Development and Validation of an Algorithm to Predict Stillbirth Gestational Age in Medicaid Billing Records.

INTRODUCTION: With Medicaid covering half of US pregnancies, Medicaid Analytic eXtract (MAX) provides a valuable data source to enrich understanding about stillbirth etiologies. OBJECTIVE: We developed and validated a claims-based algorithm to predict GA at stillbirth. METHOD: We linked the stillbirths identified in MAX 1999-2013 to Florida Fetal Death Records (FDRs) to obtain clinical estimates of GA (N=825). We tested several algorithms including using a fixed median GA, median GA at the time of specific prenatal screening tests, and expanded versions considering additional predictors of stillbirth within including linear regression and random forest models. We estimated the proportion of pregnancies with differences of ± 1, 2, 3 and 4 weeks between the predicted and FDR GA and the model mean square error (MSE). We validated the selected algorithms in two external samples. RESULTS: The best performing algorithm was a random forest model (MSE of 12.67 weeks2) with 84% of GAs within ± 4 weeks. Assigning a fixed GA of 28 weeks resulted in an MSE of 60.21 weeks2 and proportions of GA within ± 4 weeks of 32%. We observed consistent results in the external samples. DISCUSSION: Our prediction algorithm for stillbirths can facilitate pregnancy research in the Medicaid population.

Elephant Gestation: Insights Into Idiopathic Abortions and Stillbirth.

The declining African and Asian elephant populations emphasize the importance of a backup population. Successful reproduction in captivity plays a key role in maintaining such a genetically diverse ex situ population but is challenged by reproductive loss in the form of abortions and stillbirths. The elephants' biphasic prolactin pattern led us to predict a higher incidence of abortions during the time of reduced prolactin concentrations. Therefore, this study focuses on the identification of months during elephant gestation which are prone to loss of pregnancy. A metric was developed to identify the fetal age of aborted calves based on the fetal mass using a regression model. Data on idiopathic abortions in captive and wild elephants collected from zoos, tourist camps, semi-captive, and free-ranging populations since 1974 were analyzed, revealing a significantly higher prevalence of abortions during the 15th and 17th month of gestation. Additionally, the prevalence of stillbirths in the 22nd month of gestation between 2000 and 2023 was assessed. Although stillbirths showed a declining trend over time, the average prevalence between 2019 and 2023 was still 2.8%. Consequently, the 15th, 17th, and 22nd month of gestation were identified as stages prone to pregnancy loss. These findings underscore the necessity of researching risk factors and preventative measures for pregnancy loss in these 3 months, especially exploring a possible link with prolactin during the 15th and 17th month of gestation. The identification of stages prone to fetal loss is a key step towards enhancing elephant reproductive success and welfare.

Foeto-Maternal outcomes of pregnancies beyond 41 weeks of gestation after induced or spontaneous labour.

Objective: It has been suggested that induction of labour before 42 weeks of pregnancy prevents foetal complications. To evaluate the maternal and foetal outcomes of induced and spontaneous labour beyond gestational week 41 + 0. Study design: We conducted a register-based nationwide cohort study that included pregnant women who were delivered in Sweden in 2016-2021. Women were classified into two groups: induction of labour (IOL) or spontaneous onset of labour (SOL). Maternal and foetal outcomes after IOL in gestational week 41 were compared with SOL in gestational week 41 and 42. Results: Comparison between the IOL (n = 23,772) and SOL (n = 62,611) groups in gestational weeks 41 showed that various parameters were higher in the IOL group: caesarean deliveries (12.3 % and 4.6 %, P < 0.001), vacuum extraction (8.7 % and 6.9 %, P < 0.001), blood loss of > 1000 ml during labour (11 % vs 8.3 %, P < 0.001). The risks were remained significant even after adjusting for potential confounders (caesarean delivery: aOR 2.36; 95 % CI, 2.23-2.50, vacuum delivery: aOR 1.09; 95 % CI, 1.03-1.16, P = 0.002, and blood loss of >1000 ml: aOR 1.25; 95 % CI 1.18-1.31). The proportions of stillbirths (0.07 % and 0.18, P < 0.001), and newborns with apgar scores < 4 at five minutes (0.4 % vs 0.3 %, P < 0.001), were also higher in the IOL group. The risk of stillbirth after IOL in gestational week 41 was increased relative to SOL in the same week and remained high after adjusting for potential confounders (aOR 1.75; 95 % CI 1.07-2.80, P = 0.025).The IOL group in gestational weeks 41 comprised a higher proportion of caesarean deliveries (12.3 % and 8.5 %, P < 0.001), but a lower (8.7 % and 9.7 %, P = 0.006) proportion of deliveries by vacuum extraction than the SOL group (n = 4548) in week 42. Conclusions: Inducing labour at gestational week 41 in women with prolonged pregnancies may have adverse effects on foetal and maternal outcomes compared to those who experience spontaneous labour onset at the same gestational age. The risk of negative foetal outcomes after induction at week 41 appears similar to that in women who give birth after spontaneous labour at week 42.

