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1.
Arch Dis Child ; 106(10): 946-953, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34475107

RESUMO

OBJECTIVE: This study is part of the Global Maternal Sepsis Study (GLOSS). It aimed to estimate neonatal near-miss (NNM) and perinatal death frequency and maternal risk factors among births to women with infection during pregnancy in low-income and middle-income countries (LMIC). DESIGN: We conducted a 1-week inception hospital-based cohort study. SETTING: The study was carried out in 408 hospitals in 43 LMIC of all the WHO regions in 2017. PATIENTS: We included women with suspected or confirmed infection during pregnancy with at least 28 weeks of gestational age up to day-7 after birth. All babies born to those women were followed from birth until the seventh day after childbirth. Perinatal outcomes were considered at the end of the follow-up. MAIN OUTCOME MEASURES: Perinatal outcomes were (i) babies alive without severe complication, (ii) NNM and (iii) perinatal death (stillbirth and early neonatal death). RESULTS: 1219 births were analysed. Among them, 25.9% (n=316) and 10.1% (n=123) were NNM and perinatal deaths, respectively. After adjustment, maternal pre-existing medical condition (adjusted odds ratios (aOR)=1.5; 95% CI 1.1 to 2.0) and maternal infection suspected or diagnosed during labour (aOR=1.9; 95% CI 1.2 to 3.2) were the independent risk factors of NNM. Maternal pre-existing medical condition (aOR=1.7; 95% CI 1.0 to 2.8), infection-related severe maternal outcome (aOR=3.8; 95% CI 2.0 to 7.1), mother's infection suspected or diagnosed within 24 hours after childbirth (aOR=2.2; 95% CI 1.0 to 4.7) and vaginal birth (aOR=1.8; 95% CI 1.1 to 2.9) were independently associated with increased odds of perinatal death. CONCLUSIONS: Overall, one-third of births were adverse perinatal outcomes. Pre-existing maternal medical conditions and severe infection-related maternal outcomes were the main risk factors of adverse perinatal outcomes.


Assuntos
Países em Desenvolvimento/estatística & dados numéricos , Near Miss/estatística & dados numéricos , Mortalidade Perinatal , Complicações Infecciosas na Gravidez , Natimorto/epidemiologia , Adulto , Comorbidade , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Nascido Vivo/epidemiologia , Parto , Morte Perinatal/etiologia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Estudos Prospectivos , Fatores de Risco , Vagina , Adulto Jovem
2.
Biomed Res Int ; 2021: 5254997, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34435044

RESUMO

In this study, we aimed to document adverse pregnancy outcomes and maternal complications among pregnant women who acquired asymptomatic bacteriuria in Addis Ababa, Ethiopia. We used hospital-based prospective cohort study design in which we followed 44 pregnant women with asymptomatic bacteriuria confirmed by urine culture result of ≥105cfu/ml of urine. We documented adverse pregnancy outcomes and maternal complications in terms of frequency, percentage, mean, and standard deviation. Additionally, we used Pearson's correlation coefficient to investigate associations of selected variables with perinatal death as one of adverse pregnancy outcomes. Of the 44 pregnant women enrolled in the study, complete data was collected from 43 participants with one lost to follow-up. Six (14%) of women developed fever and were treated with antibiotic during pregnancy, 26 (60.5%) delivered with cesarean section, two (4.3%) perinatal deaths within seven days of delivery, one miscarriage, and 4 (9.3%) newborns were found underweight. The mean birth weight of the newborns was 3.1 kg ± 0.60. Almost half 21(48.8%) were born before 37 weeks of gestational age. Fourteen (32.6%) of newborns were born asphyxiated. Twenty-two (51.2%) of newborns developed early neonatal fever within 48 hours of delivery and treated with antibiotic. Correlation coefficient analysis revealed that weight and gestational age of newborns at birth, Apgar score at 1st and 5th minutes of birth and miscarriage were positively correlated and significantly associated with perinatal death. The occurrence of unsought pregnancy outcomes were frequent, and substantial number of pregnant women developed maternal complications. Therefore, screening pregnant women for asymptomatic bacteriuria and treating may reduce the possible maternal complications and adverse pregnancy outcomes.


Assuntos
Bacteriúria/microbiologia , Bacteriúria/patologia , Morte Perinatal/etiologia , Complicações Infecciosas na Gravidez/microbiologia , Complicações Infecciosas na Gravidez/patologia , Resultado da Gravidez , Adolescente , Adulto , Bacteriúria/epidemiologia , Bacteriúria/urina , Peso ao Nascer , Cesárea , Etiópia/epidemiologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Pessoa de Meia-Idade , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/urina , Estudos Prospectivos , Adulto Jovem
4.
Placenta ; 112: 97-104, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34329973

