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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.

BackgroundDespite significant global progress in reducing neonatal mortality, bacterial sepsis remains a major cause of neonatal deaths. Klebsiella pneumoniae (K. pneumoniae) is the leading pathogen globally underlying cases of neonatal sepsis and is frequently resistant to antibiotic treatment regimens recommended by the World Health Organization (WHO), including first-line therapy with ampicillin and gentamicin, second-line therapy with amikacin and ceftazidime, and meropenem. Maternal vaccination to prevent neonatal infection could reduce the burden of K. pneumoniae neonatal sepsis in low- and middle-income countries (LMICs), but the potential impact of vaccination remains poorly quantified. We estimated the potential impact of such vaccination on cases and deaths of K. pneumoniae neonatal sepsis and project the global effects of routine immunization of pregnant women with the K. pneumoniae vaccine as antimicrobial resistance (AMR) increases.Methods and findingsWe developed a Bayesian mixture-modeling framework to estimate the effects of a hypothetical K. pneumoniae maternal vaccine with 70% efficacy administered with coverage equivalent to that of the maternal tetanus vaccine on neonatal sepsis infections and mortality. To parameterize our model, we used data from 3 global studies of neonatal sepsis and/or mortality-with 2,330 neonates who died with sepsis surveilled from 2016 to 2020 undertaken in 18 mainly LMICs across all WHO regions (Ethiopia, Kenya, Mali, Mozambique, Nigeria, Rwanda, Sierra Leone, South Africa, Uganda, Brazil, Italy, Greece, Pakistan, Bangladesh, India, Thailand, China, and Vietnam). Within these studies, 26.95% of fatal neonatal sepsis cases were culture-positive for K. pneumoniae. We analyzed 9,070 K. pneumoniae genomes from human isolates gathered globally from 2001 to 2020 to quantify the temporal rate of acquisition of AMR genes in K. pneumoniae isolates to predict the future number of drug-resistant cases and deaths that could be aver

Aims/hypothesis: Continuous subcutaneous insulin infusion by insulin pump is often superior in improving glycaemic control compared with conventional multiple daily insulin injection (MDI). However, whether pump treatment leads to improved pregnancy outcomes in terms of congenital malformations and perinatal death remains unknown. The present aim was to evaluate the risk of malformations and perinatal and neonatal death in pregnant women with type 1 diabetes treated with pump or MDI. Methods: We performed a secondary analysis of a prospective multinational cohort of 2088 pregnant women with type 1 diabetes in a real-world setting who were treated by pump (n=750) or MDI (n=1338). ORs for offspring with congenital malformations or perinatal or neonatal death were calculated using crude data and by logistic regression on propensity score-matched data. Results: At enrolment (gestational week 8; 95% CI 4, 14), pump users had a higher educational level (university degree: 37.3% vs 25.1%; p<0.001) and better glycaemic control (mean HbA1c: 51±10 mmol/mol [6.8±0.9%] vs 54±14 mmol/mol [7.1±1.3%], p<0.001) compared with MDI users. Moreover, a greater proportion of pump users had an HbA1c level below 75 mmol/mol (9%) (97.6% vs 91.9%, p<0.001), and more often reported taking folic acid supplementation (86.3% vs 74.8%; p<0.001) compared with MDI users. All clinically important potential confounders were balanced after propensity score matching, and HbA1c remained lower in pump users. The proportion of fetuses with at least one malformation was 13.5% in pump users vs 11.2% in MDI users (crude OR 1.23; 95% CI 0.94, 1.61; p=0.13; propensity score-matched (adjusted) OR 1.11; 95% CI 0.81, 1.52; p=0.52). The proportion of fetuses with at least one major malformation was 2.8% in pump users vs 3.1% in MDI users (crude OR 0.89; 95% CI 0.52, 1.51; p=0.66; adjusted OR 0.78; 95% CI 0.42, 1.45; p=0.43), and the proportions of fetuses carrying on

OBJECTIVE: Reduced fetal movement (RFM), defined as a decrease in maternal perception of frequency or strength of fetal movements, is a common reason for presentation to maternity care. Observational studies demonstrate an association between RFM, stillbirth, and fetal growth restriction related to placental insufficiency. However, individual intervention studies have described varying results. This systematic review and meta-analysis aimed to determine whether interventions aiming to encourage awareness of reduced fetal movement and/or improve its subsequent clinical management reduce the frequency of stillbirth or other important secondary outcomes. DATA SOURCES: Searches were conducted in MEDLINE, EMBASE, CINAHL, The Cochrane Library, Web of Science and Google Scholar. Guidelines, trial registries, and grey literature were also searched. Databases were searched from inception to the 20th January 2022. STUDY ELIGIBILITY CRITERIA: Randomised controlled trials (RCTs) and controlled non-randomised studies (NRS) were eligible if they assessed interventions aiming to encourage awareness of fetal movement or fetal movement counting and/or improve the subsequent clinical management of RFM. Eligible populations were singleton pregnancies after 24 completed weeks of gestation. The primary review outcome was stillbirth; a number of secondary maternal and neonatal outcomes were specified in the review. STUDY APPRAISAL AND SYNTHESIS METHODS: Risk of bias was assessed using Cochrane Risk of Bias 2 and ROBINS-I for RCTs and NRS respectively. Variation due to heterogeneity was assessed using I2. Data from studies employing similar interventions was combined using random effects meta-analysis. RESULTS: 1,609 citations were identified; 190 full text papers were evaluated against the inclusion criteria, 18 studies (16 RCTs and 2 NRS) were included. The evidence is uncertain about the effect of encouraging awareness of fetal movement on stillbirth compared with standard care (two st