SARS-CoV-2 replicates in the placenta after maternal infection during pregnancy.

Objectives: Pregnant women are at increased risk for severe SARS-CoV-2 infection and adverse neonatal outcome, primarily preterm birth and stillbirth. Our study aimed to investigate to which extent SARS-CoV-2 affects placental tissue and if viral replication within the placenta is evident, thus if there is a correlation between placental damage and adverse pregnancy outcome such as stillbirth. Methods: We prospectively collected placentas from 61 SARS-CoV-2 infected pregnant women and 10 controls. Histopathological, immunohistochemical, and in situ hybridization studies were performed on all placentas with antibodies for SARS-CoV-2 proteins, ACE2, various immune cells, and inflammatory markers or probes for SARS-CoV-2 genes and an antisense strand. Results: The measured scores of SARS-CoV-2 glycoprotein, nucleocapsid, and antisense strand indicating replication correlated with both the severity of maternal symptoms and presence of stillbirth. Specifically, 15/61 placentas exhibited replication, while the three cases with stillbirth had high or maximal replication scores. ACE2-H-score was significantly higher in COVID-19 patients, while the expression of various immune cells did not differ statistically. In multivariate analysis, presence of maternal comorbidities correlated with presence of severe COVID-19 infection. Conclusion: We report evidence of active in vivo SARS-CoV-2 replication in the placenta after maternal infection in pregnancy in a case-control setting in a large population. Intensity of placental viral replication as well as viral levels were higher in women with severe or critical COVID-19 disease, supporting the rationale that severity of maternal SARS-CoV-2 infection could correlate with the severity of placentitis. Replication was maximal in cases of stillbirth, which suggests direct placental involvement in the pathophysiology of this dramatic outcome. Continuing to advocate for preventive measures against COVID-19 during pregnancy, including (re)vaccination, as well as appropriately counseling women with diagnosed infection, are of utter importance.

The influence of culture and spirituality on maternal grief following stillbirth in China: A qualitative study.

BACKGROUND: Stillbirth is a unique phenomenon with various manifestations influenced by cultural contexts and spiritual beliefs. Chinese cultural and spiritual practices produce different post-stillbirth grief experiences for bereaved mothers in China. However, the majority of research on perinatal loss and grief has been conducted in Western cultures. In the Chinese cultural context, the post-stillbirth grief experience of bereaved mothers may differ from the types of Western bereavement examined in the dominant research. OBJECTIVE: This study investigated the influence of culture and spirituality on grieving mothers who had experienced a stillbirth in China. METHODS: This qualitative study was grounded in an interpretivist constructionist epistemology. In-depth interviews were conducted with mothers who had experienced a stillbirth within the previous year. Thematic analysis was used to analyse the data. FINDINGS: A total of 28 women were interviewed by trained interviewers. Three key themes were identified: 1) The influence of culture on grief expression, with four subthemes: restrained expressions of grief, unattainable mourning ceremonies, hospital policy as a barrier to grieving, and others-oriented self; 2) Cultural characteristics of post-stillbirth experiences, with four subthemes: paternalistic medical culture, "Kong yuezi", embarrassment during postpartum visits, and cultural taboos on dealing with deceased babies' possessions; and 3) Finding significance in spiritual healing process, with four subthemes: seeking meaning in the event, accepting and reconciling with the event, reshaping beliefs and views about life and death, and achieving personal growth. CONCLUSION: Chinese culture and spirituality have different influences on bereaved mothers' expressions of grief and post-stillbirth healing. This research demonstrates specific aspects of spirituality that contribute to or hinder the grieving process and the different roles of Chinese culture and spirituality for individuals. The findings suggest the need for the development of culturally sensitive interventions and support systems to assist mothers in navigating grief and healing. Future studies could explore the roles of Chinese culture and spirituality over time in the different stages of grief and healing after stillbirth.

