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1.
RECIIS (Online) ; 13(4): 863-876, out.-dez. 2019. ilus, tab
Artigo em Português | LILACS | ID: biblio-1047592

RESUMO

Este artigo se baseia em um estudo de série temporal sobre os óbitos fetais por malformações congênitas no estado do Maranhão relativo ao período de 2006 a 2016. Foram construídos indicadores epidemiológicos para estimar o risco de morte fetal e sua tendência ao longo da série estudada. Os dados são provenientes do Departamento de Informática do SUS e sua análise realizada por modelos de regressão linear. Foram registrados 17.843 óbitos fetais no período abordado pelo estudo, 528 dos quais decorrentes de malformações congênitas (2,96%). Observou-se uma tendência significativa de aumento do coeficiente de mortalidade fetal geral, correspondente a 6,99% (ß1=0,17; p=0,004) e do específico por malformações congênitas, equivalente a 5,13% (ß1=0,01; p=0,04). Os resultados deste estudo corroboram a tendência histórica dos serviços de saúde negligenciarem os óbitos fetais. É importante destacar que parte destes óbitos são preveníveis e potencialmente evitáveis. Desse modo, a implementação dos comitês de investigação de óbitos fetais e infantis e a sua vigilância adequada poderiam melhorar a assistência prestada tanto no pré-natal quanto no parto.


This article bases on a time series study about fetal deaths due to congenital malformations in the state of Maranhão, Brazil, occurred from 2006 to 2016. Epidemiological indicators were constructed to estimate the risk of fetal death and its trend throughout the series studied. The data were obtained in the Department of Informatics of SUS and analyzed by linear regression models. There were 17,843 fetal deaths during the analysed period, from which 528 were a direct result of congenital malformations (2.96%). A significant tendency towards an increase in the coefficient of general fetal mortality corresponding to 6.99% (ß1=0.17; p=0.004) and in the coefficient of specific fetal mortality due to congenital malformations equivalent to 5.13% (ß1=0.01; p=0.04) were observed. The end results of this study corroborate the historical trend toward negligence in Brazilian health centres with regard to fetal deaths. It is important to remark that some of these deaths can be presumed and potentially preventable. Thus, the implementation of the fetal and infant death investigation committees and their adequate surveillance could improve care during prenatal and delivery.


Este artículo se basa en un estudio de serie temporal acerca de muertes de fetos por malformaciones congénitas en el estado de Maranhão, Brasil, concerniente al periodo de 2006 a 2016. Se construyeron indicadores epidemiológicos para estimar el riesgo de la muerte fetal y su tendencia a lo largo de la serie estudiada. Los datos son provenientes del Departamento de Informática del SUS y fueron analizados por modelos de regresión lineal. Se registraron 17.843 muertes de fetos en el período estudiado, de los cuales 528 fueron resultado de malformaciones congénitas (2,96%). Se observó una tendencia significativa al aumento del coeficiente de mortalidad fetal general correspondiente a 6.99% (ß1=0,17; p=0,004) y del específico, por malformaciones congénitas, equivalente a 5,13% (ß1=0,01; p=0,04). Los resultados del estudio corroboran la tendencia histórica a la negligencia de los centros de salud brasileños con respecto a las muertes de los fetos. Por su importancia debemos destacar que parte de esas muertes son presumibles y pueden ser evitadas. De ese modo, la implementación de los comités de investigación de muertes de fetos y infantiles y su vigilancia adecuada podrían mejorar la asistencia prestada en el prenatal y en el parto.


Assuntos
Humanos , Anormalidades Congênitas , Sistemas de Informação , Epidemiologia , Mortalidade Fetal/tendências , Estudos Ecológicos , Morte Fetal/etiologia , Cuidado Pré-Natal , Saúde Materno-Infantil , Mortalidade , Indicadores de Desenvolvimento
2.
Am J Epidemiol ; 188(2): 347-354, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30358819

RESUMO

Arsenic crosses the placenta, possibly increasing the risk of adverse reproductive outcomes. We aimed to examine the association between maternal arsenic exposure and fetal/neonatal survival using data from a prospective cohort study of 1,616 maternal-infant pairs recruited at a gestational age of ≤16 weeks in Bangladesh (2008-2011). Arsenic concentration in maternal drinking water was measured at enrollment. Extended Cox regression (both time-dependent coefficients and step functions) was used to estimate the time-varying association between maternal arsenic exposure and fetal/neonatal death (all mortality between enrollment and 1 month after birth). In a sensitivity analysis, we assessed gestational arsenic exposure using maternal urine samples taken at enrollment. We observed 203 fetal losses and 20 neonatal deaths. Higher arsenic exposure was associated with a slightly decreased mortality rate up to the middle of the second trimester, and then the mortality rate switched directions around 20 weeks' gestation. In the step function model, the hazard ratios for combined mortality (fetal loss and neonatal death) per unit increase in the natural log of drinking water arsenic concentration (µg/L) ranged from 1.35 (95% CI: 1.08, 1.69) in weeks 25-28 to 0.81 (95% CI: 0.65, 1.02) in weeks 9-12. This nonlinear association suggests that arsenic may exert survival pressure on developing fetuses, potentially contributing to survival bias, and may also indicate that arsenic toxicity differs by fetal developmental stage.


