain that placental findings are significant in a case of stillbirth they should reflect (relevant) changes that occurred prior to fetal death. Thus, there should be no artefact from in-utero retention or storage. Placental findings should give information regarding conditions present and be specific for adverse pregnancy outcome (i.e. not occur in healthy pregnancy). Ultimately, the information obtained must be useful, aiding understanding of death by clinicians and inform future care. Storage and fixation of placental tissue can alter findings on examination. Naeye et al. states that “troublesome artefacts” can appear after 48 hours of refrigeration [8]. This is supported by qualitative and quantitative assessment Garrod et al. demonstrated changes in villous vascularity after 48 hours refrigeration [9]. Thus, every effort should be made to minimise the time of storage prior to examination. The effects of retention in utero before birth are more difficult to assess as the time of fetal death is usually unknown. Genest estimated that in utero retention was associated with villous degeneration, particularly of fetal blood vessels and villous stroma [10]. A systematic review of histopathological assessment of the placenta found that a placental cause is reported in 11.2 - 64.9% and associated with stillbirth in 31.5% - 84% of cases [11]. The greatest influence on the proportion of stillbirths classified as having “placental” abnormalities was the classification system employed. The specificity of placental abnormalities for stillbirth has previously been questioned by the high incidence of histological lesions in apparently normal pregnancies and the large variation in agreement between pathologists when identifying lesions (Kappa – 0.25-0.91) [12,13]. These data highlight the importance of international consensus in the definition of placental lesions to improve study quality. Accurate description of lesions will also enable better understanding of their origins. One example of this is syncytial knots (also known as syncytial nuclear aggregates). The formation of syncytial knots are increased in hypoxia and oxidative stress in vitro[14], which supports the reported association between syncytial knots/nuclear aggregates and maternal vascular malperfusion [13,15]. Furthermore, evaluation of placental structure and function can be used to explore clinical scenarios relating to stillbirth such as maternal perception of reduced fetal movements, advanced maternal age and fetal growth restriction [16-18]. These clinical conditions are all associated with alterations in placental structure, specifically increased syncytial knots/nuclear aggregates, changes in trophoblast proliferation and alterations in amino-acid transport [14,19-21]. Importantly, these observations provide plausible biological association between these clinical scenarios and stillbirth from placental causes. These suggest that better appreciation of placental function in utero may provide an opportunity to identify pregnancies at risk of stillbirth to target intervention [22,23].

Update from New Zealand

The Auckland Stillbirth Study, a prospective population-based case control study, was the first study to report maternal sleep related practices as risk factors for stillbirth [1]. In brief there were 155 women with a singleton late stillbirth (at or greater than 28 weeks’ gestation) without congenital abnormality, born between July 2006 and June 2009 and booked to deliver in Auckland. They were compared with 310 women with single ongoing pregnancies and gestation matched to that at which the stillbirth occurred. The prevalence of late stillbirth in this study was 3.09/1000 births. No relationship was found between snoring or day time sleepiness and risk of late stillbirth. However, women who slept on their back or on their right side on the last night (prior to stillbirth or interview) were more likely to experience a late stillbirth compared to women who slept on their left side (back: aOR 2.54; 95% CI: 1.04 to 6.18; and right side: aOR 1.74; 95% CI: 0.98 to 3.01). Women who got up to the toilet once or less on the last night were more likely to experience a late stillbirth compared to women who got up more frequently (aOR 2.28; 95% CI: 1.40 to 3.71). Women who regularly slept during the day, in the last month, were also more likely to experience a late stillbirth compared to those who did not (aOR 2.03; 95% CI 1.26 to 3.27). If maternal sleeping position is causally related to stillbirth then 37% of stillbirths might be prevented if mothers slept on their left side. However, the authors urged caution as this was the first time that an association has been described between maternal sleep practices and late stillbirth risk. Further studies are needed to confirm or refute these findings before public health interventions are launched. In New Zealand there is a multicentre case-control study, which began in 2012, led by Lesley McCowan, and in England there is the Midland and North of England Stillbirth Study (MiNESS), which began in 2014, led by Alex Heazell [2]. Despite urging caution, midwives appear to have accepted the findings and are advising their patients to sleep on the left side. This has resulted in a significant increase in left sided sleep position, from 35.9% in The Auckland Stillbirth Study (2006-9) to 62.5% in late 2011 (unpublished findings). This has been associated with a reduction in late stillbirth for New Zealand (excluding congenital abnormalities and multiple pregnancies). 2007 184 2008 187 2009 205 2010 162 2011 146 2012 136 Although we cannot exclude other reasons for the decline, it is tempting to believe that the declined is a consequence of more pregnant women sleeping on their left.

