Community-Based Knowledge Translation Strategies for Maternal, Neonatal, and Perinatal Outcomes: A Systematic Review of Quantitative and Qualitative Data.

Objective: To identify and assess the effect of community-based Knowledge Translation Strategies (KTS) on maternal, neonatal, and perinatal outcomes. Methods: We conducted systematic searches in Medline, Embase, CENTRAL, CINAHL, PsycInfo, LILACS, Wholis, Web of Science, ERIC, Jstor, and Epistemonikos. We assessed the certainty of the evidence of the studies using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Results: We identified seven quantitative and seven qualitative studies. Quantitative findings suggest that there is a possible effect on reducing maternal mortality (RR 0.65; 95% CI, 0.48-0.87; moderate evidence certainty); neonatal mortality (RR 0.79; 95% CI 0.70-0.90; moderate evidence certainty); and perinatal mortality (RR 0.84; 95% CI 0.77-0.91; moderate evidence certainty) in women exposed to KTS compared to those who received conventional interventions or no intervention at all. Analysis of qualitative studies identified elements that allowed to generate benefit effects in improving maternal, neonatal, and perinatal outcomes. Conclusion: The KTS in maternal, neonatal, and perinatal outcomes might encourage the autonomy of communities despite that the certainty of evidence was moderate.

Perinatal mortality rate and adverse perinatal outcomes presumably attributable to placental dysfunction in (near) term gestation: A nationwide 5-year cohort study.

INTRODUCTION: Placental dysfunction can lead to perinatal hypoxic events including stillbirth. Unless there is overt severe fetal growth restriction, placental dysfunction is frequently not identified in (near) term pregnancy, particularly because fetal size is not necessarily small. This study aimed to evaluate, among (near) term births, the burden of hypoxia-related adverse perinatal outcomes reflected in an association with birth weight centiles as a proxy for placental function. MATERIAL AND METHOD: A nationwide 5-year cohort of the Dutch national birth registry (PeriNed) including 684,938 singleton pregnancies between 36+0 and 41+6 weeks of gestation. Diabetes, congenital anomalies, chromosomal abnormalities and non-cephalic presentations at delivery were excluded. The main outcome was antenatal mortality rate according to birthweight centiles and gestational age. Secondary outcomes included perinatal hypoxia-related outcomes, including perinatal death and neonatal morbidity, analyzed according to birthweight centiles. RESULTS: Between 2015 and 2019, 1,074 perinatal deaths (0.16%) occurred in the study population (n = 684,938), of which 727 (0.10%) antenatally. Of all antenatal- and perinatal deaths, 29.4% and 27.9% occurred in birthweights below the 10th centile. The incidence of perinatal hypoxia-related outcomes was highest in fetuses with lowest birthweight centiles (18.0%), falling gradually up to the 50th and 90th centile where the lowest rates of hypoxia-related outcomes (5.4%) were observed. CONCLUSION: Perinatal hypoxia-related events have the highest incidence in the lowest birthweight centiles but are identifiable throughout the entire spectrum. In fact, the majority of the adverse outcome burden in absolute numbers occurs in the group with a birthweight above the 10th centile. We hypothesize that in most cases these events are attributable to reduced placental function. Additional diagnostic modalities that indicate placental dysfunction at (near) term gestation throughout all birth weight centiles are eagerly wanted.

Measuring stillbirth and perinatal mortality rates through household surveys: a population-based analysis using an integrated approach to data quality assessment and adjustment with 157 surveys from 53 countries.

BACKGROUND: In most low-income and middle-income countries (LMICs), national surveys are the main data source for stillbirths and perinatal mortality. Data quality issues such as under-reporting and misreporting have greatly limited the usefulness of such data. We aimed to enhance the use of mortality data in surveys by proposing data quality metrics and exploring adjustment procedures to obtain the best possible measure of perinatal mortality. METHODS: We performed a population-based analysis of data from 157 demographic and health surveys (DHSs) from 1990 to 2020, with reproductive calendar and birth history data from 53 LMICs. Pregnancies terminated before 7 months' gestation were excluded. We examined data quality and compared survey values with reference values obtained from a literature review to assess misreporting of the age at early neonatal death, omission and transference of stillbirths, and very early neonatal deaths. Real cohort life-table rates of stillbirth, early neonatal, and perinatal mortality per 1000 births were calculated. The underlying risks of stillbirth and daily deaths were modelled using modified Gompertz-Makeham models. FINDINGS: Data for 2 008 807 pregnancies of ≥7 months' gestational age were extracted from the reproductive calendar for the analysis period. Age heaping at day 7 occurred in most surveys. The median value for the heaping index of deaths at day 7 was 2·05 (IQR 1·36-2·87). The median ratio of stillbirths to deaths on days 0-1 was 1·15 (0·86-1·51). Of the 157 surveys, 23 (15%) were considered to have plausible ratios, 71 (45%) had probable ratios, and 63 (40%) had improbable ratios. The ratio of deaths on days 0-1 to deaths on days 2-6 varied considerably between surveys and 119 surveys (76%) had ratios of less than 2·4, indicative of under-reporting of very early neonatal deaths in most surveys. The fully adjusted model increased the median stillbirth rates from 12·2 (9·4-15·9) to 25·6 (18·0-33·4) per 1000 births, with a median relative increase of 95·0% (56·6-136·6). The median perinatal mortality rate also increased from 32·6 (23·6-38·3) to 44·8 (32·8-58·0) per 1000 births, with a median relative increase of 47·8% (6·9-61·0). INTERPRETATION: A simultaneous focus on stillbirths and early neonatal mortality facilitates a comprehensive assessment of inaccurate reporting in household surveys and allows for better use of surveys in planning and monitoring of efforts to reduce stillbirths and early neonatal mortality. FUNDING: None.