Assuntos
Arsênico/análise , Mortalidade Fetal/tendências , Mortalidade Infantil/tendências , Exposição Materna/estatística & dados numéricos , Poluentes Químicos da Água/análise , Adolescente , Adulto , Bangladesh/epidemiologia , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Gravidez , Trimestres da Gravidez , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores Socioeconômicos , Adulto Jovem
4.
PLoS One ; 13(8): e0202318, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30110380

RESUMO

OBJECTIVE: This study was conducted to analyze recent trends of multiple birth rates (MBR) and fetal/neonatal/infant mortalities according to the number of gestations in Korea. METHODS: Data from 2009 to 2015 of live births, infant deaths and stillbirths were obtained from the Korean Vital Statistics. Neonatal mortality rate (NMR), infant mortality rate (IMR), and fetal mortality rate (FMR) in singleton, twin and triplet pregnancies were analyzed according to gestational period (GP; ≤ 23, 24-27, 28-31, and 32-36 weeks). RESULTS: From 2009 to 2015, twin and triplet birth rates increased 34.5% and 154.3%, respectively. In twin births, NMR and FMR have been decreased significantly (from 10.92 to 8.62, p = 0.034 and from 41.00 to 30.55, p< 0.001, respectively), but IMR did not show significant decrease. There was no significant change of NMR, IMR, and FMR, in triplet births. Overall, in singleton, twin, and triplet births, NMR was 1.26 ± 0.09, 10.6 ± 1.12, and 34.32 ± 11.72, respectively, and IMR was 2.38 ± 0.26, 14.52 ± 1.38, and 41.13 ± 12.2, respectively. FMRs were 12 ± 1.73, 35.99 ± 3.55, and 88.85 ± 16.55, respectively, in singleton, twin, and triplet pregnancies. In spite of decreasing trends in overall mortalities, the odds ratios of NMRs and IMRs in 2015 were approximately 9-fold and 6-fold higher, respectively, in twin births, and approximately 37-fold and 20-fold higher, respectively, in triplet births, than those in singleton births. There were no significant differences in odds ratios of NMRs and IMRs at GP 32-36 among single, twin, and triplet births, although the odds ratios of FMR at GP 32-36 in triplet gestation was significantly higher than those in singleton and twin gestation. CONCLUSION: Neonatal/infant mortality in multiple births is still significantly high, which is mainly related with preterm birth. Close fetal monitoring is needed to prevent fetal death in triplet pregnancies, after 32 gestational weeks.


Assuntos
Mortalidade Fetal , Mortalidade Infantil , Prole de Múltiplos Nascimentos , Estudos de Coortes , Feminino , Mortalidade Fetal/tendências , Humanos , Lactente , Mortalidade Infantil/tendências , Gravidez , Resultado da Gravidez , Gravidez Múltipla , República da Coreia/epidemiologia
5.
Arch Argent Pediatr ; 116(4): e567-e574, 2018 Aug 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30016034

RESUMO

INTRODUCTION: Few studies have established a relationship between adverse social conditions by geographic area (GA) and fetal mortality (FM). Objective. To assess health inequalities in relation to FM by GA. POPULATION AND METHODS: Descriptive, ecological study. The principal components of 525 GAs were analyzed. A socioeconomic status indicator and indices of inequality were developed and estimated, and the FM ratio was calculated. RESULTS: The Kunst and Mackenbach relative index of inequality ranged from 1.8 to 1.4 in the 2007/2008 and 2013/2014 biennia, and a higher FM ratio was estimated for the highly unfavorable socioeconomic level stratum. CONCLUSION: The FM ratio is higher in this stratum. The gap between the ends of the socioeconomic spectrum narrowed towards the latest biennium. Regardless of this, in the GAs with a very unfavorable socioeconomic status, the FM ratio reduced in the latest biennium and increased in those with a very favorable socioeconomic status.