RESUMO

INTRODUCTION: Pregnant women with covid-19 are more likely to experience preterm birth. The virus seems to be associated with a wide range of placental lesions, none of them specific. METHOD: We collected cases of Covid-19 maternal infection during pregnancy associated with poor pregnancy outcomes, for which we received the placenta. We studied clinical data and described pathological findings of placenta and post-mortem examination of fetuses. We performed an immunohistochemical study and RT-PCR of SARS-Cov-2 on placenta samples. RESULTS: We report 5 cases of poor fetal outcome, 3 fetal deaths and 2 extreme premature neonates, one with growth restriction, without clinical and biological sign of SARS-Cov-2 infection. All placenta presented massive perivillous fibrin deposition and large intervillous thrombi associated with strong SARS-Cov-2 expression in trophoblast and SARS-CoV-2 PCR positivity in amniotic fluid or on placenta samples. Chronic histiocytic intervillositis was present in 4/5 cases. Placental ultrasound was abnormal and the sFLT1-PIGF ratio was increased in one case. Timing between mothers' infection and the poor fetal outcome was ≤10 days in 4 cases. The massive placental damage are directly induced by the virus whose receptors are expressed on trophoblast, leading to trophoblast necrosis and massive inflammation in villous chamber, in a similar way it occurs in diffuse alveolar damage in adults infected by SARS-Cov-2. DISCUSSION: SARS-Cov-2 can be associated to a rare set of placental lesions which can lead to fetal demise, preterm birth, or growth restriction. Stronger surveillance of mothers infected by SARS-Cov-2 is required.


Assuntos
COVID-19/complicações , Doenças Placentárias/etiologia , Nascimento Prematuro/etiologia , Natimorto , Adulto , COVID-19/diagnóstico , COVID-19/patologia , Feminino , Morte Fetal/etiologia , França , Humanos , Recém-Nascido , Masculino , Morte Perinatal/etiologia , Placenta/patologia , Placenta/virologia , Doenças Placentárias/diagnóstico , Doenças Placentárias/patologia , Doenças Placentárias/virologia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/patologia , Resultado da Gravidez , Nascimento Prematuro/patologia , Nascimento Prematuro/virologia , SARS-CoV-2/fisiologia , Trofoblastos/patologia , Trofoblastos/virologia
6.
Aust N Z J Obstet Gynaecol ; 61(4): 540-547, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33792893

RESUMO

BACKGROUND: Stillbirth rates have shown little improvement for two decades in Australia. Perinatal mortality audit is key to prevention, but the literature suggests that implementation is suboptimal. AIM: To determine the proportion of perinatal deaths which are associated with contributing factors relating to care in Queensland, Australia. MATERIALS AND METHODS: Retrospective audit of perinatal deaths ≥ 34 weeks gestation by the Health Department in Queensland was undertaken. Cases and demographic information were obtained from the Queensland Perinatal Data Collection. A multidisciplinary panel used the Perinatal Society of Australia and New Zealand (PSANZ) perinatal mortality audit guidelines to classify the cause of death and to identify contributing factors. Contributing factors were classified as 'insignificant', 'possible', or 'significant'. RESULTS: From 1 January to 31 December 2018, 65 deaths (56 stillbirths and nine neonatal deaths) were eligible and audited. Most deaths were classified as unexplained (51.8% of stillbirths). Contributing factors were identified in 46 (71%) deaths: six insignificant (all stillbirths), 20 possibly related to outcome (17 stillbirths), and 20 significantly (16 stillbirths). Areas for practice improvements mainly related to the care for women with risk factors for stillbirth, especially antenatal care. The PSANZ guidelines were applied and enabled a systematic approach. CONCLUSIONS: A high proportion of late gestation perinatal deaths are associated with contributing factors relating to care. Improving antenatal care for women with risk factors for stillbirth is a priority. Perinatal mortality audit is a valuable step in stillbirth prevention and the PSANZ guidelines allow a systematic approach to aid implementation and reporting.


Assuntos
Morte Perinatal , Causas de Morte , Feminino , Humanos , Recém-Nascido , Morte Perinatal/etiologia , Morte Perinatal/prevenção & controle , Mortalidade Perinatal , Gravidez , Estudos Retrospectivos , Natimorto/epidemiologia
7.
Taiwan J Obstet Gynecol ; 60(2): 355-358, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33678342

RESUMO

OBJECTIVE: We reported a fetus that presenting with persistent left superior vena cava (PLSVC), polyhydramnios, and a small gastric bubble during prenatal examination and identified VACTERL association after birth. CASE REPORT: A 34-year-old woman underwent amniocentesis at 18 weeks of gestation because of advanced maternal age and the result was normal. Subsequently, an ultrasound revealed single umbilical artery (SUA) at 21 weeks of gestation. She received a detailed fetal anatomy survey that presented the same findings and PLSVC. A small visible gastric bubble was noted at that time, and the other organs were unremarkable. Polyhydramnios was identified at 30 weeks of gestation and amnioreduction was subsequently performed at 32 weeks of gestation. However, polyhydramnios was persisted despite amnioreduction and intrauterine growth restriction was also detected. A cesarean section was performed because of fetal distress at 36 + 2 weeks, and a 1832-g female baby was delivered. Pre-axial polydactyly at left thumb, SUA and esophageal atresia with distal tracheoesophageal fistula (TEF) were identified after birth. The neonate died at age of 4 days because of surgical complication following esophageal anastomosis. CONCLUSION: Prenatal diagnosis of PLSVC associated with polyhydramnios and a small gastric bubble may indicate esophageal atresia with TEF, and further examination for associated syndromes such as VACTERL association is warranted.