Background: Premature birth is associated with an increased risk of mortality and morbidity, and strategies to prevent preterm birth are few in number and resource intensive. In 2020, the ASPIRIN trial showed the efficacy of low-dose aspirin (LDA) in nulliparous, singleton pregnancies for the prevention of preterm birth. We sought to investigate the cost-effectiveness of this therapy in low-income and middle-income countries. Methods: In this post-hoc, prospective, cost-effectiveness study, we constructed a probabilistic decision tree model to compare the benefits and costs of LDA treatment compared with standard care using primary data and published results from the ASPIRIN trial. In this analysis from a health-care sector perspective, we considered the costs and effects of LDA treatment, pregnancy outcomes, and neonatal health-care use. We did sensitivity analyses to understand the effect of the price of the LDA regimen, and the effectiveness of LDA in reducing both preterm birth and perinatal death. Findings: In model simulations, LDA was associated with 141 averted preterm births, 74 averted perinatal deaths, and 31 averted hospitalisations per 10 000 pregnancies. The reduction in hospitalisation resulted in a cost of US$248 per averted preterm birth, $471 per averted perinatal death, and $15·95 per disability-adjusted life year. Interpretation: LDA treatment in nulliparous, singleton pregnancies is a low-cost, effective treatment to reduce preterm birth and perinatal death. The low cost per disability-adjusted life year averted strengthens the evidence in support of prioritising the implementation of LDA in publicly funded health care in low-income and middle-income countries. Funding: Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Background: Premature birth is associated with an increased risk of mortality and morbidity, and strategies to prevent preterm birth are few in number and resource intensive. In 2020, the ASPIRIN trial showed the efficacy of low-dose aspirin (LDA) in nulliparous, singleton pregnancies for the prevention of preterm birth. We sought to investigate the cost-effectiveness of this therapy in low-income and middle-income countries. Methods: In this post-hoc, prospective, cost-effectiveness study, we constructed a probabilistic decision tree model to compare the benefits and costs of LDA treatment compared with standard care using primary data and published results from the ASPIRIN trial. In this analysis from a health-care sector perspective, we considered the costs and effects of LDA treatment, pregnancy outcomes, and neonatal health-care use. We did sensitivity analyses to understand the effect of the price of the LDA regimen, and the effectiveness of LDA in reducing both preterm birth and perinatal death. Findings: In model simulations, LDA was associated with 141 averted preterm births, 74 averted perinatal deaths, and 31 averted hospitalisations per 10 000 pregnancies. The reduction in hospitalisation resulted in a cost of US$248 per averted preterm birth, $471 per averted perinatal death, and $15·95 per disability-adjusted life year. Interpretation: LDA treatment in nulliparous, singleton pregnancies is a low-cost, effective treatment to reduce preterm birth and perinatal death. The low cost per disability-adjusted life year averted strengthens the evidence in support of prioritising the implementation of LDA in publicly funded health care in low-income and middle-income countries. Funding: Eunice Kennedy Shriver National Institute of Child Health and Human Development.

OBJECTIVE: Reduced fetal movement (RFM), defined as a decrease in maternal perception of frequency or strength of fetal movements, is a common reason for presentation to maternity care. Observational studies demonstrate an association between RFM, stillbirth, and fetal growth restriction related to placental insufficiency. However, individual intervention studies have described varying results. This systematic review and meta-analysis aimed to determine whether interventions aiming to encourage awareness of reduced fetal movement and/or improve its subsequent clinical management reduce the frequency of stillbirth or other important secondary outcomes. DATA SOURCES: Searches were conducted in MEDLINE, EMBASE, CINAHL, The Cochrane Library, Web of Science and Google Scholar. Guidelines, trial registries, and grey literature were also searched. Databases were searched from inception to the 20th January 2022. STUDY ELIGIBILITY CRITERIA: Randomised controlled trials (RCTs) and controlled non-randomised studies (NRS) were eligible if they assessed interventions aiming to encourage awareness of fetal movement or fetal movement counting and/or improve the subsequent clinical management of RFM. Eligible populations were singleton pregnancies after 24 completed weeks of gestation. The primary review outcome was stillbirth; a number of secondary maternal and neonatal outcomes were specified in the review. STUDY APPRAISAL AND SYNTHESIS METHODS: Risk of bias was assessed using Cochrane Risk of Bias 2 and ROBINS-I for RCTs and NRS respectively. Variation due to heterogeneity was assessed using I2. Data from studies employing similar interventions was combined using random effects meta-analysis. RESULTS: 1,609 citations were identified; 190 full text papers were evaluated against the inclusion criteria, 18 studies (16 RCTs and 2 NRS) were included. The evidence is uncertain about the effect of encouraging awareness of fetal movement on stillbirth compared with standard care (two st