Assuntos
Mortalidade Fetal/tendências , Disparidades nos Níveis de Saúde , Argentina , Feminino , Humanos , Gravidez , Análise de Componente Principal , Fatores Socioeconômicos
6.
Prog. obstet. ginecol. (Ed. impr.) ; 61(1): 22-30, ene.-feb. 2018. tab, graf
Artigo em Inglês | IBECS | ID: ibc-171498

RESUMO

Objective: The problem of maternal mortality in regions such as sub-Saharan Africa, which reaches average values almost 100 times higher than in developed countries, is framed in the Millennium Development Goals. Our main objective was to estimate the factors involved in high maternal mortality. Material and methods: We designed an ecological, cross-sectional study taking the individual country as a unit of analysis. Results: We obtained significant correlations between the maternal mortality rate and infantile mortality rate, institutional deliveries, 4 visits during pregnancy, and fertility index (p <0.05). We observed a clear decrease in the maternal mortality rate as the socioeconomic level increased. Conclusions: The results show that maternal mortality is influenced primarily by factors associated with health care, followed by socioeconomic factors. The methodological limitations of this study prevent us from establishing causal relationships (AU)


Objetivo: la elevada mortalidad materna en regiones como África Subsahariana constituye un problema enmarcado en los Objetivos del Milenio, alcanzando cifras medias casi 100 veces superiores que los países desarrollados. Nuestro objetivo principal fue estimar los factores implicados en ella. Material y métodos: diseñamos un estudio ecológico y transversal usando cada país como unidad de análisis. Resultados: obtuvimos correlaciones especialmente significativas entre la tasa de mortalidad materna y la tasa de mortalidad infantil, partos institucionales, realización de 4 visitas durante la gestación e índice de fertilidad (p < 0,05). Obtuvimos una franca disminución de la tasa de mortalidad materna conforme aumentábamos los diferentes grados socioeconómicos, a excepción del índice de desigualdad de género (que expresó una relación inversa a las demás). Conclusiones: conforme a los resultados obtenidos, encontramos una mortalidad materna influenciada primariamente por factores derivados de la asistencia sanitaria y secundariamente por otros de índole socioeconómica. Las limitaciones metodológicas de este diseño nos impiden establecer relaciones de causalidad (AU)


Assuntos
Humanos , Feminino , Gravidez , Mortalidade Infantil/tendências , Mortalidade Materna/tendências , Mortalidade Fetal/tendências , Complicações na Gravidez/mortalidade , Complicações do Trabalho de Parto/mortalidade , África ao Sul do Saara/epidemiologia , Estudos Transversais , Fatores Socioeconômicos
7.
Health Serv Res ; 53(6): 4437-4459, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29349772

RESUMO

OBJECTIVE: To examine the effect that the introduction of new diagnostic technology in obstetric care has had on fetal death. DATA SOURCE: The Medical Birth Registry of Norway provided detailed medical information for approximately 1.2 million deliveries from 1967 to 1995. Information about diagnostic technology was collected directly from the maternity units, using a questionnaire. STUDY DESIGN: The data were analyzed using a hospital fixed-effects regression with fetal mortality as the outcome measure. The key independent variables were the introduction of ultrasound and electronic fetal monitoring at each maternity ward. Hospital-specific trends and risk factors of the mother were included as control variables. The richness of the data allowed us to perform several robustness tests. PRINCIPAL FINDING: The introduction of ultrasound caused a significant drop in fetal mortality rate, while the introduction of electronic fetal monitoring had no effect on the rate. In the population as a whole, ultrasound contributed to a reduction in fetal deaths of nearly 20 percent. For post-term deliveries, the reduction was well over 50 percent. CONCLUSION: The introduction of ultrasound made a major contribution to the decline in fetal mortality at the end of the last century.


Assuntos
Cardiotocografia/estatística & dados numéricos , Mortalidade Fetal/tendências , Invenções/estatística & dados numéricos , Ultrassonografia/estatística & dados numéricos , Cardiotocografia/instrumentação , Parto Obstétrico , Feminino , Humanos , Recém-Nascido , Invenções/tendências , Noruega , Gravidez , Sistema de Registros , Inquéritos e Questionários , Ultrassonografia/instrumentação
8.
Congenit Heart Dis ; 13(2): 203-209, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29063738

RESUMO

AIMS: Pregnancy in patients with Marfan's syndrome (MFS) carries an increased risk of cardiovascular complications, resulting in increased maternal and fetal mortality and morbidity. Literature on MFS pregnant patients is relatively sparse, and there has yet to be a concrete consensus on the management of this unique patient population. The purpose of our paper is to provide a literature review of case reports and studies on MFS during pregnancy (published between 2005 and 2015) and to explore cardiovascular outcomes of patients with MFS. METHODS AND RESULTS: Of the 852 women in our review, there were 1112 pregnancies, with an aortic dissection rate of 7.9% and mortality of 1.2%. Data demonstrated a trend that patients whose aortic diameter ≥40 mm had a greater rate of dissection than MFS patients whose aortic diameter <40 mm (Fisher's exact test, P = .0504). Fetal outcome included a 5.6% mortality rate and 41% of births were cesarean deliveries and of those reported, 75% secondary to cardiac emergencies. CONCLUSIONS: Patients with MFS, especially those whose initial aortic diameters ≥40 mm, planning a pregnancy or currently pregnant should be carefully counseled about the maternal and fetal risks throughout pregnancy. MFS patients whose aortic diameters ≥40 mm should be advised to ideally await pregnancy until prophylactic aortic surgery. As MFS varies in its phenotypic expression, each patient's risk of adverse cardiac events should be assessed individually through a joint Maternal Fetal Medicine and Cardiology Center.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Ecocardiografia/métodos , Síndrome de Marfan/complicações , Complicações Cardiovasculares na Gravidez , Ultrassonografia Pré-Natal/métodos , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/epidemiologia , Aneurisma Dissecante/etiologia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/epidemiologia , Aneurisma da Aorta Torácica/etiologia , Feminino , Mortalidade Fetal/tendências , Saúde Global , Humanos , Incidência , Recém-Nascido , Síndrome de Marfan/epidemiologia , Mortalidade Materna/tendências , Gravidez , Resultado da Gravidez
9.
BMJ Open ; 7(11): e017963, 2017 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-29146644