Assuntos
Canal Anal/anormalidades , Esôfago/anormalidades , Cardiopatias Congênitas/diagnóstico , Rim/anormalidades , Deformidades Congênitas dos Membros/diagnóstico , Veia Cava Superior Esquerda Persistente/diagnóstico , Poli-Hidrâmnios/diagnóstico , Diagnóstico Pré-Natal/métodos , Coluna Vertebral/anormalidades , Gastropatias/diagnóstico , Traqueia/anormalidades , Adulto , Canal Anal/embriologia , Esôfago/embriologia , Feminino , Retardo do Crescimento Fetal/diagnóstico , Retardo do Crescimento Fetal/genética , Cardiopatias Congênitas/embriologia , Cardiopatias Congênitas/genética , Humanos , Recém-Nascido , Rim/embriologia , Deformidades Congênitas dos Membros/embriologia , Deformidades Congênitas dos Membros/genética , Morte Perinatal/etiologia , Veia Cava Superior Esquerda Persistente/embriologia , Veia Cava Superior Esquerda Persistente/genética , Poli-Hidrâmnios/genética , Gravidez , Coluna Vertebral/embriologia , Gastropatias/congênito , Gastropatias/embriologia , Traqueia/embriologia
8.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 48(1): 36-40, ene.-mar. 2021. ilus
Artigo em Espanhol | IBECS | ID: ibc-201989

RESUMO

La pentalogía de Cantrell, o también llamada hernia diafragmática peritoneo-pericárdica, es un síndrome raro que engloba cinco defectos básicos de corazón, esternón, pared abdominal supraumbilical, diafragma y pericardio, cuya incidencia es de aproximadamente uno por cada 200.000 nacimientos1 con un predominio masculino con una relación de 1,35:12. Los doctores Cantrell, Haller y Ravitch describieron esta patología en 19581, recientemente se propuso una hexalogía adicionando al diagnóstico la presencia de una arteria umbilical única3. Se describe el caso de una paciente de 20 años, cursando un embarazo de 26,3 semanas cuyo feto desarrolló una pentalogía de Cantrell asociada a transposición de los grandes vasos. OBJETIVO: El presente artículo pretende describir un caso de pentalogía de Cantrell con una revisión de su fisiopatología, datos diagnósticos, clasificación y manejo. MÉTODOS/ESTRATEGIA DE BÚSQUEDA: Revisión de la historia clínica de la paciente dentro del Servicio de Ginecología y Obstetricia del Hospital San Vicente de Paúl en Ibarra, Ecuador. RESULTADOS: Ecografía obstétrica reporta feto de 26 semanas de gestación, evidenciándose defecto de pared torácica de 2,84 cm al corte axial, que provoca ectopia cardíaca completa, defecto de pared abdominal superior de 4,3 cm al corte transversal que produce protrusión de parénquima hepático, a la ecocardiografía se evidencia transposición de los grandes vasos, se cataloga como pentalogía de Cantrell tipo I. Se decide terminación de embarazo por incompatibilidad con la vida, obteniéndose recién nacido masculino, en el que se comprobó los defectos torácico y abdominal, fallece a los pocos minutos. IMPLICACIONES PARA LA PRÁCTICA: Resaltar la importancia de la ecografía estructural o morfológica, entre las 18 a 24 semanas, para detectar malformaciones congénitas mayores, obtener un diagnóstico certero y realizar un manejo oportuno. IMPLICACIONES PARA LA INVESTIGACIÓN: Se requieren más estudios para determinar etiología y manejo para estos pacientes, ya que se reportan casos de sobrevivencia de los mismos


Cantrell's Pentalogy, and also called peritoneum-pericardial diaphragmatic hernia, is a rare syndrome that includes five basic defects of the heart, sternum, supra-umbilical abdominal wall, diaphragm, and pericardium. Its incidence is approximately 1 for every 200,000 births, with a male predominance with a ratio of 1.35: 1. Doctors Cantrell, Haller and Ravitch described this pathology in 1958 and recently a hexalogy was proposed, adding the presence of a single umbilical artery to the diagnosis. The case is presented on a 20-year-old woman in a 26.3 weeks pregnancy in whom the foetus developed Cantrell's Pentalogy associated with transposition of the great vessels. PURPOSE: This article aims to describe a case of Cantrell's Pentalogy with a review of its physiopathology, diagnostic data, classification, and management. METHODS/SEARCH STRATEGY: Review of the patient's clinical history in the gynaecology and obstetrics service of the San Vicente de Paul Hospital in Ibarra - Ecuador. RESULTS: Obstetric ultrasound showed a foetus of 26 weeks of gestation, with a chest wall defect of 2.84 cm at the axial section that caused complete cardiac ectopy, as well as an upper abdominal wall defect of 4.3cm at the cross section that produced a protrusion of the liver parenchyma. In the cardiac ultrasound transposition of the great vessels could be seen, and was classified as Cantrell's Pentalogy type I. Termination of pregnancy was decided due to incompatibility with life, obtaining a male newborn in whom the thoracic and abdominal defects were verified, and died within a few minutes. IMPLICATIONS FOR PRACTICE: Highlights the importance of structural or morphological ultrasound, between 18 to 24 weeks, to detect major congenital malformations, obtain an accurate diagnosis and timely management. IMPLICATIONS FOR RESEARCH: More studies are required to determine the aetiology and management of these patients, because cases of survival are reported