Stillbirth Simulation for Nursing and Midwifery.

Collaboration is necessary to design and execute a nursing simulation that meets undergraduate and graduate competency expectations for communication, effective relationships, and stillbirth care. This simulation plan aligns with the ten international healthcare simulation standards published by the International Nursing Association for Clinical Simulation and Learning (INACSL). Course faculty work with simulation faculty, staff, and volunteer actors to plan and implement a consistent experience for pre-licensure and or graduate nursing students to develop critical clinical skills and attitudes across spheres of care while caring for parents experiencing pregnancy loss.

Foetal outcome of Leptospira and Rickettsial infections during pregnancy: a systematic review.

BACKGROUND: Leptospirosis and rickettsial infections are bacterial zoonoses prevalent in different geographical locations and presents with overlapping symptoms. OBJECTIVE: To identify foetal outcomes in pregnant women diagnosed with rickettsial infections, including scrub typhus and leptospirosis, along with their associated factors. METHODS: A comprehensive search was conducted in MEDLINE/PubMed, Scopus, CENTRAL (Cochrane), Web of Science, PsycINFO, Academic Search Premier, CINAHL, and Embase using defined search terms. Studies involving pregnant women with diagnosed leptospirosis and rickettsial infections, including scrub typhus, were selected. Two independent reviewers screened titles and abstracts using the Rayyan Web interface. Data extraction was performed in Microsoft Excel, with Zotero for reference management. Study quality was assessed using Joanna Briggs Institute Critical Appraisal tools. Data synthesis included narrative analysis. RESULTS: Fifty-four studies were included: 22 on scrub typhus, 14 on rickettsial infection, 16 on leptospirosis, and 2 on all three infections. Of 176 scrub typhus cases, 53 resulted in foetal loss and 3 in neonatal death. Among 38 rickettsial infection cases, 4 had foetal loss. Out of 63 leptospirosis cases, 13 experienced foetal loss. Six maternal deaths occurred due to scrub typhus and one due to Rocky Mountain spotted fever. CONCLUSION: Leptospirosis and rickettsial infections, including scrub typhus, are important causes of pregnancy loss. Further research is needed to better understand and mitigate these risks in pregnant women.

Trend, Pattern, and Prevalence of Adverse Pregnancy Outcomes among Women of Reproductive Age in India, 1992-2021.

Background: Adverse pregnancy outcomes (APOs) are the most important vital statistics used to assess maternal health and child health statistics. They are an indicator of the quality of maternal and child health care services, i.e., antenatal care, intrapartum care, and medical services. Material and Methods: The objective of the study is to analyze the trend, pattern, and prevalence of APOs among women of reproductive age group at the national level over successive NFHS rounds. The current study uses data from the National Family Health Survey (NFHS), conducted during 1992-2021. The study uses geo-spatial mapping techniques through QGIS software and report analysis to arrive at definitive conclusions. Results: The study finds that the incidence of APOs among women of reproductive age (15-49 years) has increased over the years. Twenty states and union territories have APOs that are below the national average. On the other hand, States like Madhya Pradesh, Meghalaya, Sikkim, Goa, Maharashtra, Andhra Pradesh, Karnataka, and Kerala have witnessed their APOs worsening as per NFHS-5 vis-à-vis NFHS-4. The study also finds that apart from the Himalayan belt and the east coast of India, APOs are more prominent in the contiguous regions adjoining these areas. Conclusions: The findings of the study have thrown on very interesting facts. Despite rapid economic development during the intervening period between NFHS-4 and NFHS-5, rising APOs are a testament to the fact that the policymakers in the country need to be more target-oriented and get their acts together.