RESUMO

OBJECTIVE: To analyse the prevalence of fetal and infant deaths due to birth defects in Korea and those trends according to maternal age. DESIGN: Retrospective national cohort study SETTING: Korean Vital Statistics database of the Korean Statistical Information Service, between 2009 and 2015. PARTICIPANTS: 2176 infant deaths and 4343 fetal deaths caused by birth defects, among 3 181 145 total live births and 43 385 fetal deaths during the study periods. METHODS: Infant and fetal mortality rates (IMRs and FMRs) by birth defects, from deaths caused by birth defects, were analysed. They were compared, according to maternal age groups: (I) '10-19 years'; (II) '20-29 years'; (III) '30-34 years'; (IV) '35-39 years'; and (V) '40-55 years'. MAIN OUTCOME MEASURES: IMRs and FMRs by birth defects and comparison according to maternal age group. RESULTS: IMRs and FMRs by birth defects were 6.84 per 10 000 live births and 13.47 per 10 000 total births. The most common causes of infant deaths and fetal deaths by birth defect were anomaly of the circulatory system (51.1%, IMR 3.5) and chromosomal abnormality (33.1%, FMR 4.46), respectively. Among groups by maternal age, FMRs by birth defects were significantly higher in groups I and V compared with group III (OR 6.59, 95% CI 3.49 to 12.43; and OR 3.46, 95% CI 1.77 to 6.78, respectively). IMR and FMR by nervous system anomaly were significantly higher in group I at 3.63 (OR 2.0, 95% CI 1.97 to 2.03) and 29.84 (OR 15.04, 95% CI 3.59 to 62.96) compared with 0.32 and 1.97 in group III. CONCLUSION: FMRs by birth defects were the highest in the extreme maternal age groups. Severe anomalies, except for chromosomal abnormality, were most prevalent in teenage pregnancies.


Assuntos
Anormalidades Congênitas/classificação , Anormalidades Congênitas/mortalidade , Mortalidade Fetal/tendências , Mortalidade Infantil/tendências , Idade Materna , Adolescente , Adulto , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , República da Coreia/epidemiologia , Estudos Retrospectivos , Adulto Jovem
10.
Ann Epidemiol ; 27(9): 570-574, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28888835

RESUMO

PURPOSE: Although studies have examined overall temporal changes in gestational age-specific fetal mortality rates, there is little information on the current status of racial/ethnic differences. We hypothesize that differences exist between racial/ethnic groups across gestational age and that these differences are not equally distributed. METHODS: Using the 2009-2013 data from US fetal death and live birth files for non-Hispanic white (NHW); non-Hispanic black (NHB); Hispanic; and American Indian/Alaska Native (AIAN) women, we conducted analyses to examine fetal mortality rates and estimate adjusted prevalence rate ratios and 95% confidence intervals (CIs). RESULTS: There were lower risks of fetal mortality among NHB women (aPRR = 0.76; 95% CI = 0.71-0.81) and Hispanic women (aPRR = 0.89; 95% CI = 0.83-0.96) compared with NHWs at 22-23 weeks' gestation. For NHB women, the risk was higher starting at 32-33 weeks (aPRR = 1.11; 95% CI = 1.04-1.18) and continued to increase as gestational age increased. Hispanic and AIAN women had lower risks of fetal mortality compared with NHW women until 38-39 weeks. CONCLUSIONS: Further examination is needed to identify causes of fetal death within the later pregnancy period and how those causes and their antecedents might differ by race and ethnicity.


