Risk Factors For Stillbirth Research Articles

Obesity as a potential risk factor for stillbirth: The Japan Environment and Children’s Study

The relationship between high body mass index (BMI) >25 kg/m2 and risk for stillbirth in the Japanese population remains unclear. This study aimed to estimate the impact of maternal obesity on the risk of stillbirth in a Japanese population. This prospective cohort study used data from the Japan Environment and Children’s Study, which recruited pregnant individuals between 2011 and 2014. A total of 93,772 fetuses were considered eligible for inclusion in this study. Stillbirth (fetal death before or during labor at ≥22 completed weeks of gestation) rates were compared among four pre-pregnancy BMI groups: underweight (<18.5 kg/m2), reference (18.5 to <25.0 kg/m2), overweight (25.0 to <30.0 kg/m2), and obese (≥30.0 kg/m2). The association between pre-pregnancy BMI and the risk of stillbirth was estimated using multiple logistic regression analyses. The overall stillbirth incidence was 0.33% (305/93,722). Compared with the reference group, the risk of stillbirth was significantly higher in the overweight group (adjusted odds ratio [aOR]: 1.55; 95% confidence interval [CI]: 1.08–2.23) and the obese group (aOR: 2.60; 95% CI: 1.59–4.24). The overall incidence of early stillbirth (i.e., <28 weeks) was 0.17% (155/93,722). Similarly, after adjusting for potential confounding factors, the risk of early stillbirth was significantly higher in the obese group (aOR: 4.33; 95% CI: 2.44–7.70). Increased maternal BMI was associated with an increased risk of stillbirth in the Japanese population. Therefore, counselling women planning for pregnancy on the importance of an appropriate pre-pregnancy BMI to minimize the risk of stillbirth is important.

A Novel Approach to Predicting Early Pregnancy Outcomes Dynamically in a Prospective Cohort Using Repeated Ultrasound and Serum Biomarkers

This study aimed to develop a dynamic model for predicting outcome during the first trimester of pregnancy using baseline demographic data and serially collected blood samples and transvaginal sonographies. A prospective cohort of 203 unselected women with an assumed healthy pregnancy of < 8 weeks’ gestation was followed fortnightly from 4–14 weeks’ gestation until either miscarriage or confirmed first trimester viability. The main outcome was development of a model to predict outcome from gestational age-dependent hazard ratios using both baseline and updated serial data from each visit. Secondary outcomes were descriptions of risk factors for miscarriage. The results showed that 18% of the women experienced miscarriages. A fetal heart rate detected before 8 weeks’ gestation indicated a 90% (95% CI 85–95%) chance of subsequent delivery. Maternal age (≥ 35 years), insufficient crown-rump-length (CRL) and mean gestational sac diameter (MSD) development, and presence of bleeding increased the risk of miscarriage. Serum biomarkers, including hCG, progesterone, and estradiol, were found to impact the risk of miscarriage with estradiol as the most important. The best model to predict miscarriage was a combination of maternal age, vaginal bleeding, CRL, and hCG. The second-best model was the sonography-absent model of maternal age, bleeding, hCG, and estradiol. This study suggests that combining maternal age, and evolving data from hCG, estradiol, CRL, and bleeding could be used to predict fetal outcome during the first trimester of pregnancy.Trial registration ClinicalTrials.gov identifier: NCT02761772.

More than a hundred thousand respondents within 48 h: How the power of social media helped to understand pregnancy loss in Poland – A retrospective population-based cohort study

BackgroundMiscarriage is defined as the loss of pregnancy before 20–24 weeks of gestation, and it is the most common complication of early pregnancy. The aim of the study was to determine the prevalence and risk factors of spontaneous abortion in the population of Polish females to provide a reference for clinical work. Methods: A cross-sectional self-administered on-line survey was distributed between 4th and 5th of October 2019 in the social media across Poland. A total of 100,026 recipients responded to the questionnaire and 93,636 valid respondents were included in the analyses. Results: Among respondents who had ever been pregnant, 31.2% reported at least one spontaneous abortion. The prevalence of miscarriage varied based on age, parity, place of residence and the education level. The first symptom of miscarriage was a vaginal bleeding (56.2%) and abdominal cramps (25.8%), while 43% of respondents had no symptoms and found out during doctor’s visit. No medical assistance was required after complete spontaneous abortion in 39.2% of cases. Conclusions: Miscarriage is a common complication of pregnancy, but it is not yet fully understood. The goal of future medicine is to minimize the medicalization of spontaneous abortion and excessive medical intervention by raising awareness about natural miscarriage route.