Racial and ethnic differences in access to and outcomes of elective induction of labor in low-risk pregnancies: a scoping review.

PURPOSE: Elective induction of labor (IOL) has been increasingly performed since growing data suggesting its safety and potential improved maternal and neonatal outcomes. Recommendations of elective IOL for patients from racial or ethnic minority backgrounds given the data showing increased risk of stillbirth for some populations has been met with criticism. This scoping review aims to determine if there are racial disparities in access to elective IOL and maternal and neonatal outcomes. METHODS: A review of the literature on IOL that appeared in English journals was performed using MEDLINE and EMBASE. The search strategy included the combination of key terms "induction of labour" and "race" or "ethnicity" in titles, abstracts, or keywords. RESULTS: A total of 8 studies were identified and included. The articles were heterogenous in the race or ethnicity distinctions they used for analysis. Three out of 4 studies that analyzed the rate of elective IOL by race found that White patients were more likely to receive the intervention. Three out of 4 studies that analyzed outcomes of IOL found no difference, while one study found Black patients benefit most from IOL at 38 weeks compared to other races that had the lowest risk of complications with IOL at 39 weeks. CONCLUSION: Racial and ethnic disparities exist with White patients being most likely to access this intervention. The majority of data points to similar outcomes, suggesting no increased harm to elective IOL for a particular group. However, the optimal timing of elective IOL given disproportionate stillbirth risk remains to be elucidated.

Differences in Factors Associated With Preterm and Term Stillbirth: A Secondary Cohort Analysis of the DESiGN Trial.

OBJECTIVE: To identify whether maternal and pregnancy characteristics associated with stillbirth differ between preterm and term stillbirth. DESIGN: Secondary cohort analysis of the DESiGN RCT. SETTING: Thirteen UK maternity units. POPULATION: Singleton pregnant women and their babies. METHODS: Multiple logistic regression was used to assess whether the 12 factors explored were associated with stillbirth. Interaction tests assessed for a difference in these associations between the preterm and term periods. MAIN OUTCOME MEASURE: Stillbirth stratified by preterm (<37+0 weeks') and term (37+0-42+6 weeks') births. RESULTS: A total of 195 344 pregnancies were included. Six hundred and sixty-seven were stillborn (3.4 per 1000 births), of which 431 (65%) were preterm. Significant interactions were observed for maternal age, ethnicity, IMD, BMI, parity, smoking, PAPP-A, gestational hypertension, pre-eclampsia and gestational diabetes but not for chronic hypertension and pre-existing diabetes. Stronger associations with term stillbirth were observed in women with obesity compared to BMI 18.5-24.9 kg/m2 (BMI 30.0-34.9 kg/m2 term adjusted OR 2.1 [95% CI 1.4-3.0] vs. preterm aOR 1.1 [0.8-1.7]; BMI ≥ 35.0 kg/m2 term aOR 2.2 [1.4-3.4] vs. preterm aOR 1.5 [1.2-1.8]; p-interaction < 0.01), nulliparity compared to parity 1 (term aOR 1.7 [1.1-2.7] vs. preterm aOR 1.2 [0.9-1.6]; p-interaction < 0.01) and Asian ethnicity compared with White (p-interaction < 0.01). A weaker or lack of association with term, compared to preterm, stillbirth was observed for older maternal age, smoking and pre-eclampsia. CONCLUSION: Differences in association exist between mothers experiencing preterm and term stillbirth. These differences could contribute to design of timely surveillance and interventions to further mitigate the risk of stillbirth.

Prioritisation of early pregnancy risk factors for stillbirth: An international multistakeholder modified e-Delphi consensus study.