Assuntos
Humanos , Feminino , Gravidez , Adulto Jovem , Pentalogia de Cantrell/diagnóstico por imagem , Hérnia Diafragmática/complicações , Morte Perinatal/etiologia , Equador/epidemiologia , Ultrassonografia Pré-Natal/métodos , Anormalidades Múltiplas/diagnóstico por imagem
9.
Sci Rep ; 11(1): 2377, 2021 01 27.
Artigo em Inglês | MEDLINE | ID: mdl-33504864

RESUMO

MicroRNA-125b, the first microRNA to be identified, is known to promote cardiomyocyte maturation from embryonic stem cells; however, its physiological role remains unclear. To investigate the role of miR-125b in cardiovascular biology, cardiac-specific miR-125b-1 knockout mice were generated. We found that cardiac-specific miR-125b-1 knockout mice displayed half the miR-125b expression of control mice resulting in a 60% perinatal death rate. However, the surviving mice developed hearts with cardiac hypertrophy. The cardiomyocytes in both neonatal and adult mice displayed abnormal mitochondrial morphology. In the deficient neonatal hearts, there was an increase in mitochondrial DNA, but total ATP production was reduced. In addition, both the respiratory complex proteins in mitochondria and mitochondrial transcription machinery were impaired. Mechanistically, using transcriptome and proteome analysis, we found that many proteins involved in fatty acid metabolism were significantly downregulated in miR-125b knockout mice which resulted in reduced fatty acid metabolism. Importantly, many of these proteins are expressed in the mitochondria. We conclude that miR-125b deficiency causes a high mortality rate in neonates and cardiac hypertrophy in adult mice. The dysregulation of fatty acid metabolism may be responsible for the cardiac defect in the miR-125b deficient mice.


Assuntos
Cardiomegalia/etiologia , Predisposição Genética para Doença , MicroRNAs/genética , Miócitos Cardíacos/metabolismo , Morte Perinatal/etiologia , Animais , Cardiomegalia/metabolismo , Cardiomegalia/patologia , Cardiomegalia/fisiopatologia , Biologia Computacional , Perfilação da Expressão Gênica , Regulação da Expressão Gênica , Marcação de Genes , Estudos de Associação Genética , Testes de Função Cardíaca , Humanos , Imuno-Histoquímica , Camundongos , Camundongos Knockout , Mitocôndrias Cardíacas/genética , Mitocôndrias Cardíacas/metabolismo , Especificidade de Órgãos/genética , Fenótipo , Proteômica/métodos , Interferência de RNA , Transcriptoma
10.
J Paediatr Child Health ; 57(6): 841-846, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33450113

RESUMO

AIM: To determine the causes of early neonatal death and the avoidable factors associated with these deaths among women participating in a cluster-randomised crossover trial in Papua New Guinea. METHODS: Early neonatal deaths were identified by retrospective chart review of the Women and Newborn Trial of Antenatal Interventions and Management study participants between July 2017 and January 2020. Causes of death and avoidable factors were identified using the Perinatal Problem Identification Program system. RESULTS: There were 35 early neonatal deaths among 2499 livebirths (14 per 1000 births). Fifty-seven percent (20/35) of deaths occurred on the first day of life. Idiopathic preterm birth was the leading obstetric cause of perinatal death (29%; 10/35). Extreme multi-organ immaturity (23%; 8/35) and hypoxic ischaemic encephalopathy (17%; 6/35) were the most common final causes of neonatal death. Forty-six avoidable factors were identified among 26 deaths, including delays in care-seeking, insufficient resources at health facilities, poor intrapartum care and immediate care of the newborn, including neonatal resuscitation. CONCLUSION: In this study, potentially preventable causes and avoidable factors were identified in the majority of early neonatal deaths. Addressing these factors will require health system strengthening, particularly the upskilling of primary level health staff, as well as targeted health education of women and the community.


Assuntos
Morte Perinatal , Nascimento Prematuro , Feminino , Humanos , Mortalidade Infantil , Recém-Nascido , Papua Nova Guiné/epidemiologia , Morte Perinatal/etiologia , Gravidez , Ressuscitação , Estudos Retrospectivos
11.
J Obstet Gynaecol Res ; 47(2): 544-550, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33145865

RESUMO

AIM: To compare the distribution of various causes of perinatal mortality in a public hospital in low-middle-income country setting. METHODS: A prospective cohort study was conducted from January 2016 to December 2018 at a large public hospital, Services Institute of Medical Sciences, Services Hospital, in Lahore, Pakistan. We applied the World Health Organization's perinatal mortality coding in the International Classification of Diseases. All stillbirths after 28 weeks' gestation weighing more than 1 kg were identified and followed up till delivery. All live births were followed up till discharge or early neonatal death. A multidisciplinary group of obstetricians, pediatricians, midwife and related healthcare professionals was established to assess each case of fatality. The associated maternal conditions were identified for each of the antepartum, intrapartum and neonatal deaths. RESULTS: Of 11 850 births, there were 690 perinatal deaths, with 240 stillbirths (antepartum 167, intrapartum 73) and 450 early neonatal deaths (perinatal mortality rate 58.2/1000 births). Among antepartum deaths, hypoxia accounted for 70 (42%) cases. Among intrapartum deaths, an acute event was responsible for 50 (68%) cases. Among neonatal deaths (450, 65% of total), low birthweight and prematurity contributed to 152 (34%) cases. A maternal condition was found in 183 (76%) of stillbirths and 355 (79%) patients with neonatal death. CONCLUSION: In our study, the most important causes of perinatal deaths were maternal in origin. There was an excess in the distribution of neonatal causes of perinatal deaths. These data should inform policy and practice.