Effect of Maternal Multiple Micronutrient vs Iron–Folic Acid Supplementation on Infant Mortality and Adverse Birth Outcomes in Rural Bangladesh

Importance Maternal micronutrient deficiencies may adversely affect fetal and infant health, yet there is insufficient evidence of effects on these outcomes to guide antenatal micronutrient supplementation in South Asia. Objective To assess effects of antenatal multiple micronutrient vs iron–folic acid supplementation on 6-month infant mortality and adverse birth outcomes. Design, Setting, and Participants Cluster randomized, double-masked trial in Bangladesh, with pregnancy surveillance starting December 4, 2007, and recruitment on January 11, 2008. Six-month infant follow-up ended August 30, 2012. Surveillance included 127 282 women; 44 567 became pregnant and were included in the analysis and delivered 28 516 live-born infants. Median gestation at enrollment was 9 weeks (interquartile range, 7-12). Interventions Women were provided supplements containing 15 micronutrients or iron–folic acid alone, taken daily from early pregnancy to 12 weeks postpartum. Main Outcomes and Measures The primary outcome was all-cause infant mortality through 6 months (180 days). Prespecified secondary outcomes in this analysis included stillbirth, preterm birth ( Results Among the 22 405 pregnancies in the multiple micronutrient group and the 22 162 pregnancies in the iron–folic acid group, there were 14 374 and 14 142 live-born infants, respectively, included in the analysis. At 6 months, multiple micronutrients did not significantly reduce infant mortality; there were 764 deaths (54.0 per 1000 live births) in the iron–folic acid group and 741 deaths (51.6 per 1000 live births) in the multiple micronutrient group (relative risk [RR], 0.95; 95% CI, 0.86-1.06). Multiple micronutrient supplementation resulted in a non–statistically significant reduction in stillbirths (43.1 vs 48.2 per 1000 births; RR, 0.89; 95% CI, 0.81-0.99; P = .02) and significant reductions in preterm births (18.6 vs 21.8 per 100 live births; RR, 0.85; 95% CI, 0.80-0.91; P P Conclusions and Relevance In Bangladesh, antenatal multiple micronutrient compared with iron–folic acid supplementation did not reduce all-cause infant mortality to age 6 months but resulted in a non–statistically significant reduction in stillbirths and significant reductions in preterm births and low birth weight. Trial Registration clinicaltrials.gov Identifier:NCT00860470

Women's Experiences of Fetal Movements before the Confirmation of Fetal Death--Contractions Misinterpreted as Fetal Movement.

Decreased fetal movement often precedes a stillbirth. The objective of this study was to describe women's experiences of fetal movement before the confirmation of fetal death. Data were collected through a Web-based questionnaire. Women with stillbirths after 28 gestational weeks were self-recruited. Content analysis was used to analyze the answers to one open question. The statements from mothers of a stillborn, born during gestational weeks 28 to 36 were compared with those of a stillborn at term. The women's 215 answers were divided into three categories: decreased, weak, and no fetal movement at all; 154 (72%) of the descriptions were divided into three subcategories: decreased and weak movement (106; 49%), no movement at all (35; 16%), and contraction interpreted as movement (13; 6%). The category fetal movement as normal includes 39 (18%) of the descriptions. The third category, extremely vigorous fetal activity followed by no movement at all, includes 22 (10%) of the descriptions. Eight (15%) of the women with stillbirths in gestational weeks 28 to 36 interpreted contractions as fetal movement as compared to 5 (5%) of the women with stillbirths at term. Uterine contractions can be interpreted as fetal movement. A single episode of extremely vigorous fetal activity can precede fetal death. The majority of the women experienced decreased, weaker, or no fetal movement at all 2days before fetal death was diagnosed. Mothers should be educated to promptly report changes in fetal movement to their health care providers. Using fetal movement information to evaluate possible fetal distress may lead to reductions in stillbirths.