Neonatal and perinatal mortality in the urban continuum: a geospatial analysis of the household survey, satellite imagery and travel time data in Tanzania.

INTRODUCTION: Recent studies suggest that the urban advantage of lower neonatal mortality in urban compared with rural areas may be reversing, but methodological challenges include misclassification of neonatal deaths and stillbirths, and oversimplification of the variation in urban environments. We address these challenges and assess the association between urban residence and neonatal/perinatal mortality in Tanzania. METHODS: The Tanzania Demographic and Health Survey (DHS) 2015-2016 was used to assess birth outcomes for 8915 pregnancies among 6156 women of reproductive age, by urban or rural categorisation in the DHS and based on satellite imagery. The coordinates of 527 DHS clusters were spatially overlaid with the 2015 Global Human Settlement Layer, showing the degree of urbanisation based on built environment and population density. A three-category urbanicity measure (core urban, semi-urban and rural) was defined and compared with the binary DHS measure. Travel time to the nearest hospital was modelled using least-cost path algorithm for each cluster. Bivariate and multilevel multivariable logistic regression models were constructed to explore associations between urbanicity and neonatal/perinatal deaths. RESULTS: Both neonatal and perinatal mortality rates were highest in core urban and lowest in rural clusters. Bivariate models showed higher odds of neonatal death (OR=1.85; 95% CI 1.12 to 3.08) and perinatal death (OR=1.60; 95% CI 1.12 to 2.30) in core urban compared with rural clusters. In multivariable models, these associations had the same direction and size, but were no longer statistically significant. Travel time to the nearest hospital was not associated with neonatal or perinatal mortality. CONCLUSION: Addressing high rates of neonatal and perinatal mortality in densely populated urban areas is critical for Tanzania to meet national and global reduction targets. Urban populations are diverse, and certain neighbourhoods or subgroups may be disproportionately affected by poor birth outcomes. Research must capture, understand and minimise risks specific to urban settings.

Decrease in perinatal mortality after closure of obstetric services in a community hospital in Amsterdam, the Netherlands. A retrospective cohort study.

OBJECTIVE: To assess differences in adverse maternal and neonatal outcomes before and after closure of a secondary obstetric care unit of a community hospital in an urban district. STUDY DESIGN: Retrospective cohort study using aggregated data from National Perinatal Registry of the Netherlands (PERINED) in the very urban region of Amsterdam, consisting of data of five secondary and two tertiary hospitals. We assessed maternal and neonatal outcomes in singleton hospital births between 24+0 weeks of gestational age (GA) up to 42+6 weeks. Data of 78.613 births were stratified in two groups: before closure (years 2012-2015) and after closure (2016-2019). RESULTS: Perinatal mortality decreased significantly from 0.84 % to 0.63 % (p = 0.0009). The adjusted odds ratio (aOR) of the closure on perinatal mortality was 0.73 (95 % CI 0.62-0.87). Both antepartum death (0.46 % vs 0.36 %, p = 0.02) and early neonatal death (0.38 % vs 0.28 %, p = 0.015) declined after closure of the hospital. The number of preterm births decreased significantly (8.7 % vs 8.1 %, p=<0.007) as well as number of neonates with congenital abnormalities (3.2 % vs2.2 %, p=<0.0001). APGAR < 7 after 5 min increased (2.3 % vs 2.5 %, p = 0.04). There was no significant difference in SGA or NICU admission. Postpartum hemorrhage increased significantly from 7.7 % to 8.2 % (p=<0.003). Perinatal mortality from 32 weeks onwards was not significantly different after closure 0.29 % to 0.27 %. CONCLUSIONS: After closure of an obstetric unit in a community hospital in Amsterdam, there was a significant decrease in perinatal, intrapartum and early neonatal mortality in neonates born from 24+0 onwards. The mortality decrease coincides with a reduction of preterm deliveries. The increasing trend in asphyxia and postpartum hemorrhage is of concern.. Centralization of care and increasing birth volume per hospital may lead to improvement of quality of care. A broad integrated, multidisciplinary maternity healthcare system linked with the social domain can achieve health gains in maternity care for all women.