OBJECTIVE: To identify and prioritise early pregnancy risk factors for stillbirth to inform prognostic factor and model research. STUDY DESIGN: We used a modified e-Delphi method and consultation meeting to achieve consensus. Risk factors for early, late and stillbirth at any gestation identified from an umbrella review of risk factors for stillbirth were entered into a two-stage online Delphi survey with an international group of stakeholders made up of healthcare professionals and researchers. The RAND/ University of California at Los Angeles appropriateness method was used to evaluate consensus. Responders voted on a scale of 1-9 for each risk factor in terms of importance for early, late, and stillbirth at any gestation. Consensus for inclusion was reached if the median score was in the top tertile and at least two thirds of panellists had scored the risk factor within the top tertile. RESULTS: Twenty-six risk factors were identified from an umbrella review and presented to stakeholders in round 1 of our e-Delphi survey. Round 1 was completed by 68 stakeholders, 79% (54/68) of whom went on to complete the second round. Seventeen risk factors were discussed at the consensus meeting. From the twenty-six risk factors identified, fifteen of these were prioritised for stillbirth at any gestation, eleven for early stillbirth, and sixteen for late stillbirth, across three domains of maternal characteristics, ultrasound markers and biochemical markers. The prioritised maternal characteristics common to early, late, and stillbirth at any gestation were: maternal age, smoking, drug misuse, history of heritable thrombophilia, hypertension, renal disease, diabetes, previous stillbirth and multiple pregnancy. Maternal BMI, access to healthcare, and socioeconomic status were prioritised for late stillbirth and stillbirth at any gestation. Previous pre-eclampsia and previous small for gestational age baby were prioritised for late stillbirth. Of the ultrasound markers, uterine artery Doppler pulsatility index and congenital fetal anomaly were prioritised for all. One biochemical marker, placental growth factor, was prioritised for stillbirth at any gestation. CONCLUSIONS: Our prioritised risk factors for stillbirth can inform formal factor-outcome evaluation of early pregnancy risk factors to influence public health strategies on prevention of such risk factors to prevent stillbirth.

Adverse pregnancy outcomes in maternal malarial infection: A systematic review and meta-analysis.

Background: Malaria in pregnancy is a critical public health issue that can lead to severe adverse outcomes for both mother and fetus. This systematic review and meta-analysis evaluated the prevalence of adverse birth outcomes in malaria-infected pregnancies and examines their association with the condition. Method: We searched databases up to January 30, 2024, for observational studies on pregnant women with malaria. Data were analyzed using a random-effects model to calculate pooled prevalence rates and risk ratios (RRs) for adverse outcomes, with statistical support from R software version 4.3. Results: Thirty-one studies were included, showing high prevalence of low birth weight (LBW; 17.4 %), preterm birth (17.9 %), and small for gestational age (SGA; 16.1 %) in malaria-affected pregnancies. Infected mothers were significantly more likely to have LBW infants (RR = 1.755), preterm births (RR = 1.484), and SGA infants (RR = 1.554). The risk of stillbirth was not significantly increased (RR = 1.238). Conclusion: Malaria in pregnancy significantly elevates the risk of LBW, preterm birth, and SGA, underscoring the need for effective malaria prevention and treatment strategies in endemic regions. Future research should aim to refine and implement these strategies to enhance maternal and neonatal health outcomes.

Epidemiology and placental pathology of intrauterine fetal demise in a tertiary hospital in the Philippines.

Objectives: The Philippines has at least 25,000 stillbirth or intrauterine fetal demise (IUFD) cases every year. Despite its burden, there is scarce information on IUFD epidemiology in the Philippines. Hence, this study reported the epidemiology and placental pathology of IUFD in a tertiary hospital in the Philippines. Study design: This cross-sectional study analyzed second- and third-trimester IUFD cases at the Philippine General Hospital from 2012 to 2021. We reviewed maternal sociodemographic and clinical characteristics and evaluated placental pathology. All statistical tests were done with GraphPad Prism software version 8.0. Results: We recorded 947 (2.28 %) cases of IUFD out of 41,562 obstetric deliveries from 2012 to 2021. Out of 947 IUFD cases, 532 had placental pathology reports. Second-trimester IUFD cases showed higher rates of no antenatal care (42.86 %) compared to third-trimester cases (10.61 %). Hypertensive disorders were more common in third-trimester IUFD. Infarcts (23.34 %), calcifications (4.12 %), and hemorrhages/hematomas (3.00 %) were the most prevalent placental abnormalities. While these abnormalities were more common in third-trimester IUFD, placental and fetal membrane infections like chorioamnionitis were more frequent in second-trimester IUFD. Conclusion: The results highlighted the differences in maternal sociodemographic and clinical characteristics, and placental pathology between second- and third-trimester cases of IUFD. These observations revealed distinct pathological processes and potential etiologies contributing to IUFD in the Philippines.