OBJECTIVE: Reduced fetal movement (RFM), defined as a decrease in maternal perception of frequency or strength of fetal movements, is a common reason for presentation to maternity care. Observational studies demonstrate an association between RFM, stillbirth, and fetal growth restriction related to placental insufficiency. However, individual intervention studies have described varying results. This systematic review and meta-analysis aimed to determine whether interventions aiming to encourage awareness of reduced fetal movement and/or improve its subsequent clinical management reduce the frequency of stillbirth or other important secondary outcomes. DATA SOURCES: Searches were conducted in MEDLINE, EMBASE, CINAHL, The Cochrane Library, Web of Science and Google Scholar. Guidelines, trial registries, and grey literature were also searched. Databases were searched from inception to the 20th January 2022. STUDY ELIGIBILITY CRITERIA: Randomised controlled trials (RCTs) and controlled non-randomised studies (NRS) were eligible if they assessed interventions aiming to encourage awareness of fetal movement or fetal movement counting and/or improve the subsequent clinical management of RFM. Eligible populations were singleton pregnancies after 24 completed weeks of gestation. The primary review outcome was stillbirth; a number of secondary maternal and neonatal outcomes were specified in the review. STUDY APPRAISAL AND SYNTHESIS METHODS: Risk of bias was assessed using Cochrane Risk of Bias 2 and ROBINS-I for RCTs and NRS respectively. Variation due to heterogeneity was assessed using I2. Data from studies employing similar interventions was combined using random effects meta-analysis. RESULTS: 1,609 citations were identified; 190 full text papers were evaluated against the inclusion criteria, 18 studies (16 RCTs and 2 NRS) were included. The evidence is uncertain about the effect of encouraging awareness of fetal movement on stillbirth compared with standard care (two st

OBJECTIVE: Reduced fetal movement (RFM), defined as a decrease in maternal perception of frequency or strength of fetal movements, is a common reason for presentation to maternity care. Observational studies demonstrate an association between RFM, stillbirth, and fetal growth restriction related to placental insufficiency. However, individual intervention studies have described varying results. This systematic review and meta-analysis aimed to determine whether interventions aiming to encourage awareness of reduced fetal movement and/or improve its subsequent clinical management reduce the frequency of stillbirth or other important secondary outcomes. DATA SOURCES: Searches were conducted in MEDLINE, EMBASE, CINAHL, The Cochrane Library, Web of Science and Google Scholar. Guidelines, trial registries, and grey literature were also searched. Databases were searched from inception to the 20th January 2022. STUDY ELIGIBILITY CRITERIA: Randomised controlled trials (RCTs) and controlled non-randomised studies (NRS) were eligible if they assessed interventions aiming to encourage awareness of fetal movement or fetal movement counting and/or improve the subsequent clinical management of RFM. Eligible populations were singleton pregnancies after 24 completed weeks of gestation. The primary review outcome was stillbirth; a number of secondary maternal and neonatal outcomes were specified in the review. STUDY APPRAISAL AND SYNTHESIS METHODS: Risk of bias was assessed using Cochrane Risk of Bias 2 and ROBINS-I for RCTs and NRS respectively. Variation due to heterogeneity was assessed using I2. Data from studies employing similar interventions was combined using random effects meta-analysis. RESULTS: 1,609 citations were identified; 190 full text papers were evaluated against the inclusion criteria, 18 studies (16 RCTs and 2 NRS) were included. The evidence is uncertain about the effect of encouraging awareness of fetal movement on stillbirth compared with standard care (two st

OBJECTIVE: Reduced fetal movement (RFM), defined as a decrease in maternal perception of frequency or strength of fetal movements, is a common reason for presentation to maternity care. Observational studies demonstrate an association between RFM, stillbirth, and fetal growth restriction related to placental insufficiency. However, individual intervention studies have described varying results. This systematic review and meta-analysis aimed to determine whether interventions aiming to encourage awareness of reduced fetal movement and/or improve its subsequent clinical management reduce the frequency of stillbirth or other important secondary outcomes. DATA SOURCES: Searches were conducted in MEDLINE, EMBASE, CINAHL, The Cochrane Library, Web of Science and Google Scholar. Guidelines, trial registries, and grey literature were also searched. Databases were searched from inception to the 20th January 2022. STUDY ELIGIBILITY CRITERIA: Randomised controlled trials (RCTs) and controlled non-randomised studies (NRS) were eligible if they assessed interventions aiming to encourage awareness of fetal movement or fetal movement counting and/or improve the subsequent clinical management of RFM. Eligible populations were singleton pregnancies after 24 completed weeks of gestation. The primary review outcome was stillbirth; a number of secondary maternal and neonatal outcomes were specified in the review. STUDY APPRAISAL AND SYNTHESIS METHODS: Risk of bias was assessed using Cochrane Risk of Bias 2 and ROBINS-I for RCTs and NRS respectively. Variation due to heterogeneity was assessed using I2. Data from studies employing similar interventions was combined using random effects meta-analysis. RESULTS: 1,609 citations were identified; 190 full text papers were evaluated against the inclusion criteria, 18 studies (16 RCTs and 2 NRS) were included. The evidence is uncertain about the effect of encouraging awareness of fetal movement on stillbirth compared with standard care (two st