Scourge of intra-partum foetal death in Sub-Saharan Africa.

Intra-partum foetal death has been variously defined. However, a definition adopted at a technical consultation in 2006 is employed in this review. The quality of intra-partum care is a crucial factor for pregnancy outcome for both mothers and new-borns. Intra-partum stillbirth is defined as late foetal death during labour, which clinically presents as fresh stillbirth. The largest proportion of the world's stillbirths occurs in the late preterm, term and intra-partum periods. The Western Pacific region has the greatest reduction in stillbirth with a 3.8% annual decline between 1995 and 2009; however, the annual decline in the African region is less than 1%. Caesarean delivery is still uncommon, especially in rural areas: 1% of births in rural Sub-Saharan Africa and 5% in rural South Asia are by caesarean delivery; 62% of stillbirths occurred during the intra-partum period; 61.4% of stillbirths are attributable to obstetrical complications. Preventive measures aimed at reducing the incidence of intra-partum foetal death entail all measures aimed at improving quality antenatal care and preventing intra-partum asphyxia. This review discusses intra-partum foetal deaths from a Sub-Saharan African perspective. It explores the contribution of research within the region to identifying its impact on new-born health and potential cost-effective policy interventions.

Effects of various procedures for synchronisation of parturition in sows. Assessment of sows with a complication-free birth.

The effects of various parturition controlling measures in sows on the relevant parameters for parturition were investigated. A total of 1975 study animals were divided into five groups: control group: A (n=710); trial groups: B (n=719), C (n=180), D (n=175), E (n=191). The control group (A) included sows that spontaneously farrowed until day114 of gestation. The remaining sows were administered a PGF2α-analogue (175µg cloprostenol) on day114. All sows that farrowed within 24hours after prostaglandin-medication were summarised in trial groupB. Dams that did not farrow until day115 were either administered oxytocin (20 IU i.m., groupC) or carbetocin in two different doses (70µg, groupD or 35µg, groupE). The sows were monitored during the peripartal period over 24hours. 83.8% of the farrowings were without any complications. The percentage of dystocia varied between the individual groups. Given a complication-free farrowing the expulsion stage began 13.0hours (groupB), 2.4hours (groupC), 1.6hours (groupD) and 1.4hours (groupE) after medication. The expulsion interval of the farrowing of two piglets decreased from 21.1minutes with spontaneous farrowings (groupA) to 18.6 minutes (groupE) as a result of the administration of 35µg carbetocin. The rate of stillborn piglets as well as the incidence of puerperal disorders and the losses of the suckling piglets also gradually, partly even significantly (p≤0.05) decreased from groupA to E. The results of this study show that the use of the long-acting oxytocin carbetocin has advantages compared to oxytocin (e. g. shortened duration of birth, reduction of stillbirths). The tested dosages of carbetocin (35µg or 70µg) proved to be equally effective. Administration of the lower dose is recommended, since this reduces use of the active ingredient.

Effect of maternal multiple micronutrient vs iron-folic acid supplementation on infant mortality and adverse birth outcomes in rural Bangladesh: the JiVitA-3 randomized trial.