COVID-19 en la mortalidad materna, perinatal y neonatal de cuatro localidades de Bogotá. Estudio descriptivo / COVID-19 in maternal, perinatal and neonatal mortality in four locations in Bogotá. Descriptive study

Fundamentos: Los múltiples efectos de la pandemia por la COVID-19 se empiezan a ver a partir de la alteración de las cifrasde estadísticas vitales. Esto se resume en cambios en las causas de muertes habituales y el exceso de mortalidad atribuible, lo quefinalmente se puede ver en modificaciones estructurales de las poblaciones de los países. Por esta razón se crea esta investigaciónque tuvo como objetivo determinar el impacto de la pandemia de COVID-19 sobre la mortalidad materna, perinatal y neonatal encuatro localidades de Bogotá D.C. (Colombia).Métodos: Se realizó una investigación de tipo longitudinal retrospectiva en el que se analizaron 217.419 datos de mortalidades laslocalidades de Kennedy, Fontibón, Bosa y Puente Aranda de la ciudad de Bogotá - Colombia ocurridas entre los años 2018 a 2021, de loscuales se determinaron las muertes maternas (54), perinatales (1.370) y neonatales (483) a fin de identificar antecedente de infecciónpor SARS-CoV-2 que pudiera estar relacionada con el exceso de mortalidad asociada a la COVID-19. Los datos fueron recopilados delos registros abiertos de estadísticas vitales del Departamento Nacional de Estadística (DANE), en donde fueron analizados a partirde medidas de frecuencias o tendencia central y dispersión de acuerdo con los tipos de variables. Se calcularon los indicadores demortalidad específicos relacionados con los eventos de muerte materna, perinatal y neonatal.Resultados: Se evidenció una disminución en la mortalidad perinatal y neonatal desde el año 2020, la cual estuvo asociada a ladisminución progresiva de embarazos en esos mismos años; de forma adicional se observó un aumento considerable de las muertesmaternas para 2021 con respecto a los demás años analizados. La proporción de las muertes maternas en 2020 y 2021 en un 10% y17%, respectivamente, se atribuyeron a la COVID-19.Conclusiones: Se observa que la tendencia de la mortalidad materna está relacionada con el aumento de la mortalidad...(AU)

Background: The multiple effects of the COVID-19 pandemic are beginning to be seen from the alteration of vital statisticsfigures. This is summarized in changes in the usual causes of death and excess attributable mortality, which can finally be seen instructural changes in the populations of the countries. For this reason, this research was created with the objective of determining theimpact of the COVID-19 pandemic on maternal, perinatal and neonatal mortality in four locations in Bogotá D.C. (Colombia).Methods: A retrospective longitudinal investigation was carried out in which 217,419 mortality data were analyzed in the towns ofKennedy, Fontibón, Bosa and Puente Aranda in the city of Bogotá - Colombia that occurred between the years 2018 to 2021, of whichmaternal (54), perinatal (1,370) and neonatal (483) deaths in order to identify a history of SARS-CoV-2 infection that could be related tothe excess mortality associated with COVID-19. The data were collected from the open records of vital statistics of the National StatisticsDepartment (DANE), where they were analyzed from frequency measures or central tendency and dispersion according to the types ofvariables. The specific mortality indicators related to maternal, perinatal and neonatal death events were calculated.Results: A decrease in perinatal and neonatal mortality was evidenced since 2020, which was associated with the progressive de-crease in pregnancies in those same years; Additionally, a considerable increase in maternal deaths was observed for 2021 compared tothe other years analyzed. The proportion of maternal deaths in 2020 and 2021 by 10% and 17%, respectively, were attributed to COVID-19.Conclusions: It is observed that the trend of maternal mortality is related to the increase in mortality from COVID-19, maternaldeaths associated with COVID-19 occurred specifically in the zonal planning units that registered more than 160 cases of COVID-19for the year 2021.(AU)

Impact of the EURO-PERISTAT Reports on obstetric management: a difference-in-regression-discontinuity analysis.