Introducción. La muerte perinatal es la muerte del feto o del recién nacido desde las 28 semanas de embarazo hasta la primera semana de vida y desencadena una experiencia traumática conocida como duelo perinatal. A pesar de su gran relevancia y sus graves consecuencias, la muerte del feto o del recién nacido es un tema tabú en la sociedad, dificultando el afrontamiento tanto para las familias como para los profesionales sanitarios al cuidado de las mismas. Justificación. La muerte perinatal es considerada actualmente como un evento “antinatural”, lo cual puede complicar el proceso de duelo. Esta invisibilidad en la que envolvemos la muerte perinatal puede provocar en las familias consecuencias que van más allá de la tristeza, de ahí la importancia de normalizar y visibilizar este tipo de situaciones en la sociedad. Objetivos. Conocer y comparar los factores culturales y de género que influyen en el afrontamiento de la muerte perinatal, así como estudiar la actuación de los profesionales sanitarios en el manejo de este tipo de situaciones. Métodos. Se llevó a cabo una búsqueda sistemática en las bases de datos Medline, Cuiden, Scielo y PsychInfo empleando una serie de palabras clave y aplicando los criterios de inclusión y exclusión seleccionados. Resultados. Fueron incluidos 20 estudios en el trabajo: 12 estudios descriptivos, 1 resumen de conferencia, 3 estudios de diseño mixto, 1 estudio fenomenológico y 3 estudios exploratorios. Conclusión. Como profesionales, entender las influencias sociales y culturales es crucial para mejorar el apoyo proporcionado a los padres y para lograr acabar con el estigma que rodea la muerte perinatal. La sociedad deberá ser fortalecida y sensibilizada a las necesidades de las familias en duelo para poder acabar con la estigmatización, la culpa y la invisibilización de la muerte perinatal., Introdución. A morte perinatal é a morte do feto ou do recén nacido dende as 28 semanas de embarazo ata a primeira semana de vida e desencadea unha experiencia traumática coñecida como duelo perinatal. A pesar da súa gran relevancia e as súas graves consecuencias, a morte do feto ou do recén nacido é un tema tabú na sociedade, dificultando o afrontamento tanto para as familias como para os profesionais sanitarios ao coidado das mesmas. Xustificación. A morte perinatal é considerada actualmente como un evento “antinatural”, o cal pode complicar o proceso de duelo. Esta invisibilidade na que envolvemos a morte perinatal pode provocar nas familias consecuencias que van máis alá da tristeza, de ahí a importancia de normalizar e visibilizar este tipo de situacións na sociedade. Obxectivos. Coñecer e comparar os factores culturais e de xénero que inflúen no afrontamento da morte perinatal, así como estudar a actuación dos profesionais sanitarios no manexo deste tipo de situacións. Métodos. Levouse a cabo unha búsqueda sistemática nas bases de datos Medline, Cuiden. Scielo e PsychInfo empleando unha serie de palabras clave e aplicando os criterios de inclusión e exclusión seleccionados. Resultados. Foron incluidos 20 estudios no traballo: 12 estudios descriptivos, 1 resumo de conferencia, 3 estudos de diseño mixto, 1 estudio fenomenolóxico e 2 estudos exploratorios. Conclusión. Como profesionais, entender as influencias sociais e culturais é crucial para mellorar o apoio proporcionado aos pais e para lograr acabar co estigma que rodea a morte perinatal. A sociedade deberá ser fortalecida e sensibilizada ás necesidades das familias en duelo para poder acabar ca estigmatización, a culpa e a invisibilización da morte perinatal., Introduction. Perinatal death is the death of the fetus or newborn from 28 weeks of pregnancy to the first week of life and it triggers a traumatic experience known as perinatal grief. Despite its great relevance and serious consequences, the death of the fetus or newborn is a taboo issue in our society, making coping difficult for both familias and health professionals. Justification. Perinatal death is currently considered an unnatural event, which can complicate the grieving process. This invisibility in which we involve perinatal death can cause consequences in families that go beyond sadness, hence the importance of normalizing and making visible this type of situations in our society. Aim. To know and to compare the cultural and gender factors that influence coping with perinatal death, as well as study health professionals’ behaviour in relation to the management of this type of situations. Methods. A systematic review was conducted through journal databases Medline, Cuiden, Scielo and PsychInfo using keywords and applying the selected inclusion and exclusion criteria. Results. A total of 20 articles were included: 12 descriptive studies, 1 conference summary, 3 mixed methods studies, 1 phenomenological study and 2 exploratory studies. Conclusions. As professionals, understanding social and cultural influences is crucial to improve the support provided to parents and to break down the stigma surrounding perinatal death. Society must be strengthened and sensitized to the needs of bereaved families in order to end stigmatization, guilt and invisibility.

Massive foeto-maternal transfusion (FMT) is the passage into the maternal circulation of >20% of foetal blood volume. It is associated with high perinatal morbidity and mortality1. FMT affects approximately 0.3-1:1,000 births and in non-complicated near-term pregnancies is frequently idiopathic1.Clinical manifestations are non-specific and are mostly represented by a decrease in active foetal movements (AFM). Foetal anaemia can be suggested by a sinusoidal rhythm on cardiotocography (CTG) and by high peak systolic velocity (PSV) of the middle cerebral artery (MCA); both tests, however, are liable to yield false negative results1. The conclusive diagnosis of FMT is based on maternal laboratory blood tests such as the Kleihauer-Betke, although the gold standard is currently flow cytometry which has been proven to be more sensitive and time-saving2. However, the latter test is not always available, and therefore FMT is to be considered when other possible origins of neonatal anaemia have been excluded. We aim to demonstrate the long-lasting persistence of foetal blood cells in the maternal circulation in a case of massive FMT. These data are useful in a clinical scenario when FMT is not immediately suspected or investigated.