Designing a behaviour change intervention to address the behavioural risk factors for stillbirth: A study protocol

Introduction Stillbirth is a devastating outcome that, in some cases, has the potential to be prevented by addressing some of its modifiable risk factors such as smoking, alcohol consumption, illicit drug use, high maternal weight, lack of attendance to antenatal care, and sleep position. The aim of this study will be to design a behaviour change intervention focusing on the behavioural risk factors for stillbirth and based on the COM-B model and the Behaviour Change Wheel (BCW) systematic framework. Methods The first stage of the BCW framework involves understanding the target behaviour and defining the problem in behavioural terms. The second stage involves identifying intervention options, including intervention functions and policy categories. Finally, the third stage involves identifying content and implementation options, including behaviour change techniques (BCTs) and the mode of delivery. We will use multiple studies already conducted in our research team to inform the different stages of the BCW framework, these include a series of systematic reviews of the literature, qualitative interviews with pregnant women, and a survey study with healthcare professionals. Further, we will utilise a stakeholder group to obtain input through the process of the design of the intervention. Discussion This protocol provides a systematic and evidence-based approach to intervention design. The systematic review of the literature, qualitative interviews, and expert consensus workshops will ensure that the intervention design is based on the needs and preferences of pregnant women, healthcare professionals, and stakeholders involved in stillbirth prevention. The proposed intervention could be adapted and implemented in other settings to prevent stillbirth in high-risk populations.

An in-depth analysis of perinatal related mortality among women of South Asian ethnicity in Aotearoa New Zealand

BackgroundInternational and national New Zealand (NZ) research has identified women of South Asian ethnicity at increased risk of perinatal mortality, in particular stillbirth, with calls for increased perinatal research among this ethnic group. We aimed to analyse differences in pregnancy outcomes and associated risk factors between South Asian, Māori, Pacific and NZ European women in Aotearoa NZ, with a focus on women of South Asian ethnicity, to ultimately understand the distinctive pathways leading to adverse events.MethodsClinical data from perinatal deaths between 2008 and 2017 were provided by the NZ Perinatal and Maternal Mortality Review Committee, while national maternity and neonatal data, and singleton birth records from the same decade, were linked using the Statistics NZ Integrated Data Infrastructure for all births. Pregnancy outcomes and risk factors for stillbirth and neonatal death were compared between ethnicities with adjustment for pre-specified risk factors.ResultsWomen of South Asian ethnicity were at increased risk of stillbirth (aOR 1.51, 95%CI 1.29–1.77), and neonatal death (aOR 1.51, 95%CI 1.17–1.92), compared with NZ European. The highest perinatal related mortality rates among South Asian women were between 20–23 weeks gestation (between 0.8 and 1.3/1,000 ongoing pregnancies; p < 0.01 compared with NZ European) and at term, although differences by ethnicity at term were not apparent until ≥ 41 weeks (p < 0.01). No major differences in commonly described risk factors for stillbirth and neonatal death were observed between ethnicities. Among perinatal deaths, South Asian women were overrepresented in a range of metabolic-related disorders, such as gestational diabetes, pre-existing thyroid disease, or maternal red blood cell disorders (all p < 0.05 compared with NZ European).ConclusionsConsistent with previous reports, women of South Asian ethnicity in Aotearoa NZ were at increased risk of stillbirth and neonatal death compared with NZ European women, although only at extremely preterm (< 24 weeks) and post-term (≥ 41 weeks) gestations. While there were no major differences in established risk factors for stillbirth and neonatal death by ethnicity, metabolic-related factors were more common among South Asian women, which may contribute to adverse pregnancy outcomes in this ethnic group.

A study examining the correlation between serum 25-OH-VitD levels, CD3-CD19+ B lymphocytes, and the risk of early spontaneous abortion in pregnant women