BACKGROUND: Population health monitoring, such as perinatal mortality and morbidity rankings published by the European Perinatal Health (EURO-PERISTAT) reports may influence obstetric care providers' decision-making and professional behaviour. We investigated short-term changes in the obstetric management of singleton term deliveries in the Netherlands following publication of the EURO-PERISTAT reports in 2003, 2008 and 2013. METHODS: We used a quasi-experimental difference-in-regression-discontinuity approach. National perinatal registry data (2001-15) was used to compare obstetric management at delivery in four time windows (1, 2, 3 and 5 months) surrounding publication of each EURO-PERISTAT report. RESULTS: The 2003 EURO-PERISTAT report was associated with higher relative risks (RRs) for an assisted vaginal delivery across all time windows [RR (95% CI): 1 month: 1.23 (1.05-1.45), 2 months: 1.15 (1.02-1.30), 3 months: 1.21 (1.09-1.33) and 5 months: 1.21 (1.11-1.31)]. The 2008 report was associated with lower RRs for an assisted vaginal delivery at the 3- and 5-month time windows [0.86 (0.77-0.96) and 0.88 (0.81-0.96)]. Publication of the 2013 report was associated with higher RRs for a planned caesarean section across all time windows [1 month: 1.23 (1.00-1.52), 2 months: 1.26 (1.09-1.45), 3 months: 1.26 (1.12-1.42) and 5 months: 1.19(1.09-1.31)] and lower RRs for an assisted vaginal delivery at the 2-, 3- and 5-month time windows [0.85 (0.73-0.98), 0.83 (0.74-0.94) and 0.88 (0.80-0.97)]. CONCLUSIONS: This study showed that quasi-experimental study designs, such as the difference-in-regression-discontinuity approach, are useful to unravel the impact of population health monitoring on decision-making and professional behaviour of healthcare providers. A better understanding of the contribution of health monitoring to the behaviour of healthcare providers can help guide improvements within the (perinatal) healthcare chain.

2008 economic crisis impact on perinatal and infant mortality in Southern European countries.

INTRODUCTION: The study of crisis events provides important lessons to prepare for upcoming events. The Great Recession's impact on perinatal health in Europe can provide relevant insights into the healthcare and social protection systems' response to the protection of the health of the most vulnerable groups. OBJECTIVE: To assess time trends and international disparities in perinatal mortality rates (PMR) and infant mortality rates (IMR), following the Great Recession, and their association with socioeconomic indicators in Portugal, Greece, Italy and Spain. METHODS: Associations were assessed through generalised linear models for all four countries. A Poisson joinpoint regression model was applied to explore PMR and IMR trend changes between 2000 and 2018. Country disparities were analysed using mixed-effects multilevel models. RESULTS: IMR and PMR have decreased overall in the four selected countries between 2000 and 2018. Still, whereas in Spain, Italy and Portugal the decreasing pace was attenuated after 2009, in Greece a positive trend was found after the 2008 crisis. IMR and PMR were significantly associated with socioeconomic indicators in all four countries. National disparities in the evolution of IMR and PMR were significantly associated with most socioeconomic indicators between 2000 and 2018. CONCLUSION: Our results confirm the impact of the Great Recession on PMR and IMR trends in all four countries, taking recurring associations between macroeconomic cycles, variations in mortality trends, macroeconomic volatility and stagnation of IMR and PMR into account. The association with socioeconomic indicators stresses the need to strengthen social protection and healthcare systems to better protect the population's health from the earliest days.

Determinants of perinatal mortality at tertiary hospitals in East Wollega, Western Ethiopia: a case-control study.

OBJECTIVE: This study was performed to determine predisposing factors of perinatal mortality among deliveries at tertiary hospitals in East Wollega, Western Ethiopia. METHODS: This institutional-based unmatched retrospective case-control study involved 810 samples (270 perinatal deaths and 540 controls) selected from the study hospitals. For each case, two controls were selected. Data were collected using a pretested structured questionnaire. Data were entered into EpiData Version 3.1 and exported to SPSS Version 25 for analysis. Descriptive analysis and logistic regression were performed. The adjusted odds ratio with 95% confidence interval was calculated, and statistical significance was declared at a P-value of <0.05. RESULTS: The statistical analysis revealed the following independent determinants of perinatal mortality: rural residence, lack of antenatal care, preterm delivery, induction of labor, presence of obstetric complications, breech presentation, shoulder presentation, low birth weight, congenital malformation, and not using a partograph. CONCLUSION: Given the determinant factors of perinatal mortality in the study area, health facilities are recommended to implement appropriate antenatal care, intrapartum care, and neonatal care to prevent perinatal mortality. They are also advised to use partographs and ensure better access to antenatal care facilities.