Assuntos
Morte Perinatal , Feminino , Humanos , Mortalidade Infantil , Recém-Nascido , Paquistão/epidemiologia , Morte Perinatal/etiologia , Mortalidade Perinatal , Gravidez , Estudos Prospectivos , Natimorto/epidemiologia
12.
Int J Gynaecol Obstet ; 153(1): 160-168, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33098672

RESUMO

OBJECTIVE: To undertake a retrospective perinatal death audit and assessment of avoidable factors associated with stillbirths among a cohort of women in two provinces in Papua New Guinea. METHODS: We used data from an ongoing cluster-randomized crossover trial in 10 sites among 4600 women in Papua New Guinea (from 2017 to date). The overarching aim is to improve birth outcomes. All stillbirths from July 2017 to January 2020 were identified. The Perinatal Problem Identification Program was used to analyze each stillbirth and review associated avoidable factors. RESULTS: There were 59 stillbirths among 2558 births (23 per 1000 births); 68% (40/59) were classified "fresh" and 32% as "macerated". Perinatal cause of death was identified for 63% (37/59): 30% (11/37) were due to intrapartum asphyxia and traumatic breech birth and 19% (7/37) were the result of pre-eclampsia. At least one avoidable factor was identified for 95% (56/59) of stillbirths. Patient-associated factors included lack of response to reduced fetal movements and delay in seeking care during labor. Health personnel-associated factors included poor intrapartum care, late diagnosis of breech presentation, and prolonged second stage with no intervention. CONCLUSION: Factors associated with stillbirths in this setting could be avoided through a package of interventions at both the community and health-facility levels.


Assuntos
Morte Perinatal/etiologia , Natimorto/epidemiologia , Adulto , Asfixia Neonatal/epidemiologia , Apresentação Pélvica/epidemiologia , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Papua Nova Guiné , Aceitação pelo Paciente de Cuidados de Saúde , Pré-Eclâmpsia/epidemiologia , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Adulto Jovem
13.
BJOG ; 128(2): 214-224, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32894620

RESUMO

BACKGROUND: Stillbirth prevention is an international priority - risk prediction models could individualise care and reduce unnecessary intervention, but their use requires evaluation. OBJECTIVES: To identify risk prediction models for stillbirth, and assess their potential accuracy and clinical benefit in practice. SEARCH STRATEGY: MEDLINE, Embase, DH-DATA and AMED databases were searched from inception to June 2019 using terms relevant to stillbirth, perinatal mortality and prediction models. The search was compliant with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. SELECTION CRITERIA: Studies developing and/or validating prediction models for risk of stillbirth developed for application during pregnancy. DATA COLLECTION AND ANALYSIS: Study screening and data extraction were conducted in duplicate, using the CHARMS checklist. Risk of bias was appraised using the PROBAST tool. RESULTS: The search identified 2751 citations. Fourteen studies reporting development of 69 models were included. Variables consistently included were: ethnicity, body mass index, uterine artery Doppler, pregnancy-associated plasma protein and placental growth factor. For almost all models there were significant concerns about risk of bias. Apparent model performance (i.e. in the development dataset) was highest in models developed for use later in pregnancy and including maternal characteristics, and ultrasound and biochemical variables, but few were internally validated and none were externally validated. CONCLUSIONS: Almost all models identified were at high risk of bias. There are first-trimester models of possible clinical benefit in early risk stratification; these require validation and clinical evaluation. There were few later pregnancy models but, if validated, these could be most relevant to individualised discussions around timing of birth. TWEETABLE ABSTRACT: Prediction models using maternal factors, blood tests and ultrasound could individualise stillbirth prevention, but existing models are at high risk of bias.


Assuntos
Morte Perinatal/etiologia , Morte Perinatal/prevenção & controle , Natimorto , Feminino , Humanos , Valor Preditivo dos Testes , Gravidez , Medição de Risco
14.
Am J Obstet Gynecol ; 224(4): 389.e1-389.e9, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-32986989