The objective of this retrospective cohort study was to investigate the correlation between serum 25-OH-VitD levels, coagulation function, immune factors, and the risk of spontaneous abortion in the first trimester of pregnancy. Additionally, independent risk factors for spontaneous abortion in the first trimester of pregnancy were identified. A total of 412 pregnant women who attended Hubei Maternal and Child Health Care Hospital between October 2021 and February 2022 were included in the study. Of these, 221 met the eligibility criteria and were categorized into the early spontaneous abortion case group (n = 107) or the normal pregnancy control group (n = 114). The serum levels of 25-OH-VitD, CD3 + CD19- T lymphocytes, CD3-CD19 + B lymphocytes, NK (Natural Killer) cells, TNF-α (tumor necrosis factor-α) and coagulation factors (D-dimer, Protein C, Protein S) in both these groups were measured during early pregnancy (within 12 weeks) and evaluated using logistic regression analysis. Compared to the control group, body mass index, Protein S, CD19 + CD3-B lymphocytes, and 25-OH-VitD were significantly lower in the spontaneous abortion group during early pregnancy (P = .001; P = .004; P = .009; P = .001), blood glucose (fasting) and TNF-α significantly increased (P = .001; P = .046). Logistic regression analysis of potential mixed factors showed that fasting blood glucose and TNF-α were significantly different from the control group and were positively correlated (P = .001, P = .038). Fasting blood glucose 0R value is 2.264, 95% confidence interval is 0.043~0.25, TNF-α 0R value is 0.126, 95% confidence interval is 0.800~0.972. CD19 + CD3-B cells and 25-OH-VitD were correlated with spontaneous abortion (P = .005; P = .001), respectively 0R value and 95% confidence interval being −0.007 (1.002~1.012), −0.179 (1.139~1.256). Risk factors for spontaneous abortion in the first trimester (&lt;12 weeks) of pregnancy include fasting glucose tolerance, decreased CD19 + CD3-energy B lymphocytes and 25-OH-VitD, and abnormal increase of TNF-α. Therefore, it is recommended that women with fertility needs be examined as early as possible to avoid adverse outcomes.

Circadian patterns of heart rate variability in fetal sheep after hypoxia-ischaemia: A biomarker of evolving brain injury.

Hypoxia-ischaemia (HI) before birth is a key risk factor for stillbirth and severe neurodevelopmental disability in survivors, including cerebral palsy, although there are no reliable biomarkers to detect at risk fetuses that may have suffered a transient period of severe HI. We investigated time and frequency domain measures of fetal heart rate variability (FHRV) for 3weeks after HI in preterm fetal sheep at 0.7 gestation (equivalent to preterm humans) until 0.8 gestation (equivalent to term humans). We have previously shown that this is associated with delayed development of severe white and grey matter injury, including cystic white matter injury (WMI) resembling that observed in human preterm infants. HI was associated with suppression of time and frequency domain measures of FHRV and reduced their circadian rhythmicity during the first 3 days of recovery. By contrast, circadian rhythms of multiple measures of FHRV were exaggerated over the final 2weeks of recovery, mediated by a greater reduction in FHRV during the morning nadir, but no change in the evening peak. These data suggest that the time of day at which FHRV measurements are taken affects their diagnostic utility. We further propose that circadian changes in FHRV may be a low-cost, easily applied biomarker of antenatal HI and evolving brain injury. KEY POINTS: Hypoxia-ischaemia (HI) before birth is a key risk factor for stillbirth and probably for disability in survivors, although there are no reliable biomarkers for antenatal brain injury. In preterm fetal sheep, acute HI that is known to lead to delayed development of severe white and grey matter injury over 3weeks, was associated with early suppression of multiple time and frequency domain measures of fetal heart rate variability (FHRV) and loss of their circadian rhythms during the first 3 days after HI. Over the final 2weeks of recovery after HI, exaggerated circadian rhythms of frequency domain FHRV measures were observed. The morning nadirs were lower with no change in the evening peak of FHRV. Circadian changes in FHRV may be a low-cost, easily applied biomarker of antenatal HI and evolving brain injury.

Substantial increase in stillbirth rate during the COVID-19 pandemic: results from a population-based study in the Indian state of Bihar

IntroductionWe report on the stillbirth rate (SBR) and associated risk factors for births during the COVID-19 pandemic, and change in SBR between prepandemic (2016) and pandemic periods in the Indian...

Racial and Ethnic Disparities in Stillbirth among Pregnant Women with Obesity.

The aim of this study was to examine the relationship between obesity and risk of stillbirth among pregnant women with obesity in the United States, with a focus on racial and ethnic disparities. We conducted a retrospective cross-sectional analysis of birth and fetal data from the 2014 to 2019 National Vital Statistics System (N = 14,938,384 total births) to examine associations between maternal body mass index (BMI) and risk of stillbirth. Cox's proportional hazards regression model was used to compute adjusted hazard ratios (HR) as a measure of risk of stillbirth in relation to maternal BMI. The stillbirth rate was 6.70 per 1,000 births among women with prepregnancy obesity, while the stillbirth rate among women with a normal (nonobese) prepregnancy BMI was 3.85 per 1,000 births. The risk of stillbirth was greater among women with obesity compared with women without obesity (HR: 1.39; 95% confidence interval [CI]: 1.37-1.41). Compared with non-Hispanic (NH) Whites, women identifying as NH-other (HR: 1.66; 95% CI: 1.61-1.72) and NH-Black (HR: 1.31; 95% CI: 1.26-1.35) were at higher risk of stillbirth, while Hispanic women had a decreased likelihood of stillbirth (HR: 0.38; 95% CI: 0.37-0.40). Obesity is a modifiable risk factor for stillbirth. Public health awareness campaigns and strategies targeting weight management in women of reproductive age and racial/ethnic populations at highest risk for stillbirth, are needed. · Stillbirth rates differ by race and ethnicity.. · Risk of stillbirth was greatest among women with obesity.. · Stillbirth rates rise with ascending prepregnancy BMI..