Objective: Stillbirth is a potentially preventable complication of pregnancy. Identifying women at high risk of stillbirth can guide decisions on the need for closer surveillance and timing of delivery in order to prevent fetal death. Prognostic models have been developed to predict the risk of stillbirth, but none has yet been validated externally. In this study, we externally validated published prediction models for stillbirth using individual participant data (IPD) meta-analysis to assess their predictive performance. Methods: MEDLINE, EMBASE, DH-DATA and AMED databases were searched from inception to December 2020 to identify studies reporting stillbirth prediction models. Studies that developed or updated prediction models for stillbirth for use at any time during pregnancy were included. IPD from cohorts within the International Prediction of Pregnancy Complications (IPPIC) Network were used to validate externally the identified prediction models whose individual variables were available in the IPD. The risk of bias of the models and cohorts was assessed using the Prediction study Risk Of Bias ASsessment Tool (PROBAST). The discriminative performance of the models was evaluated using the C-statistic, and calibration was assessed using calibration plots, calibration slope and calibration-in-the-large. Performance measures were estimated separately in each cohort, as well as summarized across cohorts using random-effects meta-analysis. Clinical utility was assessed using net benefit. Results: Seventeen studies reporting the development of 40 prognostic models for stillbirth were identified. None of the models had been previously validated externally, and the full model equation was reported for only one-fifth (20%, 8/40) of the models. External validation was possible for three of these models, using IPD from 19 cohorts (491 201 pregnant women) within the IPPIC Network database. Based on evaluation of the model development studies, all three models had an overa

Background: Stillbirth rates are a health problem and they cause distractions in the families. There are more than 5 million perinatal deaths occurring each year, ending preventable stillbirths and neonatal deaths continues to form a significant part of the international public health agenda beyond 2015. There are several risk factors which are associated with stillbirths and this could be classified as maternal, foetal and external risk factors. Therefore, the focus of the study was on the prevalence and determinants of stillbirths in Dilokong Hospital of the Limpopo Province. Methods: A retrospective descriptive study was conducted which followed a quantitative approach. This study used secondary data from patient clinical records from the maternity ward in Dilokong Hospital. Comparison between groups for continuous and categorical variables was performed using student t-test, and chisquare test, respectively. P-value less than 0.05 at 95% confidence level was regarded as significant. Findings: The prevalence of stillbirth amongst women who delivered at Dilokong hospital between period 2016 and 2019 was 13.5 % (CI: 0.12 – 15.2). The prevalence of stillbirth is stratified by year and it shows that highest prevalence was in 2018 at 42.5% followed by 2017, 2019 and 2016 at 23.2%, 19.7% and 14.6 respectively. The prevalence of stillbirth increased with increasing maternal age from 0.4% in the age group ≤14 years to 26.2% then decreased to 21.5% in the age group 30 – 34 years. The prevalence of macerated stillbirth between period 2016 and 2019 was 11.0%, for fresh stillbirth was 2.6 %. There was significant association of age, marital status of pregnant women, level of education, parity, gravidity, syphilis and HIV status. Older women at age 18 years and above were 1.4 times more likely to have stillbirth and 1.9 times more likely to have fresh stillbirth at p<0.05. Single women were 3.3 times more likely to have stillbirth and 3 times more likely to have macerated sti

BackgroundA large proportion of early neonatal deaths occur at the time or on the first day of birth. The Preterm Birth Initiative East Africa (PTBi EA) set out to decrease mortality among preterm births through improving quality of facility-based intrapartum care. The PTBi EA cluster randomized trial's primary analysis showed the package reduced intrapartum stillbirth and neonatal death among preterm infants. This secondary analysis examines the impact of the PTBi intervention package on stillbirth and predischarge newborn deaths combined, among all births in 20 participating facilities in Kenya and Uganda.MethodsEligible facilities were pair-matched and randomly assigned (1:1) into either the intervention or the control group. All facilities received support for data strengthening and a modified World Health Organization (WHO) Safe Childbirth Checklist; facilities in the intervention group additionally received provider mentoring using PRONTO simulation and team training as well as quality improvement collaboratives. We abstracted data from maternity registers.ResultsOf the total 29 442 births that were included, Kenya had 8468 and 6465 births and Uganda had 8719 and 5790 births, in the control and intervention arms, respectively. There were 935 stillbirths and predischarge newborn deaths in the control arm and 439 in the intervention arm. The adjusted odds ratio (aOR) for the effect of the intervention on the combined outcome, among all births, was 0.96 (95% confidence interval (CI) = 0.69-1.32), which was different by country: Kenya - 1.12 (95% CI = 0.72-1.73); Uganda - 0.65 (95% CI = 0.44-0.98); Pinteraction = 0.025. These trends were similar after excluding the PTBi primary cohort.ConclusionsThe intervention package improved survival among all births in Uganda but not in Kenya. These results suggest the importance of context and facility differences that were observed between the two countries.RegistrationThis trial is registered with ClinicalTrials.gov, NCT0