A comprehensive methodology report for maternity and perinatal mortality research in the New Zealand Integrated Data Infrastructure.

AIM: The highest quality perinatal data in New Zealand is collected and collated by the Perinatal and Maternal Mortality Review Committee (PMMRC) and is made available to a limited number of researchers. Therefore, maternity, and perinatal mortality studies are generally performed on Government-held data. This report offers an alternative approach with in-depth justification for the methodology, while simultaneously improving the understanding of the data sources. METHOD: A standardised method for creating a comprehensive maternity dataset within the Statistics New Zealand Integrated Data Infrastructure (IDI) was developed and a validation dataset was created to include all births between 2008 and 2017. RESULTS: A close approximation to the PMMRC annual report data was found, with 4.0% over-reporting of perinatal deaths and 0.05% over-reporting of live births in the IDI dataset. Several variables, including important pregnancy risk factors, were validated for use. Limitations to the datasets were explored and additional tables in the IDI were proposed, to include variables on pregnancy complications, ethnicity and country of birth, and socio-economic data. CONCLUSION: This methodological report describes an opportunity for standardised, high-quality maternity research in New Zealand using the IDI, including a variety of national data sources. Recommendations for further enhancement of these resources have been offered.

Effectiveness evaluation of an antenatal care intervention addressing disparities to improve perinatal outcomes in Denmark: A nationwide register-based analysis of a cluster randomised controlled trial (MAMAACT).

OBJECTIVE: To evaluate whether MAMAACT, an antenatal care (ANC) intervention, aimed at reducing ethnic and social disparities in perinatal mortality, affected perinatal health outcomes. DESIGN: Cluster randomised controlled trial. SETTING: Nineteen of 20 maternity wards in Denmark. POPULATION: All newborn children within a pre-implementation period (2014-2017) or an implementation period (2018-2019) (n = 188 658). INTERVENTION: A 6-h training session for midwives in intercultural communication and cultural competence, two follow-up dialogue meetings, and health education materials for pregnant women on warning signs of pregnancy complications in six languages. METHODS: Nationwide register-based analysis of the MAMAACT cluster randomised controlled trial. Mixed-effects logistic regression models were used to estimate the change in outcomes from pre- to post-implementation in the intervention group relative to the control group. Results were obtained for the overall study population and for children born to immigrants from low- to middle-income countries, separately. Models were adjusted for confounders selected a priori. MAIN OUTCOME MEASURES: A composite perinatal mortality and morbidity outcome, including stillbirths, neonatal deaths, Apgar score <7, umbilical arterial pH < 7.0, admissions to a neonatal intensive care unit (NICU) >48 h, and NICU admissions for mechanical ventilation. Additional outcomes were the individual measures. RESULTS: The intervention increased the risk of the composite outcome (adjusted odds ratio [aOR] 1.16, 95% confidence interval [CI] 0.99-1.34), mainly driven by differences in NICU admission risk (composite outcome excluding NICU, aOR 0.98, 95% CI 0.84-1.14). The intervention slightly increased the risk of low Apgar score and decreased the risk of low arterial pH, reflecting, however, small differences in absolute numbers. Other outcomes were unchanged. CONCLUSIONS: Overall, the MAMAACT intervention did not improve the composite perinatal mortality and morbidity outcome (when excluding NICU admissions). The lack of effects may be due to contextual factors including organisational barriers in ANC hindering the midwives from changing practices.

The challenges of selective fertility and carryover effects in within-sibship analyses: the effect of assisted reproductive technology on perinatal mortality as an example.

BACKGROUND: Within-sibship analyses show lower perinatal mortality after assisted reproductive technology (ART) compared with natural conception (NC), a finding that appears biologically unlikely. We investigated whether this may be attributed to bias from selective fertility and carryover effects. METHODS: Using data from national registries in Denmark (1994-2014), Finland (1990-2014) and Norway and Sweden (1988-2015), we studied 5 722 826 singleton pregnancies, including 119 900 ART-conceived and 37 590 exposure-discordant sibships. Perinatal mortality at the population level and within sibships was compared using multilevel logistic regression with random and fixed intercepts, respectively. We estimated selective fertility as the proportion of primiparous women with and without perinatal loss who had a second delivery, and carryover effects through bidirectional and crosswise associations. RESULTS: Population analysis showed higher perinatal mortality among ART conception compared with NC (odds ratio 1.21, 95% CI 1.13 to 1.30), whereas within-sibship analysis showed the opposite (OR 0.36, 95% CI 0.31 to 0.43). Primiparous women with perinatal loss were more likely to give birth again (selective fertility) and to use ART in this subsequent pregnancy (carryover effects), resulting in strong selection of double-discordant sibships with death of the naturally conceived and survival of the ART-conceived sibling. After controlling for conception method and outcome in the first pregnancy, ART was not consistently associated with perinatal mortality in the second pregnancy. CONCLUSIONS: Whereas population estimates may be biased by residual confounding, within-sibship estimates were biased by selective fertility and carryover effects. It remains unclear whether ART conception contributes to perinatal mortality.

