Termination of pregnancy among very preterm births and its impact on very preterm mortality: results from ten European population-based cohorts in the MOSAIC study.

OBJECTIVE: To study the impact of terminations of pregnancy (TOP) on very preterm mortality in Europe. DESIGN: European prospective population-based cohort study. SETTING: Ten regions from nine European countries participating in the MOSAIC (Models of OrganiSing Access to Intensive Care for very preterm babies) study. These regions had different policies on screening for congenital anomalies (CAs) and on pregnancy termination. POPULATION OR SAMPLE: Births 22-31 weeks gestational age. METHODS: The analysis compares the proportion of TOP among very preterm births and assesses differences in mortality between the regions. MAIN OUTCOME MEASURES: Pregnancy outcomes (termination, antepartum death, intrapartum death and live birth) and reasons for termination, presence of CAs and causes of death for stillbirths and live births in 2003. RESULTS: Pregnancy terminations constituted between 1 and 21.5% of all very preterm births and between 4 and 53% of stillbirths. Most terminations were for CAs, although some were for obstetric indications (severe pre-eclampsia, growth restriction, premature rupture of membranes). TOP contributed substantially to overall fetal mortality rates in the two regions with late second-trimester screening. There was no clear association between policies governing screening and pregnancy termination and the proportion of CAs among stillbirths and live births, except in Poland, where neonatal deaths associated with CAs were more frequent, reflecting restrictive pregnancy termination policies. CONCLUSION: Proportions of TOP among very preterm births varied widely between European regions. Information on terminations should be reported when very preterm live births and stillbirths are compared internationally since national policies related to screening for CAs and the legality and timing of medical terminations differ.

Delayed childbearing and maternal mortality.

OBJECTIVES: To assess the maternal age trend in pregnant women in Flanders, Belgium, and examine the impact of maternal age on maternal mortality. STUDY DESIGN: Retrospective analysis of a population based regional perinatal database during one decade. RESULTS: Between 1991 and 2000 a significant increase in maternal age was found, in primiparous as well as in multiparous women. The maternal mortality ratio was 5.8, and strongly related to maternal age, with a relative risk of 7.0 (95% CI: 3.0-16.2) from the age of 35 on, and of 30.0 (95% CI: 11.4-80.6) in women aged 40 years or beyond. CONCLUSIONS: These data call for further research and action to facilitate career and reproduction, and for special care for older pregnant women.

The Flemish Centre for the Study of Perinatal Epidemiology and its registry.

The Flemish Centre for the Study of Perinatal Epidemiology was formally established in 1986. Its objectives are the promotion of perinatal epidemiology and the study of maternal and perinatal mortality and morbidity. One of the means to accomplish these objectives was the creation of a databank of perinatal medicine. The registry at present covers almost 80% of all deliveries in Flanders. The registry indicates a maternal death rate of 5.8/100,000 living births whereas the Belgian official national statistics indicate a maternal death rate of 2.8/100,000. This means that either the matter is under reported at the national level or there is a real problem in the Flemish part of the country. The perinatal death rate varies among the participating services form 3.9 to 22.4%.

Quality assurance of obstetrical care in Belgium.

OBJECTIVE: To assist Obstetric Departments in observing their own performance and comparing it with other departments. METHODS: Voluntary questionnaire concerning performance filled in at the time of delivery. Data processed by the Ministry of Health and Universities. Coordination by the College of Obstetricians and Gynaecologists. RESULTS: Thirty seven per cent of the Flemish obstetrical departments were participating at the end of the first year. The profiles show wide variations in intervention rates.

Perinatal outcome of pregnancies after assisted reproduction: a case-control study.

OBJECTIVE: We conducted a case-control study of all pregnancies obtained with assisted reproduction technology in the Dutch-speaking part of Belgium from 1992 until 1997 to investigate differences in peripartum obstetric events and the perinatal outcome. STUDY DESIGN: Three thousand fifty-seven singleton and 1241 twin pregnancies were studied. About 90% of pregnancies resulted from in vitro fertilization; the remainder resulted from intracytoplasmic sperm injection. Control subjects were selected from a regional register and were matched for maternal age, parity, fetal sex, plurality, and date of delivery. The main outcome measures were duration of gestation, birth weight, perinatal death, perinatal morbidity, incidence of congenital malformations, and incidence of cesarean delivery. RESULTS: Odds ratios and 95% confidence intervals were 2.6 (1.4-4.8) for perinatal mortality, 3.5 (2.2-5.7) for birth before 33 weeks of gestation, and 1.7 (1.5-1.9) for cesarean delivery in singleton pregnancies that resulted after in vitro fertilization. Twin pregnancies obtained with in vitro fertilization, on the contrary, were similar for all outcome measures, except for the incidence of cesarean delivery (odds ratio, 1.4; 95% confidence interval, 1.2-1.7) compared with spontaneously conceived twin pregnancies. CONCLUSION: The perinatal outcome of singleton pregnancies obtained with in vitro fertilization is significantly worse than that of spontaneously conceived pregnancies, mainly because of the increased rate of preterm birth. The outcome of twin pregnancies obtained with in vitro fertilization is comparable with that of normally conceived twins. For both singleton and twin pregnancies obtained with in vitro fertilization, the incidence of cesarean delivery is increased.

Serum ferritin as a guide for iron stores in chronic hemodialysis patients.

The serum ferritin (SF) level was measured in 58 chronic hemodialysis (CHD) patients (46 living and 12 deceased subjects) and compared to bone marrow iron concentrations, cytological bone marrow iron stores (BMIS), and histological BMIS. In the 12 deceased subjects, liver iron concentrations, histological liver parenchymal, and Kupffer cell iron stores were also studied. The mean SF level of the whole group was 302 +/- 251 ng/ml (mean +/- SD). No close relationship was found between transferrin saturation and cytological BMIS. A high correlation was found between SF level and cytological BMIS (Spearman rank rs = 0.74). In the deceased CHD patients a close correlation was observed between histological parenchymal liver iron stores and histological Kupffer cell iron stores, but not between liver and bone marrow iron stores. A good correlation was found between SF levels and liver iron concentrations. It is concluded that in CHD patients SF levels are higher than in healthy controls, even in the absence of iron therapy (except in the form of blood transfusions); in some of these patients iron is disproportionately stored in the bone marrow and the liver. Although the level of BMIS cannot be estimated unequivocally from an SF measurement in every CHD patient, SF levels provide useful estimates of BMIS.