[EU] Sarrera eta helburua: Heriotza perinatala familietan zein osasun profesionalengan emozio desberdinak eta dolu prozesua pizten duen ezusteko gertakaria da. Berrikuspen sistematiko honen helburuak heriotza perinatalari aurre egiteko erizainen gaitasuna determinatzea eta gurasoen dolua eramangarriagoa egiteko interbentzio efektiboak identifikatzea dira. Metodologia: PRISMA ezarpenetan oinarritutako berrikusketa sistematikoa. Lau datu baseetan (Medline, Web of Science, Scopus eta Cochrane Library) erabili zen bilaketa protokoloa zehaztu zen, eta 2009ko urtarrila eta 2020ko urtarrila artean egindako behaketazko hainbat ikerlan erantsi zitzaizkion. Emaitzak: Berrikusketarako, kohorteseko ikerketa prospektibo bat eta kalitate metodologiko eskasa duten zeharkako 10 ikerlan deskriptibo erabili ziren: horietako zortzitan heriotza perinatala pairatu zuten ama edota aiten testigantzak erabili ziren, beste bitan osasun profesionalenak, eta beste batean, aita, ama eta profesionalen testigantzak erabili ziren. Osasun-profesionalek zainketa fisikoetan zentratzeko joera dute; gurasoek haien egoera emozionalari buruz galdetuak izatea, haurtxoari identitatea ematea, familiako kide kontsideratzea eta haren memoriak sortzea eskertzen dute. Ondorioak: Osasun-profesionalen prestakuntza falta badago ere, alderdi emozionala tratatzeak eta gurasoak haurtxoaren memoriak sortzera animatzeak dolu prozesuan lagun dezakete., [ES] Introducción y objetivo: La muerte perinatal y neonatal es un suceso inesperado que desencadena diferentes emociones y un proceso de duelo tanto en familiares como en profesionales de la salud. Los objetivos de esta revisión sistemática se centran en determinar la capacidad de la enfermería para afrontar la muerte perinatal e identificar intervenciones efectivas para hacer un duelo menos traumático. Metodología: Revisión sistemática en base a las disposiciones PRISMA. Se elaboró un protocolo de búsqueda que se utilizó en cuatro diferentes bases de datos (Medline, Web of Science, Scopus y Cochrane Library) y se incluyeron estudios observacionales publicados entre enero de 2009 y enero de 2020. Resultados: La revisión se realizó a partir de 11 estudios descriptivos transversales de escasa calidad metodológica: en 8 de ellos se contó con los testimonios de padres y/o madres, en 2 de ellos con el de profesionales de la salud y en otro con el padres, madres y médicos, y un estudio de cohortes prospectivo realizado sobre 26 madres que sufrieron una muerte perinatal. Los profesionales de la salud tienden a centrarse en el cuidado físico; los padres agradecen ser preguntados por su estado emocional, dar identidad al bebé, considerarlo un miembro más de la familia y crear memorias del mismo. Conclusiones: A pesar de la falta de formación del personal sanitario, tratar el aspecto emocional y animar a crear memorias del bebé pueden ayudar en el proceso de duelo., [EN] Background and objective: Perinatal death is an unexpected event that triggers different emotions and a grieving process in families and also in health care professionals. The aims of this systematic review are to assess nursing ability to cope with perinatal death and determine effective interventions to make a bearable grief in parents who have suffered perinatal death. Methods: A PRISMA-based Systematic Review was performed. A search protocol was developed to be used in 4 databases (Medline, Web of Science, Scopus and Cochrane Library). Observational studies published between January 2009 and January 2020 were included. Results: The review was done from one prospective cohort study and 11 cross-sectional descriptive studies with limited methodological quality: in 8 testimonies of fathers and/or mothers who have suffered perinatal death were used, in 2 others healthcare professionals’ testimonies and in another one fathers’, mothers’ and professionals’ testimonies were used. Health care professionals tend to focus on physical care; parents appreciate being asked about their emotional state, giving an identity to the baby, considering him or her as a family member and creating baby’s memories. Conclusions: Despite the lack of training of health care professionals, treating the emotional aspect and encouraging parents creating baby’s memories can help in the grieving process.

Objective To investigate the association between mirtazapine exposure in pregnancy and risk of specific adverse pregnancy outcomes.Methods A register-based nationwide cohort study was conducted including all registered pregnancies in Denmark from 1997 to 2016. Mirtazapine-exposed pregnancies were compared with mirtazapine unexposed pregnancies in a 1:4 ratio matched according to propensity scores. Outcomes were major congenital malformations analyzed using log binomial models, and spontaneous abortion, stillbirth and neonatal death analyzed using Cox proportional hazard regression.Results From a source population of 1,650,649 pregnancies, the propensity score-matched cohort included 4475 pregnancies (895 mirtazapine exposed) in the analysis of major congenital malformations. The analyses of spontaneous abortion included 9 500 pregnancies (1900 mirtazapine exposed), and for the analyses of stillbirths and neonatal deaths 9725 (1 945 mirtazapine-exposed) and 4485 pregnancies (897 mirtazapine-exposed) were included, respectively. Thirty-one (3.5%) children were diagnosed with major congenital malformation among the mirtazapine exposed compared with 152 (4.3%) among the unexposed pregnancies (OR=0.81, 95% CI 0.55-1.20). Spontaneous abortion occurred in 237 (12.5%) of the mirtazapine exposed compared with 931 (12.3%) of the unexposed pregnancies (HR = 1.04%, 95% CI 0.91-1.20). The analyses revealed no increased risk of stillbirth (HR = 0.88%, 95% CI 0.34-2.29) or neonatal death (HR = 0.60%, 95% CI 0.18-2.02).Conclusions In this nationwide Danish register study, mirtazapine exposure in pregnancy was not associated with major congenital malformations, spontaneous abortion, stillbirth, or neonatal death. Clinicians and patients can be reassured that mirtazapine is safe in pregnancy.