Stillbirth rates following the change in definition of fetal mortality in Quebec.

OBJECTIVES: In 2019, Quebec changed its stillbirth definition to include fetal deaths at 20 weeks gestation or more. Previously, the criterion was a minimum birth weight of 500 g. We assessed the impact of the new definition on stillbirth rates. METHODS: We conducted a retrospective study of stillbirth rates between 2010 and 2021 in Quebec. The exposure consisted of the period during the new definition versus the preceding period. We assessed how the new definition affected stillbirth rates using interrupted time series regression, and compared the period during the new definition with the preceding period using prevalence differences and prevalence ratios with 95% confidence intervals (CI). We determined the extent to which fetuses at the limit of viability (under 500 g or 20‒23 weeks) accounted for any increase in rates. RESULTS: Stillbirth rates went from 4.11 before the new definition to 6.76 per 1000 total births immediately after. Overall, the change in definition led to an absolute increase of 2.58 stillbirths per 1000 total births, for a prevalence ratio of 1.76 (95% CI 1.61‒1.92) compared with the preceding period. Fetal deaths due to congenital anomalies increased by 6.82 per 10,000 (95% CI 4.85‒8.78), while deaths due to pregnancy termination increased by 10.47 per 10,000 (95% CI 8.04‒12.89). Once the definition changed, 37% of stillbirths were under 500 g and 42% were between 20 and 23 weeks, with around half of these caused by congenital anomalies and terminations. CONCLUSION: Stillbirth rates increased after the definition changed in Quebec, mainly due to congenital anomalies and pregnancy terminations.

RéSUMé: OBJECTIFS: En 2019, le Québec a modifié sa définition de mortinaissance pour inclure les morts fœtales à 20 semaines de gestation ou plus. Auparavant, le critère était un poids minimum de 500 g à la naissance. Nous avons évalué l'impact du changement de définition sur la mesure de mortinatalité. MéTHODES: Nous avons mené une étude rétrospective de la mortinatalité entre 2010 et 2021 au Québec. L'exposition était la période après l'introduction de la nouvelle définition par rapport à la période précédente. Nous avons évalué l'impact du changement de définition sur la prévalence de la mortinatalité en utilisant des régressions de séries temporelles interrompues, et en comparant la période suivant le changement de définition avec la période précédente à l'aide de différences de prévalences et de ratios de prévalences avec des intervalles de confiance à 95% (IC). Nous avons déterminé dans quelle mesure les fœtus à la limite de la viabilité (moins de 500 g ou 20 à 23 semaines) contribuaient à l'augmentation. RéSULTATS: La prévalence de la mortinatalité est passé de 4,11 avant la nouvelle définition à 6,76 pour 1 000 naissances immédiatement après le changement de définition. Il y a eu une augmentation absolue de 2,58 mortinaissances pour 1 000 naissances, pour un ratio de prévalences de 1,76 (IC à 95% 1,61‒1,92) comparativement à la période précédente. Les mortinaissances dues aux anomalies congénitales ont augmenté de 6,82 pour 10 000 (IC 95% 4,85‒8,78), tandis que les décès dus aux interruptions de grossesse ont augmenté de 10,47 pour 10 000 (IC 95% 8,04‒12,89). Une fois la définition modifiée, 37 % des mortinaissances survenaient chez des fœtus pesant moins de 500 g et 42 % avaient lieu entre 20 et 23 semaines, la moitié d'entre elles étant dues à des anomalies congénitales et interruptions de grossesse. CONCLUSION: La prévalence de la mortinatalité a augmenté après le changement de définition au Québec, principalement en raison des décès causés par des anomalies congénitales et des interruptions de grossesse.

The potential impact of universal screening for vasa previa in the prevention of stillbirths.