P-474 Association between subchorionic hematoma’s size and miscarriage rate in IVF/ICSI patients

Abstract Study question What is the risk factor for miscarriage in patients undergoing IVF/ICSI with subchorionic hematoma(SCH) in the first trimester? Summary answer The size of SCH is a risk factor for miscarriage in patients undergoing IVF/ICSI. Miscarriage rate increases as the size of SCH grows. What is known already SCH is a frequently observed pathology during routine ultrasound examinations in early pregnancy. Its clinical significance has been unclear. Some studies believed that SCH found in first trimester was not correlated with adverse pregnancy outcome; Other studies believed that SCH in early pregnancy can cause a significant increase in the incidence of late pregnancy complications, such as preterm labor, preeclampsia, and postpartum hemorrhage. Besides, what are the risk factors for miscarriage in pregnant women with SCH? Answers to these questions are urgently needed. Study design, size, duration Retrospective cohort study with 646 patients undergoing IVF/ICSI at a tertiary care university hospital, between February 2017 and November 2020. Participants/materials, setting, methods All patients who underwent IVF/ICSI from February 2017 to November 2020, achieved pregnancy and underwent transvaginal ultrasound at our center during first trimester were included. Risk factors for miscarriage in patients with SCH were explored. Miscarriage rates in patients with different SCH sizes which was expressed as its' ratio to the area of the gestational sac were compared. Main results and the role of chance Patients with SCH who had more embryos transferred (P=0.01), earlier detection of IUH (P=0.003), a smaller GS area (P=0.03) was prone to miscarry. The size of SCH is a risk factor for miscarriage (P = 0.016). Miscarriage rate increased with increasing size of SCH (P for trend: 0.003). Limitations, reasons for caution The main limitation of this study is its retrospective nature and relatively small sample size. Wider implications of the findings Extra clinical attention needs to be paid to the miscarriage risk of in IVF/ICSI patients with large SCH. There is urgent need for future research on SCH affecting pregnancy outcome and the underlying pathophysiological mechanisms. Trial registration number Not applicable

P-717 Segmental aneuploidies are not related to paternal age in young women

Abstract Study question Is there an impact of paternal age on embryo segmental aneuploidy rate? Summary answer Even when segmental aneuploidies are most linked to paternal origin, results do not show a relationship between paternal age and embryo segmental aneuploidies. What is known already Most studies consider maternal age as a risk factor for spontaneous abortion, infertility and genetic defects in the offspring. However, attention has only recently turned to the impact of paternal age on reproductive outcome. In Assisted Reproduction Technology male age has been related to a decrease in sperm quality and clinical outcomes and an increase in sperm DNA damage has been identified among elderly males. Studies assessing the type of chromosomal aneuploidy associated with paternal aging have reported mixed relative risk results for chromosomes 13, 18, 21, and X. Segmental aneuploidies are most linked to paternal origin. Study design, size, duration Observational, retrospective and multicentric study. The study was approved by the local institutional review board (IRB). All the patients underwent an IVF cycle with oocytes from egg donors, followed by Preimplantation Genetic Testing for Aneuploidy (PGT-A) at IVI-RMA Madrid, IVI-RMA Valencia and IVI-RMA Barcelona from January 2018 to August 2022. A total of 3412 biopsied embryos obtained from 660 cycles were included in the study. Participants/materials, setting, methods Exclusion criteria were the following: altered karyotype, single gene disorder and male factor (sperm concentration lower than 5 million/ ml). Embryo biopsies were performed at blastocyst stage (day 5/ 6). After the trophoectoderm biopsy, all embryos were vitrified. Main outcome was segmental aneuploidy rate among different male age groups (&amp;lt;41 y.o./ ≥40 y.o.). Lineal regression analysis was used for continuous parameters and Chi square was used for categorical variables. Main results and the role of chance Descriptive parameters showed no differences, particularly in sperm concentration (43.2±15.6 vs. 40.1±14.3) and sperm motility (27.3±13.7 vs. 29.7±14.8). Lineal regression analysis showed no significant differences in segmental aneuploidy rate (p = 0.542). Statistical model showed no significant differences among male age groups (1.28% (0.76-2.01) vs 1.10% (0.69-1.66) p = 0.542). Limitations, reasons for caution The study has been conducted in three different clinics, there could be some unknown cofounding factors. Wider implications of the findings Male age don’t have an impact on the embryo segmental aneuploidy rate in young/donors’ oocyte Trial registration number Not applicable

Determinants of stillbirths in sub-Saharan Africa: A systematic review.