Using provisional or opportunistic data, three nationwide studies (The Netherlands, the USA and Denmark) have identified a reduction in preterm or extremely preterm births during periods of COVID-19 restrictions. However, none of the studies accounted for perinatal deaths. To determine whether the reduction in extremely preterm births, observed in Denmark during the COVID-19 lockdown, could be the result of an increase in perinatal deaths and to assess the impact of extended COVID-19 restrictions, we performed a nationwide Danish register-based prevalence proportion study. We examined all singleton pregnancies delivered in Denmark during the COVID-19 strict lockdown calendar periods (March 12-April 14, 2015-2020, N = 31,164 births) and the extended calendar periods of COVID-19 restrictions (February 27-September 30, 2015-2020, N = 214,862 births). The extremely preterm birth rate was reduced (OR 0.27, 95% CI 0.07 to 0.86) during the strict lockdown period in 2020, while perinatal mortality was not significantly different. During the extended period of restrictions in 2020, the extremely preterm birth rate was marginally reduced, and a significant reduction in the stillbirth rate (OR 0.69, 0.50 to 0.95) was observed. No changes in early neonatal mortality rates were found.Conclusion: Stillbirth and extremely preterm birth rates were reduced in Denmark during the period of COVID-19 restrictions and lockdown, respectively, suggesting that aspects of these containment and control measures confer an element of protection. The present observational study does not allow for causal inference; however, the results support the design of studies to ascertain whether behavioural or social changes for pregnant women may improve pregnancy outcomes. What is Known: • The aetiologies of preterm birth and stillbirth are multifaceted and linked to a wide range of socio-demographic, medical, obstetric, foetal, psychosocial and environmental factors. • The COVID-19 lockdown saw a red

[EU] Sarrera eta helburua: Heriotza perinatala familietan zein osasun profesionalengan emozio desberdinak eta dolu prozesua pizten duen ezusteko gertakaria da. Berrikuspen sistematiko honen helburuak heriotza perinatalari aurre egiteko erizainen gaitasuna determinatzea eta gurasoen dolua eramangarriagoa egiteko interbentzio efektiboak identifikatzea dira. Metodologia: PRISMA ezarpenetan oinarritutako berrikusketa sistematikoa. Lau datu baseetan (Medline, Web of Science, Scopus eta Cochrane Library) erabili zen bilaketa protokoloa zehaztu zen, eta 2009ko urtarrila eta 2020ko urtarrila artean egindako behaketazko hainbat ikerlan erantsi zitzaizkion. Emaitzak: Berrikusketarako, kohorteseko ikerketa prospektibo bat eta kalitate metodologiko eskasa duten zeharkako 10 ikerlan deskriptibo erabili ziren: horietako zortzitan heriotza perinatala pairatu zuten ama edota aiten testigantzak erabili ziren, beste bitan osasun profesionalenak, eta beste batean, aita, ama eta profesionalen testigantzak erabili ziren. Osasun-profesionalek zainketa fisikoetan zentratzeko joera dute; gurasoek haien egoera emozionalari buruz galdetuak izatea, haurtxoari identitatea ematea, familiako kide kontsideratzea eta haren memoriak sortzea eskertzen dute. Ondorioak: Osasun-profesionalen prestakuntza falta badago ere, alderdi emozionala tratatzeak eta gurasoak haurtxoaren memoriak sortzera animatzeak dolu prozesuan lagun dezakete., [ES] Introducción y objetivo: La muerte perinatal y neonatal es un suceso inesperado que desencadena diferentes emociones y un proceso de duelo tanto en familiares como en profesionales de la salud. Los objetivos de esta revisión sistemática se centran en determinar la capacidad de la enfermería para afrontar la muerte perinatal e identificar intervenciones efectivas para hacer un duelo menos traumático. Metodología: Revisión sistemática en base a las disposiciones PRISMA. Se elaboró un protocolo de búsqueda que se utilizó en cuatro diferentes bases de datos (Medline, Web of Science, Scopus y Cochrane Library) y se incluyeron estudios observacionales publicados entre enero de 2009 y enero de 2020. Resultados: La revisión se realizó a partir de 11 estudios descriptivos transversales de escasa calidad metodológica: en 8 de ellos se contó con los testimonios de padres y/o madres, en 2 de ellos con el de profesionales de la salud y en otro con el padres, madres y médicos, y un estudio de cohortes prospectivo realizado sobre 26 madres que sufrieron una muerte perinatal. Los profesionales de la salud tienden a centrarse en el cuidado físico; los padres agradecen ser preguntados por su estado emocional, dar identidad al bebé, considerarlo un miembro más de la familia y crear memorias del mismo. Conclusiones: A pesar de la falta de formación del personal sanitario, tratar el aspecto emocional y animar a crear memorias del bebé pueden ayudar en el proceso de duelo., [EN] Background and objective: Perinatal death is an unexpected event that triggers different emotions and a grieving process in families and also in health care professionals. The aims of this systematic review are to assess nursing ability to cope with perinatal death and determine effective interventions to make a bearable grief in parents who have suffered perinatal death. Methods: A PRISMA-based Systematic Review was performed. A search protocol was developed to be used in 4 databases (Medline, Web of Science, Scopus and Cochrane Library). Observational studies published between January 2009 and January 2020 were included. Results: The review was done from one prospective cohort study and 11 cross-sectional descriptive studies with limited methodological quality: in 8 testimonies of fathers and/or mothers who have suffered perinatal death were used, in 2 others healthcare professionals’ testimonies and in another one fathers’, mothers’ and professionals’ testimonies were used. Health care professionals tend to focus on physical care; parents appreciate being asked about their emotional state, giving an identity to the baby, considering him or her as a family member and creating baby’s memories. Conclusions: Despite the lack of training of health care professionals, treating the emotional aspect and encouraging parents creating baby’s memories can help in the grieving process.