RESUMO

BACKGROUND: Coronavirus disease 2019 may be associated with adverse maternal and neonatal outcomes in pregnancy, but there are few controlled data to quantify the magnitude of these risks or to characterize the epidemiology and risk factors. OBJECTIVE: This study aimed to quantify the associations of coronavirus disease 2019 with adverse maternal and neonatal outcomes in pregnancy and to characterize the epidemiology and risk factors. STUDY DESIGN: We performed a matched case-control study of pregnant patients with confirmed coronavirus disease 2019 cases who delivered between 16 and 41 weeks' gestation from March 11 to June 11, 2020. Uninfected pregnant women (controls) were matched to coronavirus disease 2019 cases on a 2:1 ratio based on delivery date. Maternal demographic characteristics, coronavirus disease 2019 symptoms, laboratory evaluations, obstetrical and neonatal outcomes, and clinical management were chart abstracted. The primary outcomes included (1) a composite of adverse maternal outcome, defined as preeclampsia, venous thromboembolism, antepartum admission, maternal intensive care unit admission, need for mechanical ventilation, supplemental oxygen, or maternal death, and (2) a composite of adverse neonatal outcome, defined as respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, 5-minute Apgar score of <5, persistent category 2 fetal heart rate tracing despite intrauterine resuscitation, or neonatal death. To quantify the associations between exposure to mild and severe or critical coronavirus disease 2019 and adverse maternal and neonatal outcomes, unadjusted and adjusted analyses were performed using conditional logistic regression (to account for matching), with matched-pair odds ratio and 95% confidence interval based on 1000 bias-corrected bootstrap resampling as the effect measure. Associations were adjusted for potential confounders. RESULTS: A total of 61 confirmed coronavirus disease 2019 cases were enrolled during the study period (mild disease, n=54 [88.5%]; severe disease, n=6 [9.8%]; critical disease, n=1 [1.6%]). The odds of adverse composite maternal outcome were 3.4 times higher among cases than controls (18.0% vs 8.2%; adjusted odds ratio, 3.4; 95% confidence interval, 1.2-13.4). The odds of adverse composite neonatal outcome were 1.7 times higher in the case group than to the control group (18.0% vs 13.9%; adjusted odds ratio, 1.7; 95% confidence interval, 0.8-4.8). Stratified analyses by disease severity indicated that the morbidity associated with coronavirus disease 2019 in pregnancy was largely driven by the severe or critical disease phenotype. Major risk factors for associated morbidity were black and Hispanic race, advanced maternal age, medical comorbidities, and antepartum admissions related to coronavirus disease 2019. CONCLUSION: Coronavirus disease 2019 during pregnancy is associated with an increased risk of adverse maternal and neonatal outcomes, an association that is primarily driven by morbidity associated with severe or critical coronavirus disease 2019. Black and Hispanic race, obesity, advanced maternal age, medical comorbidities, and antepartum admissions related to coronavirus disease 2019 are risk factors for associated morbidity.


Assuntos
COVID-19/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , SARS-CoV-2 , Adulto , Grupo com Ancestrais do Continente Africano , COVID-19/complicações , COVID-19/etnologia , Estudos de Casos e Controles , Feminino , Hispano-Americanos , Humanos , Recém-Nascido , Modelos Logísticos , Idade Materna , Morte Perinatal/etiologia , Gravidez , Complicações Infecciosas na Gravidez/etnologia , Resultado da Gravidez , Fatores de Risco
15.
J Obstet Gynaecol ; 41(1): 32-37, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32705924

RESUMO

To prevent fetal loss, preterm delivery, and perinatal morbidity of multifetal pregnancies (MPs), fetal reduction (FR) is offered to some patients. We retrospectively analysed the data of 124 MPs that underwent transabdominal FR to twin (n = 63) and singleton (n = 61) pregnancies at a mean gestational age of 12 + 6 weeks between December 2006 and January 2018. FR was performed transabdominally with the injection of potassium chloride into the intracardiac or intrathoracic space of the fetus or fetuses after ultrasound screening for nuchal translucency and anatomical defects. The initial number of embryos were 48 twins, 63 triplets, 11 quadruplets, and 2 quintuplets. The procedure-related pregnancy loss rate was 0.8% (1/124), the overall pregnancy loss rate was 2.4% (3/124), the fetal loss rate was 1.6% (2/124), and the neonatal death rate was 0.8% (1/124). The baby take-home rates were 96% for twin pregnancies and 96.7% for singletons. This study shows that transabdominal FR is an effective and safe procedure with a pregnancy loss rate of 2.4%.Impact statementWhat is already known on this subject? The incidence of multifetal pregnancies has increased over the years. Because multifetal pregnancies increase perinatal morbidity and mortality due to prematurity, fetal reduction is offed to some patients.What the results of this study add? The results of this study add to the growing body of research on fetal reduction. The study showed that transabdominal fetal reduction is a safe procedure with a pregnancy loss rate of 2.4%.What the implications are of these findings for clinical practice and/or further research? The results of this study can be used in counselling couples with multifetal pregnancies who are considering fetal reduction. Further research is needed to confirm the current findings.