Maternal micronutrient deficiencies may adversely affect fetal and infant health, yet there is insufficient evidence of effects on these outcomes to guide antenatal micronutrient supplementation in South Asia. To assess effects of antenatal multiple micronutrient vs iron-folic acid supplementation on 6-month infant mortality and adverse birth outcomes. Cluster randomized, double-masked trial in Bangladesh, with pregnancy surveillance starting December 4, 2007, and recruitment on January 11, 2008. Six-month infant follow-up ended August 30, 2012. Surveillance included 127,282 women; 44,567 became pregnant and were included in the analysis and delivered 28,516 live-born infants. Median gestation at enrollment was 9 weeks (interquartile range, 7-12). Women were provided supplements containing 15 micronutrients or iron-folic acid alone, taken daily from early pregnancy to 12 weeks postpartum. The primary outcome was all-cause infant mortality through 6 months (180 days). Prespecified secondary outcomes in this analysis included stillbirth, preterm birth (<37 weeks), and low birth weight (<2500 g). To maintain overall significance of α = .05, a Bonferroni-corrected α = .01 was calculated to evaluate statistical significance of primary and 4 secondary risk outcomes (.05/5). Among the 22,405 pregnancies in the multiple micronutrient group and the 22,162 pregnancies in the iron-folic acid group, there were 14,374 and 14,142 live-born infants, respectively, included in the analysis. At 6 months, multiple micronutrients did not significantly reduce infant mortality; there were 764 deaths (54.0 per 1000 live births) in the iron-folic acid group and 741 deaths (51.6 per 1000 live births) in the multiple micronutrient group (relative risk [RR], 0.95; 95% CI, 0.86-1.06). Multiple micronutrient supplementation resulted in a non-statistically significant reduction in stillbirths (43.1 vs 48.2 per 1000 births; RR, 0.89; 95% CI, 0.81-0.99; P = .02) and significant reductions in preterm births (18.6 vs 21.8 per 100 live births; RR, 0.85; 95% CI, 0.80-0.91; P < .001) and low birth weight (40.2 vs 45.7 per 100 live births; RR, 0.88; 95% CI, 0.85-0.91; P < .001). In Bangladesh, antenatal multiple micronutrient compared with iron-folic acid supplementation did not reduce all-cause infant mortality to age 6 months but resulted in a non-statistically significant reduction in stillbirths and significant reductions in preterm births and low birth weight. clinicaltrials.gov Identifier: NCT00860470.

A Narrative Synthesis of the Published Literature on Antenatal Care in Low and Middle Income Countries

Background: Good quality antenatal care is one of the recommended strategies to reduce maternal and neonatal mortality and improve health outcomes of the mother and her child. The utilization and quality of antenatal care in low and middle income countries is not well documented and hence deserves further study. This is a literature review of antenatal care in low and middle income countries on its utilization, the barriers and facilitators, and the available evidence of effectiveness and quality of antenatal careMethod: A systematic review of the published literature was conducted which also included published systematic reviews. Studies published between 2002 and 2012 were identified by searching Medline, EMBASE and CINAHL. This was supplemented by papers provided by international advisors from grey literature and snowballing search of reference list of all included papers. Only English language studies in low and middle income countries on antenatal care were includedResults: Twenty-three papers met the inclusion criteria. Health-facility based studies reported near universal access to antenatal care, which was not the case for community based studies. Women received at least one antenatal visit but fewer women had the recommended number of visits. Socioeconomic status and women’s education were the most frequent and the strongest predictors of antenatal care use. Antenatal care promoted the use of skilled birth attendant at delivery, but did not contribute to reductions in maternal mortality and stillbirths. The quality of care was reported as unsatisfactory; major issues being poor client-provider relationship and inferior quality of counselling.Conclusion: In order to increase the utilization of antenatal care, in the short term, less educated women from socioeconomically disadvantaged households require targeting. Long-term improvements require a focus on improving female education. Further research is needed to explore the quality of antenatal care in order to validate its effect on maternal and child health.DOI: http://dx.doi.org/10.3126/hprospect.v13i1.11341 Health Prospect Vol.13(1) 2014: 12-23

Reduction in stillbirths at term after new birth induction paradigm: results of a national intervention

ObjectiveThe risk of fetal death increases steeply after 42 gestational weeks. Since 2009, Denmark has had a more proactive policy including prevention of prolonged pregnancy, and early intervention in women...