Sub-Saharan African (SSA) countries have high stillbirth rates compared with high-income countries, yet research on risk factors for stillbirth in SSA remain scant. To identify the modifiable risk factors of stillbirths in SSA and investigate their strength of association using a systematic review. CINAHL Plus, EMBASE, Global Health and MEDLINE databases were searched for literature. Observational population- and facility-level studies exploring stillbirth risk factors, published in 2013-2019 were included. A narrative synthesis of data was undertaken and the potential risk factors were classified into subgroups. Thirty-seven studies were included, encompassing 20 264 stillbirths. The risk factors were categorised as: maternal antepartum factors (0-4 antenatal care visits, multiple gestations, hypertension, birth interval of >3 years, history of perinatal death); socio-economic factors (maternal lower wealth index and basic education, advanced maternal age, grand multiparity of ≥5); intrapartum factors (direct obstetric complication); fetal factors (low birthweight and gestational age of <37 weeks) and health systems factors (poor quality of antenatal care, emergency referrals, ill-equipped facility). The proportion of unexplained stillbirths remained very high. No association was found between stillbirths and body mass index, diabetes, distance from the facility or HIV. The overall quality of evidence was low, as many studies were facility based and did not adjust for confounding factors. This review identified preventable risk factors for stillbirth. Focused programmatic strategies to improve antenatal care, emergency obstetric care, maternal perinatal education, referral and outreach systems, and birth attendant training should be developed. More population-based, high-quality research is needed.

Incidence, causes, and risk factors of stillbirth in an Amazonian context: Saint Laurent du Maroni maternity ward 2016–2021

We aimed to describe the epidemiology of intrauterine fetal deaths in multiethnic western French Guiana and to assess its main causes and risk factors. A retrospective descriptive study was conducted based on data from January 2016 to December 2021. All information on stillbirth with a gestational age ≥20 weeks in the Western French Guiana Hospital Center was extracted. Terminations of pregnancy were excluded. We focused on medical history, clinical investigation, biological findings, placental histology, and autopsy examination to elucidate the cause of death. We used the Initial Cause of Fetal Death (INCODE) classification system for assessment. Univariable and multivariable logistic regression analyses were performed. Overall, 331 fetuses in 318 stillbirth deliveries were reviewed and compared to live births that occurred during the same period. The rate of fetal death varied between 1.3 % and 2.1 %, with an average of 1.8 % over the 6-year period. Poor antenatal care (104/318, 32.7 %), obesity ≥30kg/m2 (88/318, 31.7 %), and preeclampsia (59/318, 18.5 %) were the main risk factors associated with fetal death in this group. Four hypertensive crises were reported. According to the INCODE classification, the main causes of fetal death were obstetric complications (112/331, 33.8 %), particularly intrapartum fetal death with labor-associated asphyxia under 26 weeks (64/112, 57.1 %), and placental abruption (29/112, 25.9 %). Maternal-fetal infections were common, particularly mosquito-borne diseases (e.g., Zika virus, dengue, and malaria), re-emerging infectious agents such as syphilis, and severe maternal infections (8/331, 2.4 %). 19.3 % of fetal deaths (64/331) remained unexplained. Change in lifestyle as well as social deprivation and isolation adversely affect pregnancy in western French Guiana, in the context of a poor health care system that is similar to what is found in the Amazonian basin. Particular attention must be paid to emerging infectious agents in pregnant women and travelers returning from the Amazon region.

Placental Pathology and Maternal Risk Factors for Stillbirth: A Case-Control Study.