OBJECTIVES: To estimate the number of pregnancies complicated by vasa previa annually in nine developed countries, and the potential preventable stillbirths associated with undiagnosed cases. We also assessed the potential impact of universal screening for vasa previa on reducing stillbirth rates. METHODS: We utilized nationally-reported birth and stillbirth data from public databases in the United States, United Kingdom, Canada, Germany, Ireland, Greece, Sweden, Portugal, and Australia. Using the annual number of births and the number and rate of stillbirths in each country, and the published incidence of vasa previa and stillbirth rates associated with the condition, we estimated the expected annual number of cases of vasa previa, those that would result in a livebirth, and the potential preventable stillbirths with and without prenatal diagnosis. RESULTS: There were 6,099,118 total annual births with 32,550 stillbirths, corresponding to a summary stillbirth rate of 5.34 per 1,000 pregnancies. The total expected vasa previa cases was estimated to be 5,007 (95 % CI: 3,208-7,201). The estimated number of livebirths would be 4,937 (95 % CI: 3,163-7,100) and 3,610 (95 % CI: 2,313-5,192) in pregnancies with and without a prenatal diagnosis of VP. This implies that prenatal diagnosis would potentially prevent 1,327 (95 % CI: 850-1,908) stillbirths in these countries, corresponding to a potential reduction in stillbirth rate by 4.72 % (95 % CI: 3.80-5.74) if routine screening for vasa previa was performed. CONCLUSIONS: Our study highlights the importance of universal screening for vasa previa and suggests that prenatal diagnosis of prevention could potentially reduce 4-5 % of stillbirths.

A Position Modification Device for the Prevention of Supine Sleep During Pregnancy: A Randomised Crossover Trial.

OBJECTIVE: To assess the effectiveness and acceptability of a pillow-like position modification device to reduce supine sleep during late pregnancy, and to determine the impacts on the severity of sleep-disordered breathing (SDB) and foetal well-being. DESIGN: Randomised cross-over study. SETTING AND POPULATION: Individuals in the third trimester of pregnancy receiving antenatal care at a tertiary maternity hospital in Australia. METHODS: Participants used their own pillow for a control week and an intervention pillow for a week overnight, in randomised order. Sleep position and total sleep time for each night of both weeks were objectively monitored, with a sleep study and foetal heart rate monitoring performed on the last night of each week. MAIN OUTCOME MEASURES: Primary outcome = percentage of sleep time in the supine position; secondary outcomes = apnoea-hypopnoea index, foetal heart rate decelerations and birthweight centile. RESULTS: Forty-one individuals were randomised with data collected on 35 participants over 469 nights. There was no difference in percentage of total sleep time in the supine position overnight between the control or intervention pillow week (13.0% [6.1, 25.5] vs. 16.0% [5.6, 27.2], p = 0.81 with a mean difference of 2.5% [95% CI] = -0.7, 5.6, p = 0.12), and no difference in the severity of SDB or foetal heart rate decelerations across weeks. However, increased supine sleep was significantly related to a higher apnoea-hypopnoea index (rs = 0.37, p = 0.003), lower birthweight (rs = -0.45, p = 0.007) and lower birthweight centile (rs = -0.45, p = 0.006). The proportion of supine sleep each night of the week varied widely both within and across participants, despite awareness of side-sleeping recommendations. CONCLUSIONS: We found no evidence to suggest that the adoption of a pillow designed to discourage supine sleep was effective in late pregnancy, with women spending an average of 1 h per night supine. Alternative devices should be investigated, incorporating lessons learnt from this study to inform trials of supine sleep minimisation in pregnancy. TRIAL REGISTRATION: Clinical Trial: (Australia New Zealand Clinical Trials Registry): ACTRN12620000371998.

Feto-placental and coronary endothelial genes implicated in miscarriage, congenital heart disease and stillbirth, a systematic review and meta-analysis.