Preventing stillbirths through improved antenatal recognition of pregnancies at risk due to fetal growth restriction

Most stillbirths used to be categorized as ‘unexplained’ and were considered, by implication, unavoidable. Recent evidence indicates that they represent a combined challenge for public health and for clinical services. Independent case reviews have found that many deaths are associated with a failure to recognize risk factors and to afford them the appropriate standard of care. The majority of normally formed fetal deaths had preceding, unrecognized intrauterine growth failure. Improved training and adoption of standardized protocols has led to increased antenatal detection of fetal growth restriction, and this in turn has resulted in significant reductions in stillbirths in areas with high uptake of the training programme. A comprehensive, evidence-based growth assessment protocol (GAP) is currently being rolled out across the NHS to implement this strategy for stillbirth prevention.

Prevention of group B streptococcal disease in the first 3 months of life: Would routine maternal immunization during pregnancy be cost-effective?

BackgroundA vaccine against group B streptococcus (GBS) that is intended for routine maternal immunization during pregnancy is in clinical development. Addition of vaccination to screening and intrapartum antibiotic prophylaxis (IAP) may further reduce the burden of GBS disease in infancy; its potential cost-effectiveness is unknown, however. MethodsWe evaluated the cost-effectiveness of routine immunization at week 28 of pregnancy with the trivalent GBS (serotypes Ia, Ib and III) vaccine that is in clinical development. The vaccine was assumed to be used in addition to screening and IAP, and reduce the risk of invasive infection in infancy due to covered serotypes. We estimated the effectiveness of immunization in terms of additional cases of GBS disease prevented, deaths averted, life-years saved, and quality-adjusted life-years (QALYs) gained; potential reductions in prematurity and stillbirths were not considered. Costs considered included those of acute care for infants with GBS disease, and chronic care for those with long-term disability. The cost of immunization was assumed to be $100 per person. ResultsAssuming 85% coverage, routine maternal immunization against GBS added to screening and IAP would prevent an additional 899 cases of GBS disease and an additional 35 deaths among infants in the US. The total annual cost of immunization would be $362.7 million; estimated cost savings from prevention of GBS disease in infancy would be $43.5 million. The cost-effectiveness of immunization was estimated to be $91,321 per QALY gained. Findings were sensitive to assumptions regarding vaccine efficacy and cost. ConclusionsAddition of a trivalent GBS maternal vaccine to screening and IAP might further reduce the burden of GBS disease among infants in the US, and may be comparable in cost-effectiveness to other vaccines recently approved for use in children and adolescents.

Temporal trends in stillbirth in the United States, 1992–2004: a population‐based cohort study

To examine temporal trends in stillbirth and its risk factors in the United States (US), and to assess the contribution of labour induction and caesarean delivery to the stillbirth rate. Population-based cohort study based on linked birth-infant death and fetal death data files from the US National Vital Statistics System. Complete data were available for 44 states and the District of Columbia. Singleton births from 1992 to 2004. We assessed changes in stillbirth rates from 1992-1994 to 2002-2004 before and after adjustment for changes in maternal characteristics including maternal age, education, smoking, and medical risk factors, using Cox regression models. We also carried out an ecological study, using states as the units of analysis, to assess the impact on the stillbirth rate of increasing induction and caesarean delivery. Race-specific subgroup analyses were performed and included non-Hispanic Whites and non-Hispanic Blacks. Stillbirth rate. The stillbirth rate among non-Hispanic White singleton births decreased 11.5% from 1992-1994 (5.2 per 1000) to 2002-2004 (4.6 per 1000). After adjustment for maternal risk factors, the hazard ratio (HR) for 2002-2004 was 1.01 (0.99, 1.03) for gestational age (GA) ≤39 weeks, but 0.92 (0.86, 0.99) at 40 or more weeks. The ecologic analysis revealed a nonsignificant negative correlation of -0.17 (-0.44, 0.13) between state-level changes in stillbirth at GA ≥40 weeks and labour induction. A nonsignificant positive correlation of 0.23 (-0.07, 0.49) was observed between changes in stillbirth at all GAs and caesarean delivery and did not differ at GA ≤39 versus ≥40 weeks. Results were similar among non-Hispanic Blacks. Changes in maternal risk factors explained the reduction in stillbirth at GA ≤39 weeks but not at ≥40 weeks. The rise in labour induction and caesarean delivery rates did not explain the reduction in stillbirth ≥40 weeks of gestation.