Assuntos
Aborto Espontâneo/etiologia , Redução de Gravidez Multifetal/efeitos adversos , Redução de Gravidez Multifetal/métodos , Gravidez Múltipla/estatística & dados numéricos , Aborto Espontâneo/epidemiologia , Adulto , Feminino , Idade Gestacional , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Morte Perinatal/etiologia , Gravidez , Resultado da Gravidez , Estudos Retrospectivos
16.
J Obstet Gynaecol ; 41(2): 229-233, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32347769

RESUMO

A number of classification system are available to classify stillbirths, but there remains a lack of a uniform global system of classification. This study evaluated the feasibility of the ICD-PM classification system and COD-AC to classify the stillbirths and to discuss the interpretation of "the newer" classification system (ICD-PM) over the COD-AC system. Over a period of one year, out of 5776 total births 314 were stillborns with a stillbirth rate of 54 per 1000 total births. As per ICD PM Classification System, 69.1% of stillbirths were ante partum and rest intrapartum. The associated maternal conditions at the time of foetal death were also classified into five groups and maximum mothers (44.3%) were grouped under M4-medical/surgical disorders. According to COD-AC system of classification 90% of cases were assigned the cause of death, rest 10% remained unexplained. The ICD-PM and CODAC classification both seem to be feasible but ICD-PM clearly defines the time of foetal death and correlates feto-maternal dyad together.IMPACT STATEMENTWhat is already known on this subject? Classifying stillbirths is crucial to recognise the actual cause of foetal death and to gather the relevant information for planning the preventive strategies especially in low middle-income countries (LMICs) which contribute to 98% of total global burden of 2.6 million stillbirths annually. In literature CODAC system was found most suitable for low middle-income countries. In 2016, WHO proposed a newer system, i.e., ICD-PM: WHO application of ICD-10 to deaths during the perinatal period.What do the results of this study add? With ICD-PM classification stillbirths were categorised more clearly in different groups and feto-maternal condition were linked together along with both intrapartum and ante partum stillbirth which can help to set the priorities and future planning for prevention. The proportion of unexplained stillbirth has also reduced significantly compared to CODAC system.What are the implications of these findings for clinical practice and/or further research? CD-PM system of classification seems feasible and would facilitate the uniform and consistent stillbirth data even from LMICs for global comparison although more number of studies are needed for conclusion. The system has been changed to ICD-PM in our institute.


Assuntos
Causas de Morte , Morte Perinatal , Natimorto/epidemiologia , Feminino , Humanos , Índia/epidemiologia , Recém-Nascido , Classificação Internacional de Doenças , Mortalidade , Morte Perinatal/etiologia , Morte Perinatal/prevenção & controle , Mortalidade Perinatal , Gravidez
17.
Arch Dis Child Fetal Neonatal Ed ; 106(4): 363-369, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33239280

RESUMO

OBJECTIVE: To estimate the overall and infection-related neonatal mortality rate and the pathogens responsible using electronic death registrations. DESIGN: Retrospective analysis of national electronic death registrations data. SETTING: England and Wales. PATIENTS: Neonates aged <28 days. MAIN OUTCOME MEASURES: Overall and infection-related mortality rate per 1000 live births in term, preterm (28-36 weeks) and extremely preterm (<28 weeks) neonates; the contribution of infections and specific pathogens; comparison with mortality rates in 2003-2005. RESULTS: The neonatal mortality rate during 2013-2015 (2.4/1000 live births; 5095 deaths) was 31% lower than in 2003-2005 (3.5/1000; 6700 deaths). Infection-related neonatal mortality rate in 2013-2015 (0.32/1000; n=669) was 20% lower compared with 2003-2015 (0.40/1000; n=768), respectively. Infections were responsible for 13.1% (669/5095) of neonatal deaths during 2013-2015 and 11.5% (768/6700) during 2003-2005. Of the infection-related deaths, 44.2% (296/669) were in term, 19.9% (133/669) preterm and 35.9% (240/669) extremely preterm neonates. Compared with term infants (0.15/1000 live births), infection-related mortality rate was 5.9-fold (95% CI 4.7 to 7.2) higher in preterm (0.90/1000) and 188-fold (95% CI 157 to 223) higher in extremely preterm infants (28.7/1000) during 2013-2015. A pathogen was recorded in 448 (67%) registrations: 400 (89.3%) were bacterial, 37 (8.3%) viral and 11 (2.4%) fungal. Group B streptococcus (GBS) was reported in 30.4% (49/161) of records that specified a bacterial infection and 7.3% (49/669) of infection-related deaths. CONCLUSIONS: Overall and infection-related neonatal mortality rates have declined, but the contribution of infection and of specific pathogens has not changed. Further preventive measures, including antenatal GBS vaccine may be required to prevent the single most common cause of infection-related deaths in neonates.


Assuntos
Causas de Morte , Doenças Transmissíveis/mortalidade , Morte Perinatal/etiologia , Doenças Transmissíveis/microbiologia , Inglaterra/epidemiologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Estudos Retrospectivos , País de Gales/epidemiologia
18.
Int J Gynaecol Obstet ; 153(1): 146-153, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33029792

RESUMO

OBJECTIVE: To describe the rates and risk factors for stillbirth and pre-discharge neonatal mortality (PDNM), and impact on quality of life (QoL) among women with postpartum hemorrhage (PPH). METHODS: A secondary analysis was conducted of the WOMAN trial, which evaluated the use of tranexamic acid for PPH and collected infant outcome data to assess drug safety. The analysis was restricted to singletons (n=18 942). Overall and country-level rates of stillbirth and PDNM were calculated. Multilevel logistic regression models examined the association of stillbirth and PDNM with selected risks, and the association of mother's QoL at discharge after stillbirth or PDNM. RESULTS: For women with PPH, the rate of stillbirths was 104.42 per 1000 births (n=1978) and the rate of PDNM was 15.56 per 1000 live births (n=264). Cesarean delivery, increasing blood loss, maternal complications, and maternal death were strongly associated with these adverse outcomes. Women with stillbirth and PDNM were significantly more likely to report poorer QoL. CONCLUSION: Women with PPH experience an extremely high rate of stillbirth and slightly elevated PDNM, which is associated with markers of the severity of their condition and impacts on their QoL.