Biochemical factors affecting newborn survival in dogs and cats.

The importance and implications of small animal neonatology were underestimated until recent times. Despite the recent increasing interest for this branch of veterinary medicine, however, perinatal mortality rates in canine and feline species remain high, representing an important challenge for the clinician. In this perspective, the prompt identification of newborns requiring additional and tailored assistance becomes a key to reduce the perinatal losses in small animals. To achieve this goal, clinical and laboratory findings must be carefully evaluated. This paper focuses on biochemical parameters and their reported influence on neonatal survival, guiding through the evaluation of canine and feline newborn laboratory analyses, with a thorough discussion about the use of different biological material in these subjects. Beside blood, other biological material, such as urines and fetal fluids proved to be interesting for the identification of possible prognostic markers, thanks also to their easy and safe collection. However, the correct reading-through the results must consider many variables such as type of delivery, anesthesia protocol in case of Caesarean section, age of the newborn at samples collection, and for blood analysis, also the type of blood, site of collection, modality of collection and storage must be considered. Notwithstanding the recent progress in literature, for most of the parameters more research is needed to define cut-off values with certainty.

Pregnancy and parturition in dromedary camels III. Incidence, timing and factors affecting abortions and perinatal mortality under intensive management.

In this study, the incidence, timing and risk factors associated with abortion and perinatal mortality (PM) were described in dromedary camels under intensive management. In addition, overall pregnancy losses were also summarized and weekly risk of pregnancy wastage was determined throughout gestation. Data were collected over 11 breeding seasons from September 2006 through June 2017 at the world's largest camel dairy farm. A total of 229 abortions were observed (5.05%) out of 4533 pregnancies after 60 days (d) of gestation. Most abortions were singleton (n = 199, 86.9%), but twin abortions were also recorded in 30 cases (13.1%). Abortions showed a pronounced seasonal distribution, with a peak in August. The age category (P < 0.01), breed or ecotype of the female (P < 0.05) and bull influenced the occurrence of singleton abortions. Dromedaries with twins tended to abort earlier than those with a singleton fetus (median = 232.5 d vs. 257 d, P = 0.053). Perinatal mortality was observed in 174 cases (3.84%) out of 4533 pregnancies after 60 d of gestation. The condition included the premature birth of non-viable calves after shorter than normal gestation (330-350 d, n = 26, 14.9%), the birth of well-developed but dead calves after normal gestation length (n = 120, 69.0%) and neonates that died within 48 h after delivery (n = 28, 16.1%). The frequency distribution of PM was parallel with that of parturitions. The most important predisposing factor for PM was difficult calving. Thirty-nine percent (68 out of 174) of these losses were associated with dystocia. In addition, age category (P < 0.05) and parity of the female (P < 0.01), month of delivery (P < 0.05) and breeding season (P < 0.05) also affected the incidence of PM. The cause of 60 cases of PM (1.4% of all deliveries) could not be determined and was considered idiopathic. In conclusion, one-third of total pregnancy losses occurred during mid to late gestation. Approximately 10% of pregnancies after Day 60 failed, and 90% resulted in the birth of a live calf that survived beyond 48 h. More than half of these pregnancy losses were abortions before 330 d of gestation, and approximately 40% were classified as PM. The weekly mean risk of pregnancy loss after 100 d of gestation remained only a fraction of that observed during the first 2-3 months.

Preterm and term pre-eclampsia: Relative burdens of maternal and perinatal complications.