Assuntos
Grupos de Populações Continentais/estatística & dados numéricos , Mortalidade Fetal/etnologia , Idade Gestacional , Disparidades nos Níveis de Saúde , Natimorto/etnologia , Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Africano , Nativos do Alasca/estatística & dados numéricos , Grupos Étnicos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Mortalidade Fetal/tendências , Hispano-Americanos/estatística & dados numéricos , Humanos , Índios Norte-Americanos/estatística & dados numéricos , Mortalidade Perinatal , Gravidez , Estudos Prospectivos , Estados Unidos/epidemiologia
11.
Balkan Med J ; 34(6): 553-558, 2017 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-28832325

RESUMO

BACKGROUND: Perinatal, foetal and neonatal mortality statistics are important to show the development of a health care system in a country. However, in our country there are very few national and regional data about the changing pattern of perinatal neonatal mortality along with the development of new technologies in this area. AIMS: Evaluation of the changes in mortality rates and the causes of perinatal and neonatal deaths within years in a perinatal reference centre which serves a high-risk population. STUDY DESIGN: Cross-sectional retrospective study. METHODS: The perinatal, neonatal and foetal mortality rates in the years 1979-1980 (1st time point) and 1988-1989 (2nd time point) were compared with the year 2008 (3rd time point). The causes of mortality were assessed by Wigglesworth classification and death reports. The neonatal mortality in the neonatal intensive care unit was also calculated. RESULTS: Foetal mortality rates were 44/1000, 31.4/1000 and 41.75/1000 births, perinatal mortality rates were 35.6/1000, 18.8/1000 and 9/1000 births, and neonatal mortality rates were 35.6/1000, 18.8/1000 and 9/1000 live births for the three study time points, respectively. The mortality rate in neonatal intensive care unit decreased consistently from 33%, to 22.6% and 10%, respectively, together with decreasing neonatal mortality rates. The causes of perinatal deaths were foetal death 85%, immaturity 4%, and lethal congenital malformations 8% according to Wigglesworth classification in 2008, showing the high impact of foetal deaths on this high perinatal mortality rate. Infectious causes of neonatal deaths decreased but congenital anomalies increased in the last decades. CONCLUSION: Although neonatal mortality rate decreased significantly; foetal mortality rate has stayed unchanged since the late eighties. In order to decrease foetal and perinatal mortality rates more efficiently, reducing consanguineous marriages and providing better antenatal care for high risk pregnancies are needed.


Assuntos
Mortalidade Fetal/tendências , Mortalidade Infantil/tendências , Mortalidade Perinatal/tendências , Asfixia Neonatal/mortalidade , Anormalidades Congênitas/mortalidade , Comparação Transcultural , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Sepse Neonatal/mortalidade , Gravidez , Cuidado Pré-Natal , Síndrome do Desconforto Respiratório do Recém-Nascido/mortalidade , Estudos Retrospectivos , Fatores de Risco , Turquia/epidemiologia
12.
J Korean Med Sci ; 32(8): 1319-1326, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28665069

RESUMO

Fetal death is an important indicator of national health care. In Korea, the fetal mortality rate is likely to increase due to advanced maternal age and multiple births, but there is limited research in this field. The authors investigated the characteristics of fetal deaths, the annual changes in the fetal mortality rate and the perinatal mortality rate in Korea, and compared them with those in Japan and the United States. Fetal deaths were restricted to those that occurred at 20 weeks of gestation or more. From 2009 to 2014, the overall mean fetal mortality rate was 8.5 per 1,000 live births and fetal deaths in Korea, 7.1 in Japan and 6.0 in the United States. While the birth rate in Korea declined by 2.1% between 2009 and 2014, the decrease in the number of fetal deaths was 34.5%. The fetal mortality rate in Korea declined by 32.9%, from 11.0 in 2009 to 7.4 in 2014, the largest decline among the 3 countries. In addition, rates for receiving prenatal care increased from 53.9% in 2009 to 75.0% in 2014. Perinatal mortality rate I and II were the lowest in Japan, followed by Korea and the United States, and Korea showed the greatest decrease in rate of perinatal mortality rate II. In this study, we identified that the indices of fetal deaths in Korea are improving rapidly. In order to maintain this trend, improvement of perinatal care level and stronger national medical support policies should be maintained continuously.


Assuntos
Mortalidade Fetal/tendências , Mortalidade Infantil/tendências , Mortalidade Perinatal/tendências , Peso ao Nascer , Demografia , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Japão , Masculino , Idade Materna , Gravidez , Cuidado Pré-Natal , República da Coreia , Razão de Masculinidade , Estados Unidos
13.
Paediatr Perinat Epidemiol ; 31(5): 385-391, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28722799