Assuntos
Mortalidade Infantil , Morte Perinatal/etiologia , Hemorragia Pós-Parto/epidemiologia , Natimorto/epidemiologia , Adulto , Cesárea/efeitos adversos , Feminino , Humanos , Lactente , Recém-Nascido , Morte Materna , Gravidez , Qualidade de Vida , Fatores de Risco , Adulto Jovem
19.
Ann Clin Lab Sci ; 50(6): 754-760, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33334790

RESUMO

OBJECTIVE: Intrauterine hypoxia/asphyxia is not the cause, but a consequence of different pathological conditions that requires a more detailed study of the morphogenesis of perinatal death. METHODS: Structural changes in placentas of intrauterine fetal demise (IUFD) in different stages of intrauterine period and placentas in early neonatal death were reviewed and compared. Control group was composed of term placentas without evidence of perinatal asphyxia or other neonatal abnormalities. Immunohistochemical investigation was performed by antibodies to Herpes simplex virus (HSV), Cytomegalovirus (CMV), and tumor necrosis factor (TNF). Morphometric analysis was performed using the Pannoramic Midi II histoscanner of "3DHISTECH" company. RESULTS: The histologic examination of placentas revealed differences between IUFD and early neonatal death. Predominant localization of HSV and CMV antigens was noted in the walls of capillaries and in placental villous stroma in absolute majority of IUFD and early neonatal death cases; importantly, colocalization of TNF, HSV, and CMV antigens was also detected in cases of IUFD and early neonatal period. CONCLUSION: Damage of placental vessels due to the influence of pathogenic factors (virus antigens, TNF) can cause acute or chronic intrauterine fetus hypoxia which is a leading pathogenetic factor of perinatal death.


Assuntos
Morte Perinatal/etiologia , Placenta/patologia , Adulto , Autopsia , Estudos de Casos e Controles , Feminino , Feto , Idade Gestacional , Humanos , Recém-Nascido , Pessoa de Meia-Idade , Morte Perinatal/prevenção & controle , Placenta/metabolismo , Gravidez , Federação Russa/epidemiologia , Natimorto
20.
JAMA Netw Open ; 3(11): e2026750, 2020 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-33206194

RESUMO

Importance: The overwhelming majority of fetal and neonatal deaths occur in low- and middle-income countries. Fetal and neonatal risk assessment tools may be useful to predict the risk of death. Objective: To develop risk prediction models for intrapartum stillbirth and neonatal death. Design, Setting, and Participants: This cohort study used data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Global Network for Women's and Children's Health Research population-based vital registry, including clinical sites in South Asia (India and Pakistan), Africa (Democratic Republic of Congo, Zambia, and Kenya), and Latin America (Guatemala). A total of 502 648 pregnancies were prospectively enrolled in the registry. Exposures: Risk factors were added sequentially into the data set in 4 scenarios: (1) prenatal, (2) predelivery, (3) delivery and day 1, and (4) postdelivery through day 2. Main Outcomes and Measures: Data sets were randomly divided into 10 groups of 3 analysis data sets including training (60%), test (20%), and validation (20%). Conventional and advanced machine learning modeling techniques were applied to assess predictive abilities using area under the curve (AUC) for intrapartum stillbirth and neonatal mortality. Results: All prenatal and predelivery models had predictive accuracy for both intrapartum stillbirth and neonatal mortality with AUC values 0.71 or less. Five of 6 models for neonatal mortality based on delivery/day 1 and postdelivery/day 2 had increased predictive accuracy with AUC values greater than 0.80. Birth weight was the most important predictor for neonatal death in both postdelivery scenarios with independent predictive ability with AUC values of 0.78 and 0.76, respectively. The addition of 4 other top predictors increased AUC to 0.83 and 0.87 for the postdelivery scenarios, respectively. Conclusions and Relevance: Models based on prenatal or predelivery data had predictive accuracy for intrapartum stillbirths and neonatal mortality of AUC values 0.71 or less. Models that incorporated delivery data had good predictive accuracy for risk of neonatal mortality. Birth weight was the most important predictor for neonatal mortality.


Assuntos
Recursos em Saúde/tendências , Morte Perinatal/etiologia , Mortalidade Perinatal/tendências , Natimorto/epidemiologia , Adulto , Peso ao Nascer , Estudos de Coortes , Congo/epidemiologia , Feminino , Guatemala/epidemiologia , Humanos , Índia/epidemiologia , Lactente , Mortalidade Infantil , Recém-Nascido , Quênia/epidemiologia , Masculino , Paquistão/epidemiologia , Valor Preditivo dos Testes , Gravidez , Estudos Prospectivos , Fatores de Risco , Zâmbia/epidemiologia
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