OBJECTIVE: To determine the relative burdens of maternal and perinatal complications for preterm and term pre-eclampsia. DESIGN: Prospective observational cohort study. SETTING: Two English maternity units. POPULATION: Unselected women with singleton pregnancies who developed pre-eclampsia (International Society for the Study of Hypertension in Pregnancy definition). METHODS: Outcomes were ascertained by health record review and compared between pregnancies with preterm (versus term) pre-eclampsia. MAIN OUTCOME MEASURES: Severe maternal hypertension, maternal mortality or major maternal morbidity, perinatal mortality or major neonatal morbidity, neonatal unit (NNU) admission ≥48 hours, and birthweight <3rd percentile. RESULTS: Among 40 241 singleton pregnancies, 298 (0.7%, 95% confidence interval [CI] 0.66-0.83) and 1194 (3.0%, 95% CI 2.8-3.1) developed preterm and term pre-eclampsia, respectively. Women with preterm (versus term) pre-eclampsia more commonly experienced adverse maternal or perinatal events: severe hypertension 18.5% (95% CI 14.5-23.3) versus 13.6% (95% CI 11.7-15.6); maternal mortality/major morbidity 7.4% (95% CI 4.9-10.9) versus 2.2% (95% CI 1.5-3.2); perinatal mortality/major neonatal morbidity 29.5% (95% CI 24.6-34.9) versus 2.2% (95% CI 1.5-3.2); and birthweight <3rd percentile 54.4% (95% CI 48.7-59.9) versus 14.2% (95% CI 12.4-16.3). However, in absolute terms, most maternal complications occurred in women with term pre-eclampsia, as did a large proportion of perinatal complications: severe hypertension 74.7% (95% CI 68.5-80.0); maternal mortality/major morbidity 54.2% (95% CI 40.3-67.4); perinatal mortality/major neonatal morbidity 22.8% (95% CI 16.1-31.3); NNU admission ≥48 hours 38.1% (95% CI 32.4-44.1); and birthweight <3rd percentile 51.2% (95% CI 45.8-56.5). CONCLUSIONS: Although adverse event risks are greater with preterm (versus term) pre-eclampsia, term disease is associated with at least equivalent total numbers of maternal, and a significant proportion of perinatal, adverse events. Increased efforts should be made to decrease the incidence of term pre-eclampsia.

Predicting perinatal mortality based on maternal health status and health insurance service using homogeneous ensemble machine learning methods.

BACKGROUND: Perinatal mortality in Ethiopia is the highest in Africa, with 68 per 1000 pregnancies intrapartum deaths. It is mainly associated with home delivery, which contributes to more than 75% of perinatal deaths. Financial constraints significantly impact timely access to maternal health care. Financial incentives, such as health insurance, may address the demand- and supply-side factors. This study, hence, aims to predict perinatal mortality based on maternal health status and health insurance service using homogeneous ensemble machine learning methods. METHODS: The data was collected from the Ethiopian demographic health survey from 2011 to 2019 G.C. The data were pre-processed to get quality data that are suitable for the homogenous ensemble machine-learning algorithms to develop a model that predicts perinatal mortality. We have applied filter (chi-square and mutual information) and wrapper (sequential forward and sequential backward) feature selection methods. After selecting all the relevant features, we developed a predictive model using cat boost, random forest, and gradient boosting algorithms and evaluated the model using both objective (accuracy, precision, recall, F1_score, ROC) and subjective (domain expert) based evaluation techniques. RESULTS: Perinatal mortality prediction models were developed using random forest, gradient boosting, and cat boost algorithms with the overall accuracy of 89.95%, 90.24%, and 82%, respectively. Risk factors of perinatal mortality were identified using feature importance analysis and relevant rules were extracted using the best performing model. CONCLUSIONS: A prediction model that was developed using gradient boosting algorithms was selected for further use in the risk factor analysis, generating relevant rules, development of artifacts, and model deployment because it has registered better performance with 90.24% accuracy. The most determinant risk factors of perinatal mortality were identified using feature importance and some of them are community-based health insurance, mother's educational level, region and place of residence, age, wealth status, birth interval, preterm, smoking cigarette, anemia level, hemoglobin level, and marital status.

Does hospital variation in intrapartum-related perinatal mortality among caesarean births reflect differences in quality of care? Cross-sectional study in 21 hospitals in Burkina Faso.

OBJECTIVES: To examine hospital variation in crude and risk-adjusted rates of intrapartum-related perinatal mortality among caesarean births. DESIGN: Secondary analysis of data from the DECIDE (DECIsion for caesarean DElivery) cluster randomised trial postintervention phase. SETTING: 21 district and regional hospitals in Burkina Faso. PARTICIPANTS: All 5134 women giving birth by caesarean section in a 6-month period in 2016. PRIMARY OUTCOME MEASURE: Intrapartum-related perinatal mortality (fresh stillbirth or neonatal death within 24 hours of birth). RESULTS: Almost 1 in 10 of 5134 women giving birth by caesarean experienced an intrapartum-related perinatal death. Crude mortality rates varied substantially from 21 to 189 per 1000 between hospitals. Variation was markedly reduced after adjusting for case mix differences (the median OR decreased from 1.9 (95% CI 1.5 to 2.5) to 1.3 (95% CI 1.2 to 1.7)). However, higher and more variable adjusted mortality persisted among hospitals performing fewer caesareans per month. Additionally, adjusting for caesarean care components did not further reduce variation (median OR=1.4 (95% CI 1.2 to 1.8)). CONCLUSIONS: There is a high burden of intrapartum-related perinatal deaths among caesarean births in Burkina Faso and sub-Saharan Africa more widely. Variation in adjusted mortality rates indicates likely differences in quality of caesarean care between hospitals, particularly lower volume hospitals. Improving access to and quality of emergency obstetric and newborn care is an important priority for improving survival of babies at birth. TRIAL REGISTRATION NUMBER: ISRCTN48510263.