The first trimester placenta is very rarely investigated for placental vascular formation in developmental or diseased contexts. Defects in placental formation can cause heart defects in the fetus, and vice versa. Determining the causality is therefore difficult as both organs develop concurrently and express many of the same genes. Here, we performed a systematic review to determine feto-placental and coronary endothelial genes implicated in miscarriages, stillbirth and congenital heart defects (CHD) from human genome wide screening studies. 4 single cell RNAseq datasets from human first/early second trimester cardiac and placental samples were queried to generate a list of 1187 endothelial genes. This broad list was cross-referenced with genes implicated in the pregnancy disorders above. 39 papers reported feto-placental and cardiac coronary endothelial genes, totalling 612 variants. Vascular gene variants were attributed to the incidence of miscarriage (8 %), CHD (4 %) and stillbirth (3 %). The most common genes for CHD (NOTCH, DST, FBN1, JAG1, CHD4), miscarriage (COL1A1, HERC1), and stillbirth (AKAP9, MYLK), were involved in blood vessel and cardiac valve formation, with roles in endothelial differentiation, angiogenesis, extracellular matrix signaling, growth factor binding and cell adhesion. NOTCH1, AKAP12, CHD4, LAMC1 and SOS1 showed greater relative risk ratios with CHD. Many of the vascular genes identified were expressed highly in both placental and heart EC populations. Both feto-placental and cardiac vascular genes are likely to result in poor endothelial cell development and function during human pregnancy that leads to higher risk of miscarriage, congenital heart disease and stillbirth.

Adverse Perinatal Outcomes Among Teenage Mothers Delivering at a Tertiary Referral Hospital in Southwestern Uganda: Prevalence and Associated Factors.

INTRODUCTION: Each year, millions of teenagers in low-resource areas experience unintended pregnancies, many of which result in childbirth. These pregnancies often carry an increased risk of negative perinatal outcomes. OBJECTIVES: The study determined the prevalence and factors associated with adverse perinatal outcomes among teenagers delivering at a tertiary referral hospital in southwestern Uganda. METHODS: This cross-sectional study was carried out in the Department of Obstetrics and Gynecology. We consecutively included all teenagers (13-19 years) in the postnatal ward who delivered. Descriptive statistics were used to summarize demographic and outcome data, and multivariable logistic regression analysis was used to identify factors associated with adverse perinatal outcomes. RESULTS: Overall, 327 participants were enrolled. The mean age was 18.4 (SD 1.1) years, while the mean number of antenatal care (ANC) visits attended was 4.6 (SD 1.9). Less than half delivered by cesarean 136 (41.6%) and 16 (4.9%) were HIV seropositive. Approximately 140 (42.8%) participants had adverse perinatal outcomes, including neonatal death (7, 2.1%), APGAR score at five minutes <7 (44, 13.5%), or low birth weight <2.5 kg (52, 15.9%). ANC attendance was mildly protective against adverse perinatal outcomes (aOR 0.91 (95% CI 1.14, 3.01), p=0.03). Feeling indifferent toward the pregnancy was associated with increased odds of one or more adverse perinatal outcomes compared to feeling happy about the pregnancy (aOR 3.39 (95% CI 1.11, 10.37), p=0.02). Participants with a history of prior miscarriage had increased odds of adverse perinatal outcomes (aOR 9.03 (95% CI 2.45, 25.53), p=0.04). CONCLUSIONS: Nearly half of teenagers experienced adverse perinatal outcomes, and a history of prior miscarriage was a significant risk factor for adverse perinatal outcomes, while ANC was protective. Prospective cohort studies to explore the newborn and child developmental outcomes among children born to teenage mothers are also recommended.

Intrahepatic cholestasis of pregnancy - Are you listening?

Through their personal experience of having intrahepatic cholestasis of pregnancy (ICP), this paper covers the development of current understanding of ICP. It summarises how research and clinical practice was developed through clinicians and followed by the inception of an ICP research group in the 1990s. This group's work has led to a better understanding of the mechanisms behind ICP, the risk threshold for stillbirth, and a genomic understanding of the condition. It focuses on how collaborative work between the author and researchers led to the formation of a charity for ICP. Despite this, some obstetric healthcare professionals continue to provide misinformation about ICP to women and birthing people. Furthermore, the views of those affected by ICP, together with the research they present to clinicians, are being ignored. It highlights a need for those managing ICP to listen to their patients and to pay closer attention to the research being published.