RESUMO

BACKGROUND: Infant mortality rate (IMR), or number of infant deaths per 1000 livebirths, varies widely across the US While fetal deaths are not included in this measure, reported infant deaths do include those delivered at previable gestations, or ≤20 weeks gestation. Variation in reporting of these events may have a significant impact on IMR estimates. METHODS: This retrospective analysis used US National Center for Health Statistics 2007-2013 data from 2391 US counties. Counties were categorised by US region, demographic characteristics, and state-level fetal death reporting requirements. County percentage of fetal deaths among all 17-20 week fetal and infant deaths was evaluated using multivariable linear regression. County-level characteristics were then included in multivariable linear regression to determine the associated change in county IMR. RESULTS: County percentage of deaths at 17-20 weeks reported as fetal ranged from 0% to 100% (mean 63.7%). Every 1 point increase in this percentage was associated with a 0.02 point decrease in county IMR (95% confidence interval (CI) 0.02, 0.03). When county IMRs were recalculated holding the percentage of fetal vs. infant deaths at 17-20 weeks constant at 63.7%, results suggest that the predicted gap in county IMR between Northeast and Midwest regions would narrow by 0.45 points. CONCLUSIONS: Variable reporting of previable fetal and infant deaths may compromise the validity of county IMR comparisons. Improved consistency and accuracy of fetal and infant death reporting is warranted.


Assuntos
Mortalidade Fetal , Mortalidade Infantil , Análise de Variância , Coleta de Dados , Bases de Dados como Assunto , District of Columbia/epidemiologia , Feminino , Mortalidade Fetal/tendências , Idade Gestacional , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Modelos Lineares , Masculino , Notificação de Abuso , Formulação de Políticas , Gravidez , Estudos Retrospectivos
15.
BMC Res Notes ; 10(1): 178, 2017 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-28482916

RESUMO

OBJECTIVES: We provide a methodology for estimating counts of single-year-of-age live-births, fetal-losses, abortions, and pregnant women from aggregated age-group counts. As a case study, we estimate counts for the 254 counties of Texas for the year 2010. RESULTS: We use interpolation to estimate counts of live-births, fetal-losses, and abortions by women of each single-year-of-age for all Texas counties. We then use these counts to estimate the numbers of pregnant women for each single-year-of-age, which were previously available only in aggregate. To support public health policy and planning, we provide single-year-of-age estimates of live-births, fetal-losses, abortions, and pregnant women for all Texas counties in the year 2010, as well as the estimation method source code.


Assuntos
Aborto Induzido/estatística & dados numéricos , Aborto Espontâneo/epidemiologia , Coeficiente de Natalidade/tendências , Mortalidade Fetal/tendências , Nascimento Vivo/epidemiologia , Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Gestantes , Texas/epidemiologia
16.
Am J Med Genet A ; 173(4): 953-958, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28328132

RESUMO

Edwards syndrome (trisomy 18) and Patau syndrome (trisomy 13) both have high natural fetal loss rates. The aim of this study was to provide estimates of these fetal loss rates by single gestational week of age using data from the National Down Syndrome Cytogenetic Register. Data from all pregnancies with Edwards or Patau syndrome that were prenatally detected in England and Wales from 2004 to 2014 was analyzed using Kaplan-Meier survival estimates. Pregnancies were entered into the analysis at the time of gestation at diagnosis, and were considered "under observation" until the gestation at outcome. There were 4088 prenatal diagnoses of trisomy 18 and 1471 of trisomy 13 in the analysis. For trisomy 18, 30% (95%CI: 25-34%) of viable fetuses at 12 weeks will result in a live birth and at 39 weeks gestation 67% (60-73%) will result in a live birth. For trisomy 13 the survival is 50% (41-58%) at 12 weeks and 84% (73-90%) at 39 weeks. There was no significant difference in survival between males and females when diagnosed at 12 weeks for trisomy 18 (P-value = 0.27) or trisomy 13 (P-value = 0.47). This paper provides the most precise gestational age-specific estimates currently available for the risk of fetal loss in trisomy 13 and trisomy 18 pregnancies in a general population.


Assuntos
Aborto Espontâneo/diagnóstico , Aborto Espontâneo/epidemiologia , Transtornos Cromossômicos/diagnóstico , Transtornos Cromossômicos/epidemiologia , Mortalidade Fetal/tendências , Trissomia/diagnóstico , Aborto Eugênico/estatística & dados numéricos , Aborto Espontâneo/genética , Adolescente , Adulto , Transtornos Cromossômicos/genética , Transtornos Cromossômicos/patologia , Cromossomos Humanos Par 13/genética , Cromossomos Humanos Par 18 , Inglaterra/epidemiologia , Feminino , Feto , Idade Gestacional , Humanos , Nascimento Vivo/epidemiologia , Nascimento Vivo/genética , Masculino , Gravidez , Diagnóstico Pré-Natal , Risco , Natimorto/epidemiologia , Natimorto/genética , Análise de Sobrevida , Trissomia/genética , Trissomia/patologia , Síndrome da Trissomia do Cromossomo 13 , Síndrome da Trissomía do Cromossomo 18 , País de Gales/epidemiologia
17.
An. pediatr. (2003. Ed. impr.) ; 86(3): 127-134, mar. 2017. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-160630