Negative effects of short birth interval on child mortality in low- and middle-income countries: A systematic review and meta-analysis.

Methods: Eight databases, PubMed, CINAHL, Web of Science, Embase, PsycINFO, Cochrane Library, Popline, and Maternity and Infant Care, were searched, covering the period of January 2000 to January 2022. Studies that had examined the association between SBI and any form of child mortality were included. The findings of the included studies were summarized through fixed-effects or random-effects meta-analysis and the model was selected based on the heterogeneity index. Results: A total of 51 studies were included. Of them, 19 were conducted in Ethiopia, 10 in Nigeria and 7 in Bangladesh. Significant higher likelihoods of stillbirth (odds ratio (OR) = 2.11; 95% confidence interval (CI) = 1.32-3.38), early neonatal mortality (OR = 1.58; 95% CI = 1.04-2.41), perinatal mortality (OR = 1.71; 95% CI = 1.32-2.21), neonatal mortality (OR = 1.85; 95% CI = 1.68-2.04), post-neonatal mortality (OR = 3.01; 95% CI = 1.43-6.33), infant mortality (OR = 1.92; 95% CI = 1.77-2.07), child mortality (OR = 1.67; 95% CI = 1.27-2.19) and under-five mortality (OR = 1.95; 95% CI = 1.56-2.44) were found among babies born in short birth intervals than those who born in normal intervals. Conclusions: SBI significantly increases the risk of child mortality in LMICs. Programmes to reduce pregnancies in short intervals need to be expanded and strengthened. Reproductive health interventions aimed at reducing child mortality should include proper counselling on family planning, distribution of appropriate contraceptives and increased awareness of the adverse effects of SBI on maternal and child health.

Evaluating the impact of maternal health care policy on stillbirth and perinatal mortality in Ghana; a mixed method approach using two rounds of Ghana demographic and health survey data sets and qualitative design technique.

BACKGROUND: Stillbirth and perinatal mortality issues continue to receive inadequate policy attention in Ghana despite government efforts maternal health care policy intervention over the years. The development has raised concerns as to whether Ghana can achieve the World Health Organization target of 12 per 1000 live births by the year 2030. PURPOSE: In this study, we compared stillbirth and perinatal mortality between two groups of women who registered and benefitted from Ghana's 'free' maternal health care policy and those who did not. We further explored the contextual factors of utilization of maternal health care under the 'free' policy to find explanation to the quantitative findings. METHODS: The study adopted a mixed method approach, first using two rounds of Ghana Demographic and Health Survey data sets, 2008 and 2014 as baseline and end line respectively. We constructed outcome variables of stillbirth and perinatal mortality from the under 5 mortality variables (n = 487). We then analyzed for association using multiple logistics regression and checked for sensitivity and over dispersion using Poisson and negative binomial regression models, while adjusting for confounding. We also conducted 23 in-depth interviews and 8 focus group discussions for doctors, midwives and pregnant women and analyzed the contents of the transcripts thematically with verbatim quotes. RESULTS: Stillbirth rate increased in 2014 by 2 per 1000 live births. On the other hand, perinatal mortality rate declined within the same period by 4 per 1000 live births. Newborns were 1.64 times more likely to be stillborn; aOR: 1.64; 95% [CI: 1.02, 2.65] and 2.04 times more likely to die before their 6th day of life; aOR: 2.04; 95% [CI: 1.28, 3.25] among the 'free' maternal health care policy group, compared to the no 'free' maternal health care policy group, and the differences were statistically significant, p< 0.041; p< 0.003, respectively. Routine medicines such as folic acid and multi-vitamins were intermittently in short supply forcing private purchase by pregnant women to augment their routine requirement. Also, pregnant women in labor took in local concoction as oxytocin, ostensibly to fast track the labor process and inadvertently leading to complications of uterine rapture thus, increasing the risk of stillbirths. CONCLUSION: Even though perinatal mortality rate declined overall in 2014, the proportion of stillbirth and perinatal death is declining slowly despite the 'free' policy intervention. Shortage of medicine commodities, inadequate monitoring of labor process coupled with pregnant women intake of traditional herbs, perhaps explains the current rate of stillbirth and perinatal death.