Background Fetal death is the delivery of a fetus with no sign of life, as indicated by the absence of breathing, heartbeat, pulsation of the umbilical cord, or definite movement of voluntary muscles. Nearly 2.6 million stillbirths are estimated to occur worldwide every year. Almost all of these (98%) stillbirths occur in low- and middle-income countries. About one-sixth of the stillbirths globally were recorded in India in 2019, making it the most burdened country in the world. In light of this, we conducted a study to identify the placental pathologies and maternal factors associated with stillbirth. Methodology A case-control study was conducted at the Department of Obstetrics & Gynecology, Veer Surendra Sai Institute of Medical Sciences and Research (VIMSAR), from June 2022 to May 2023. Cases included pregnant women with a gestational age of 28 weeks or more who delivered a stillbirth infant at VIMSAR, and controls included gestational age-matched deliveries with live birth. Consent to participate in the study was obtained before enrolment. The final sample size was 79 cases and controls. The chi-square test was performed for bivariate analysis, and logistic regression was used for multivariate analysis. Results In our study, we found a significant association between maternal age of more than 30 years (odds ratio (OR) = 3.01, 95% confidence interval (CI) = 1.91-4.22, p = 0.012), maternal education (with up to the primary level or less: OR = 6.19, 95% CI = 2.92-7.87, p = 0.012), history of addiction (tobacco chewing: OR = 5.58, 95% CI = 3.71-7.11, p = 0.03), and the number of antenatal visits (no visit: OR = 6.87, 95% CI = 2.91-7.79, p = 0.019) with an increased risk of stillbirth. Among the obstetrical complications, pre-eclampsia/eclampsia (OR = 3.87, 95% CI = 1.98-5.11, p = 0.001), premature rupture of membranes (PROM)/preterm premature rupture of the membranes (PPROM) (OR = 2.49, 95% CI = 1.31-3.91, p = 0.03) and antepartum hemorrhage (APH) (OR = 2.66, 95% CI = 1.65-3.58, p = 0.02) were found to be significantly related with stillbirth. Among placental pathologies, uteroplacental vascular pathology (OR = 7.39, 95% CI = 3.01-8.97), acute chorioamnionitis (OR = 3.35, 95% CI = 2.11-5.21), chronic inflammation (OR = 2.33, 95% CI = 1.91 4.17), calcific changes (OR = 4.46, 95% CI = 2.56-6.01), and retroplacental clots (OR = 9.95, 95% CI = 4.39-11.71) were associated with stillbirth. Conclusions In our study, advanced maternal age, absence of antenatal visits, low level of education, tobacco addiction, pre-eclampsia/eclampsia, APH, and PROM in pregnancy were the major risk factors associated with stillbirth. Uteroplacental vascular pathology, chorioamnionitis, chronic inflammation, retroplacental hematoma, and calcific changes were the most significant placental lesions associated with stillbirth.

RISK FACTORS FOR SPONTANEOUS ABORTIONS IN TWO YAOUNDÉ DISTRICT HOSPITALS

Background. Abortion is the termination of a pregnancy before the age of fetal viability which, according to the WHO, is 22 weeks of pregnancy and/or with the fetus weigh less than 500 g. Spontaneous abortion is a public health problem. It's one of the most common complications of pregnancy. In order to contribute to the decrease of the morbidity and mortality linked to spontaneous abortions, we conducted this study, which the general objective was to study risk factors of spontaneous abortion. Methods. We carried out a cross-sectional case-control study in the District Hospitals of Biyem - Assi and Efoulan in Yaoundé. During six months, we collected 3774 records of pregnant women from January 1, 2020 to December 31.,2020. For each case (record of woman who had a spontaneous abortion), two controls (records of those who gavebirth spontaneously at term) of the same age, were immediately recruited. Data were analyzed using IBM SPSS Version.23.0 software. Tools used to assess our results were: Fischer's exact test, frequency, odds ratio (OR) and P, with P signicant for any value less than 5%. Results. We recruited 104 cases and 208 controls. Being unmarried, being from the littoral region, having a history of stress, smoking, having started antenatal care and having had prenuptial check-up, independently increased the risk of spontaneous abortion with respectively aOR = 2.8 IC=1.24-6.31 aP= 0.013, aOR=4.31 IC= 1.09-17.02 aP= 0.037, aOR=11.86; CI=3.88-36.19; aP=&lt;0.001, aOR=8.57; CI=3.41-21.54; aP=&lt;0.001, aOR=10.4; CI=1.12-96.82; aP=0.04) and aOR=3.37; CI=1.67-6.79; aP&lt;0.001). Conclusion. These risk factors being mostly modiable, should be sought and prevented in order to improve the prognosis of pregnancies in our context.

Fetal Biometric Assessment and Infant Developmental Prognosis of the Tadalafil Treatment for Fetal Growth Restriction.