RESUMO

Introducción. El parto prematuro es una de las principales causas de mortalidad perinatal y fetal. Sin embargo, los factores de riesgo perinatales asociados a mortalidad fetal intraparto en partos pretérmino no han sido bien analizados. Objetivo. Analizar la mortalidad fetal y los factores de riesgo perinatales asociados a mortalidad fetal intraparto en gestaciones de menos de 32 semanas. Material y métodos. Se incluyeron en el análisis todos los partos pretérmino entre las semanas 22 y 31+6 días, nacidos en un hospital terciario durante un periodo de 7 años (2008-2014). Se realizó análisis de regresión logística para identificar factores de riesgo perinatales asociados a mortalidad fetal intraparto (excluidos malformaciones y cromosomopatías severas). Resultados. En este período el 63,1% (106/168) de la mortalidad fetal (≥22 semanas) se produjo en gestaciones menores de 32 semanas. Ochocientos ochenta y dos nacimientos entre las semanas 22 y 31+6 días fueron incluidos en el análisis. La mortalidad fetal fue del 11,3% (100/882). La mortalidad fetal intraparto fue del 2,6% (23/882), afectando en el 78,2% de los casos (18/23) a gestantes hospitalizadas. Encontramos que las técnicas de reproducción asistida, la ecografía fetal patológica, la no administración de corticoides antenatales, la menor edad gestacional y el bajo peso para la edad gestacional fueron factores de riesgo independientes asociados a mortalidad fetal intraparto. Conclusión. La mortalidad fetal intraparto afectó a un porcentaje importante de nacimientos entre las semanas 22 y 31+6 días. El análisis de la mortalidad fetal intraparto y los factores de riesgo asociados a esta resulta de gran interés clínico y epidemiológico para optimizar el cuidado perinatal y aumentar la supervivencia del recién nacido pretérmino (AU)


Introduction. Pre-term delivery is one of the leading causes of foetal and perinatal mortality. However, perinatal risk factors associated with intra-partum foetal death in preterm deliveries have not been well studied. Objective. To analyse foetal mortality and perinatal risk factors associated with intra-partum foetal mortality in pregnancies of less than 32 weeks gestational age. Material and methods. The study included all preterm deliveries between 22 and 31 +1 weeks gestational age (WGA), born in a tertiary-referral hospital, over a period of 7 years (2008-2014). A logistic regression model was used to identify perinatal risk factors associated with intra-partum foetal mortality (foetal malformations and chromosomal abnormalities were excluded). Results. During the study period, the overall foetal mortality was 63.1% (106/168) (≥22 weeks of gestation) occurred in pregnancies of less than 32 WGA. A total of 882 deliveries between 22 and 31+6 weeks of gestation were included for analysis. The rate of foetal mortality was 11.3% (100/882). The rate of intra-partum foetal death was 2.6% (23/882), with 78.2% (18/23) of these cases occurring in hospitalised pregnancies. It was found that Assisted Reproductive Techniques, abnormal foetal ultrasound, no administration of antenatal steroids, lower gestational age, and small for gestational age, were independent risk factors associated with intra-partum foetal mortality. Conclusion. This study showed that there is a significant percentage intra-partum foetal mortality in infants between 22 and 31+6 WGA. The analysis of intrapartum mortality and risk factors associated with this mortality is of clinical and epidemiological interest to optimise perinatal care and improve survival of preterm infants (AU)


Assuntos
Humanos , Masculino , Feminino , Gravidez , Recém-Nascido , Adulto , Mortalidade Fetal/tendências , Fatores de Risco , Doenças do Prematuro/epidemiologia , Recém-Nascido Prematuro , Nascimento Prematuro/mortalidade , Modelos Logísticos , Estudos Retrospectivos , Indicadores de Morbimortalidade
18.
Rev Fac Cien Med Univ Nac Cordoba ; 74(4): 386-392, 2017 12 14.
Artigo em Espanhol | MEDLINE | ID: mdl-29902148

RESUMO

Background: It has been observed that the increase in preterm births was accompanied by a decrease in fetal mortality. Objective: To evaluate the relationship between fetal mortality and prematurity in Argentina. Methods: Ecological design. The population included all live births and fetal demise in Argentina between 2003 and 2013. Outcomes: total fetal mortality rate (TFMR), fetal mortality rate by birth weight, fetal mortality rate, neonatal mortality rate, perinatal mortality rate, trends in fetal mortality rates specific for gestational age (GA), and prematurity (<37+ 0 weeks). Independent variables: age (<19 and > 35 years), education <8 years, with partner, parity 1 and > 4, multiple pregnancy and birth rate. Statistical analysis: linear regression analysis adjusted for covariates. Results: TFMR showed an annual reduction of 0.18 per thousand births that decreased with the increase of GA, being the largest reduction below 28+0 weeks (68%), while prematurity increased 0.07% per year, being the largest increase (0.75%) between 32+0 and 36+6 weeks. Linear regression model showed an inverse relationship between TFMR and prematurity (adjusted R2 0.76, p = 0.010), being the highest between 32+0 and 36+6 weeks (adjusted R2 = 0.98, p < 0.001). Conclusions: The reduction in fetal mortality was associated with the observed increase in preterm births in Argentina.