Every Newborn: the professional organisations' perspective

The International Federation of Gynecology and Obstetrics, the International Confederation of Midwives, the International Pediatric Association, and the Council of International Neonatal Nurses recognise and support the Every Newborn Action Plan,1 which is situated in the continuum of care for reproductive, maternal, newborn, and child health. The Every Newborn Action Plan calls for acceleration in action at country, regional, and local levels to accelerate reduction in stillbirth, and in neonatal and maternal mortality rates.

Trends in the incidence and mortality of multiple births by socioeconomic deprivation and maternal age in England: population-based cohort study

ObjectiveTo investigate temporal trends in multiple birth rates and associated stillbirth and neonatal mortality by socioeconomic deprivation and maternal age in England.DesignPopulation cohort study.SettingEngland.ParticipantsAll live births and stillbirths (1 January...

The effect of algal biomass supplementation in maternal diets on piglet survival in two housing systems

Current developments in the pig industry pose increased challenges for piglet survival as a result of selection for increased prolificacy and welfare pressures to abolish the use of farrowing crates. The effect of supplementation of the maternal diet with algal biomass, containing the essential fatty acid docosahexaenoic acid (DHA), on the performance of sows and their piglets farrowing in two different housing conditions was studied using a 3×2 factorial experiment. A control diet was compared to 2 levels of DHA supplementation from algal biomass (0.03% and 0.3% DHA, delivered by 1.5g/kg and 15g/kg algal biomass) during the last 4 weeks of pregnancy and lactation, using 60 sows (mean parity 4.7 sem 0.32) in two different farrowing systems (farrowing crate and PigSAFE farrowing pen). Two-way analyses of variance showed no statistically significant interactions between dietary treatment and housing system. Piglet survival and growth did not differ between the crate and pen systems. Litter size (13.1 sem 0.42) and piglet birthweight (1.45 sem 0.047kg) did not differ between dietary treatments, but the number of stillborn piglets per litter was reduced with increasing DHA supplementation (1.13, 0.67, 0.25, sem 0.205, P=0.014, with litter size covariate). This was despite an increase in farrowing duration of the sows with increased DHA supplementation (150.3, 195.2 and 216.2 sem 13.6min, P=0.02). The vitality of the piglets, as described by the latency (min) of the piglets to stand (1.92, 1.44 and 1.17, sem 0.09, P<0.001), to reach the teat (21.55, 15.71 and 11.20, sem 1.35, P<0.001) and to suckle (25.66, 19.14 and 14.83, sem 1.40, P<0.001), was also improved with increased supplementation of DHA. Mortality of liveborn piglets in the first 3 days, and number weaned per litter (after fostering) were unaffected by treatment, as were sow weight and backfat loss in lactation. However, piglet weaning weight was reduced by DHA supplementation (by up to 12%). The mechanism for the reduction in stillbirth should be further investigated.

Association between reduced stillbirth rates in England and regional uptake of accreditation training in customised fetal growth assessment

ObjectiveTo assess the effect that accreditation training in fetal growth surveillance and evidence-based protocols had on stillbirth rates in England and Wales.DesignAnalysis of mortality data from Office of National Statistics.SettingEngland...