Background and Objectives: Tadalafil is expected to treat fetal growth restriction (FGR), a risk factor for stillbirth and neonatal morbidity. This study aimed to evaluate the fetal biometric growth pattern of fetuses with FGR treated with tadalafil by ultrasonographic assessment. Materials and Methods: This was a retrospective study. Fifty fetuses diagnosed with FGR and treated by maternal administration of tadalafil and ten controls who received conventional treatment at Mie University Hospital from 2015 to 2019 were assessed. Fetal biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL), and estimated fetal weight (EFW) at the start of treatment and at two weeks and four weeks of treatment were mainly assessed by ultrasound examination. The Wilcoxon signed-rank test was used to assess the measures. The Kyoto Scale of Psychological Development (KSPD) was used to assess the developmental prognosis on tadalafil-treated children at 1.5 years of corrected age (CA) and 3 years old. Results: The median gestational age at the start of treatment was 30 and 31 weeks in the tadalafil and control groups, respectively, and the median gestational age at delivery was 37 weeks in both groups. The Z-score of HC was significantly increased at 4 weeks of treatment (p = 0.005), and the umbilical artery resistance index was significantly decreased (p = 0.049), while no significant difference was observed in the control group. The number of cases with an abnormal score of less than 70 on the KSPD test was 19% for P-M, 8% for C-A, 19% for L-S, and 11% for total area at 1.5 years CA. At 3 years old, the respective scores were 16%, 21%, 16%, and 16%. Conclusions: Tadalafil treatment for FGR may maintain fetal HC growth and infants' neuro-developmental prognosis.

Facility-based stillbirth review processes used in different countries across the world: a systematic review.

Facility-based stillbirth review provides opportunities to estimate incidence, evaluate causes and risk factors for stillbirths, and identify any issues related to the quality of pregnancy and childbirth care which require improvement. Our aim was to systematically review all types and methods of facility-based stillbirth review processes used in different countries across the world, to examine how stillbirth reviews in facility settings are being conducted worldwide and to identify the outcomes of implementing the reviews. Moreover, to identify facilitators and barriers influencing the implementation of the identified facility-based stillbirth reviews processes by conducting subgroup analyses. A systematic review of published literature was conducted by searching MEDLINE (OvidSP) [1946-present], EMBASE (OvidSP) [1974-present], WHO Global Index Medicus (globalindexmedicus.net), Global Health (OvidSP) [1973-2022Week 8] and CINAHL (EBSCOHost) [1982-present] from their inception until 11 January, 2023. For unpublished or grey literature, the WHO databases, Google Scholar and ProQuest Dissertations & Theses Global were searched, as well as hand searching the reference lists of included studies. MESH terms encompassing "∗Clinical Audit", "∗Perinatal Mortality", "Pregnancy Complications", and "Stillbirth" were used with Boolean operators. Studies that used a facility-based review process or any approach to evaluate care prior to stillbirth, and explained the methods used were included. Reviews and editorials were excluded. Three authors (YYB, UGA, and DBT) independently screened and extracted data, and assessed the risk of bias using an adapted JBI's Checklist for Case Series. A logic model was used to inform the narrative synthesis. The review protocol was registered with PROSPERO, CRD42022304239. A total of 68 studies from 17 high-income (HICs) and 22 low-and-middle-income countries (LMICs) met the inclusion criteria from a total of 7258 identified records. These were stillbirth reviews conducted at different levels: district, state, national, and international. Three types were identified: audit, review, and confidential enquiry, but not all desired components were included in most processes, which led to a mismatch between the description of the type and the actual method used. Routine data from hospital records was the most common data source for identifying stillbirths, and case assessment was based on stillbirth definition in 48 out of 68 studies. Hospital notes were the most common source of information about care received and causes/risk factors for stillbirth. Short-term and medium-term outcomes were reported in 14 studies, but impact of the review process on reducing stillbirth, which is more difficult to establish, was not reported in any study. Facilitators and barriers in implementing a successful stillbirth review process identified from 14 studies focused on three main themes: resources, expertise, and commitment. This systematic review's findings identified that there is a need for clear guidelines on how to measure the impact of implementation of changes based on outputs of stillbirth reviews and methods to enable effective dissemination of learning points in the future and promoting them through training platforms. In addition, there is a need to develop and adopt a universal definition of stillbirth to facilitate meaningful comparison of stillbirth rates between regions. The key limitation of this review is that while using a logic model for narrative synthesis was deemed most appropriate for this study, sequence of implementing a stillbirth review in the real world is not linear, and assumptions are often not met. Therefore, the logic model proposed in this study should be interpreted with flexibility when designing a stillbirth review process. The generated learnings from the stillbirth review processes inform the action plans and allow facilities to consider where the changes should happen to improve the quality of care in the facilities, enabling positive short-term and medium-term outcomes. Kellogg College, University of Oxford, Clarendon Fund, University of Oxford, Nuffield Department of Population Health, University of Oxford and Medical Research Council (MRC).