Assuntos
Mortalidade Fetal/tendências , Mortalidade Perinatal/tendências , Nascimento Prematuro/epidemiologia , Adulto , Argentina/epidemiologia , Coeficiente de Natalidade , Feminino , Humanos , Recém-Nascido , Modelos Lineares , Gravidez , Fatores Socioeconômicos , Fatores de Tempo , Adulto Jovem
19.
J Matern Fetal Neonatal Med ; 30(2): 181-185, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26978521

RESUMO

OBJECTIVE: To examine rates of unexplained intrauterine fetal demise (IUFD) and neonatal morbidity in uncomplicated term pregnancies to identify the optimal gestational age for delivery. METHODS: A retrospective case control study was performed with singleton pregnancies delivered between 37 0/7 weeks and 42 6/7 weeks. Exclusion criteria were "complicated pregnancies": emergency deliveries, maternal hypertension, diabetes, infection, fetal disease/malformations and placental abnormalities. RESULTS: Nineteen thousand two hundred and sixty-four maternal/infant pairs were examined. The overall rate of NICU admission was 2.7% and the rate of unexplained IUFD was 2.02 per 1000 births. The lowest rate of IUFD was found at 39 weeks (1.40 per 1000 births). Odds ratios adjusted for maternal smoking, ethnicity, age and mode of delivery showed 2.74 (95% CI 0.35-21.83) risk of IUFD at 42 versus 39 weeks, 2.09 (1.47-2.98) risk of NICU admission at 37 versus 38 weeks, 2.54 (1.62-3.97) risk of respiratory morbidity at 37 versus 38 weeks and 3.38 (1.84-6.18) risk of transient tachypnea of the newborn or respiratory distress syndrome at 37 versus 38 weeks. CONCLUSIONS: Neonatal respiratory morbidity was lowest for deliveries at 38-39 weeks. IUFD was 2.74 times more likely at 42 weeks versus 39 weeks. Our findings support current guidelines advising clinicians when to deliver term pregnancies.


Assuntos
Mortalidade Fetal/tendências , Idade Gestacional , Mortalidade Infantil/tendências , Morte Perinatal , Mortalidade Perinatal , Adulto , Fatores Etários , Parto Obstétrico , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Razão de Chances , Gravidez , Estudos Retrospectivos , Fatores de Tempo
20.
Lancet Glob Health ; 4(2): e98-e108, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26795602

RESUMO

BACKGROUND: Previous estimates have highlighted a large global burden of stillbirths, with an absence of reliable data from regions where most stillbirths occur. The Every Newborn Action Plan (ENAP) targets national stillbirth rates (SBRs) of 12 or fewer stillbirths per 1000 births by 2030. We estimate SBRs and numbers for 195 countries, including trends from 2000 to 2015. METHODS: We collated SBR data meeting prespecified inclusion criteria from national routine or registration systems, nationally representative surveys, and other data sources identified through a systematic review, web-based searches, and consultation with stillbirth experts. We modelled SBR (≥28 weeks' gestation) for 195 countries with restricted maximum likelihood estimation with country-level random effects. Uncertainty ranges were obtained through a bootstrap approach. FINDINGS: Data from 157 countries (2207 datapoints) met the inclusion criteria, a 90% increase from 2009 estimates. The estimated average global SBR in 2015 was 18·4 per 1000 births, down from 24·7 in 2000 (25·5% reduction). In 2015, an estimated 2·6 million (uncertainty range 2·4-3·0 million) babies were stillborn, giving a 19% decline in numbers since 2000 with the slowest progress in sub-Saharan Africa. 98% of all stillbirths occur in low-income and middle-income countries; 77% in south Asia and sub-Saharan Africa. INTERPRETATION: Progress in reducing the large worldwide stillbirth burden remains slow and insufficient to meet national targets such as for ENAP. Stillbirths are increasingly being counted at a local level, but countries and the global community must further improve the quality and comparability of data, and ensure that this is more clearly linked to accountability processes including the Sustainable Development Goals. FUNDING: Save the Children's Saving Newborn Lives programme to The London School of Hygiene & Tropical Medicine.


Assuntos
Mortalidade Fetal/tendências , Saúde Global , Mortalidade Perinatal/tendências , Natimorto/epidemiologia , África ao Sul do Saara/epidemiologia , Ásia/epidemiologia , Feminino , Idade Gestacional , Humanos , Funções Verossimilhança , Gravidez , Incerteza
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