Risk factors of stillbirths in four district hospitals on Pemba Island, Tanzania: a prospective cohort study

BackgroundMore than 2 million third-trimester stillbirths occur yearly, most of them in low- and middle-income countries. Data on stillbirths in these countries are rarely collected systematically. This study investigated the stillbirth rate and risk factors associated with stillbirth in four district hospitals in Pemba Island, Tanzania.MethodsA prospective cohort study was completed between the 13th of September and the 29th of November 2019. All singleton births were eligible for inclusion. Events and history during pregnancy and indicators for adherence to guidelines were analysed in a logistic regression model that identified odds ratios [OR] with a 95% confidence interval [95% CI].ResultsA stillbirth rate of 22 per 1000 total births in the cohort was identified; 35.5% were intrapartum stillbirths (total number of stillbirths in the cohort, n = 31). Risk factors for stillbirth were breech or cephalic malpresentation (OR 17.67, CI 7.5-41.64), decreased or no foetal movements (OR 2.6, CI 1.13–5.98), caesarean section [CS] (OR 5.19, CI 2.32–11.62), previous CS (OR 2.63, CI 1.05–6.59), preeclampsia (OR 21.54, CI 5.28–87.8), premature rupture of membranes or rupture of membranes 18 h before birth (OR 2.5, CI 1.06–5.94) and meconium stained amniotic fluid (OR 12.03, CI 5.23–27.67). Blood pressure was not routinely measured, and 25% of women with stillbirths with no registered foetal heart rate [FHR] at admission underwent CS.ConclusionsThe stillbirth rate in this cohort was 22 per 1000 total births and did not fulfil the Every Newborn Action Plan’s goal of 12 stillbirths per 1000 total births in 2030. Awareness of risk factors associated with stillbirth, preventive interventions and improved adherence to clinical guidelines during labour, and hence improved quality of care, are needed to decrease the stillbirth rate in resource-limited settings.

Placental inflammation and overweight or obesity in term singleton stillbirths in Stockholm County 2002-2018; a case control study.

Stillbirth is a severe pregnancy complication. Maternal obesity is one of the most important modifiable risk factors of stillbirth, yet the biological mechanisms behind this association remain unclear. The adipose tissue is an endocrine organ which, in persons with obesity, causes a hyperinflammatory state. The aim of this study was to investigate inflammation as a contributing mechanism to the risk of stillbirth in women with obesity and if there are possible signs of different BMI phenotypes with different risk. This was a case control study based on all cases of term singleton stillbirth without major fetal malformation in Stockholm County between 2002-2018. Placentas have been examined according to a standardized protocol. Placental inflammatory lesions were compared both between placentas from pregnancies with live born and stillborn infants with different class of body mass index (BMI) as well as among women with stillborn and live born infants with different classes of BMI, respectively. All inflammatory placental lesions were more common in placentas from women with stillbirth compared to placentas from women with live born infants. Vasculitis, funisitis and chronic villitis as well as overall fetal and maternal inflammatory response were present with a significantly increased proportion with increasing BMI in placentas from women with term stillbirth however, there were no differences between placentas from women in different BMI classes with term live born infants. Both acute and chronic inflammatory placental lesions were more common in cases of stillbirth compared to pregnancies with live born infants. There were increased proportions of both acute and chronic placental inflammation (vasculitis, chronic villitis, funisitis and overall fetal and maternal inflammatory response) with increasing BMI among cases with term stillbirth, however no differences among controls with term live born infants.

Pathways to adverse pregnancy outcomes: exploring the mediating role of intimate partner violence and depression: results from a South African rape cohort study

Adverse pregnancy outcomes (APOs) are common occurrences that contribute to negative maternal and child health outcomes. Our aim was to test the hypothesis that trauma exposure and depression are drivers of the better-recognised risk factors for miscarriage, abortion and stillbirths. Our comparative cohort study based in Durban, South Africa recruited women who reported a recent rape (n = 852) and those who had never experienced rape (n = 853), with follow-up for 36 months. We explored APOs (miscarriage, abortion or stillbirth) among those having a pregnancy during follow-up (n = 453). Potential mediators were baseline depression, post-traumatic stress symptoms, substance abuse, HbA1C, BMI, hypertension and smoking. A structural equation model (SEM) was used to determine direct and indirect paths to APO. Overall, 26.6% of the women had a pregnancy in the follow-up period and 29.4% ended in an APO, with miscarriage (19.9%) the most common outcome, followed by abortion (6.6%) and stillbirths (2.9%). The SEM showed two direct pathways from exposure to childhood trauma, rape and other trauma, to APO which were ultimately mediated by hypertension and/or BMI, but all paths to BMI were mediated by depression and IPV-mediated pathways from childhood and other trauma to hypertension. Food insecurity mediated a pathway from experiences of trauma in childhood to depression. Our study confirms the important role of trauma exposure, including rape, and depression on APOs, through their impact on hypertension and BMI. It is critical that violence against women and mental health are more systematically addressed in antenatal, pregnancy and postnatal care.