Background: Low dose aspirin (LDA) is an effective strategy to reduce preterm birth. However, LDA might have differential effects globally, based on the etiology of preterm birth. In some regions, malaria in pregnancy could be an important modifier of LDA on birth outcomes and anemia. Methods: This is a sub-study of the ASPIRIN trial, a multi-national, randomized, placebo controlled trial evaluating LDA effect on preterm birth. We enrolled a convenience sample of women in the ASPIRIN trial from the Democratic Republic of Congo (DRC), Kenya and Zambia. We used quantitative polymerase chain reaction to detect malaria. We calculated crude prevalence proportion ratios (PRs) for LDA by malaria for outcomes, and regression modelling to evaluate effect measure modification. We evaluated hemoglobin in late pregnancy based on malaria infection in early pregnancy. Results: One thousand four hundred forty-six women were analyzed, with a malaria prevalence of 63% in the DRC site, 38% in the Kenya site, and 6% in the Zambia site. Preterm birth occurred in 83 (LDA) and 90 (placebo) women, (PR 0.92, 95% CI 0.70, 1.22), without interaction between LDA and malaria (p = 0.75). Perinatal mortality occurred in 41 (LDA) and 43 (placebo) pregnancies, (PR 0.95, 95% CI 0.63, 1.44), with an interaction between malaria and LDA (p = 0.014). Hemoglobin was similar by malaria and LDA status. Conclusions: Malaria in early pregnancy did not modify the effects of LDA on preterm birth, but modified the effect of LDA on perinatal mortality. This effect measure modification deserves continued study as LDA is used in malaria endemic regions.

[EU] Sarrera eta helburua: Heriotza perinatala familietan zein osasun profesionalengan emozio desberdinak eta dolu prozesua pizten duen ezusteko gertakaria da. Berrikuspen sistematiko honen helburuak heriotza perinatalari aurre egiteko erizainen gaitasuna determinatzea eta gurasoen dolua eramangarriagoa egiteko interbentzio efektiboak identifikatzea dira. Metodologia: PRISMA ezarpenetan oinarritutako berrikusketa sistematikoa. Lau datu baseetan (Medline, Web of Science, Scopus eta Cochrane Library) erabili zen bilaketa protokoloa zehaztu zen, eta 2009ko urtarrila eta 2020ko urtarrila artean egindako behaketazko hainbat ikerlan erantsi zitzaizkion. Emaitzak: Berrikusketarako, kohorteseko ikerketa prospektibo bat eta kalitate metodologiko eskasa duten zeharkako 10 ikerlan deskriptibo erabili ziren: horietako zortzitan heriotza perinatala pairatu zuten ama edota aiten testigantzak erabili ziren, beste bitan osasun profesionalenak, eta beste batean, aita, ama eta profesionalen testigantzak erabili ziren. Osasun-profesionalek zainketa fisikoetan zentratzeko joera dute; gurasoek haien egoera emozionalari buruz galdetuak izatea, haurtxoari identitatea ematea, familiako kide kontsideratzea eta haren memoriak sortzea eskertzen dute. Ondorioak: Osasun-profesionalen prestakuntza falta badago ere, alderdi emozionala tratatzeak eta gurasoak haurtxoaren memoriak sortzera animatzeak dolu prozesuan lagun dezakete., [ES] Introducción y objetivo: La muerte perinatal y neonatal es un suceso inesperado que desencadena diferentes emociones y un proceso de duelo tanto en familiares como en profesionales de la salud. Los objetivos de esta revisión sistemática se centran en determinar la capacidad de la enfermería para afrontar la muerte perinatal e identificar intervenciones efectivas para hacer un duelo menos traumático. Metodología: Revisión sistemática en base a las disposiciones PRISMA. Se elaboró un protocolo de búsqueda que se utilizó en cuatro diferentes bases de datos (Medline, Web of Science, Scopus y Cochrane Library) y se incluyeron estudios observacionales publicados entre enero de 2009 y enero de 2020. Resultados: La revisión se realizó a partir de 11 estudios descriptivos transversales de escasa calidad metodológica: en 8 de ellos se contó con los testimonios de padres y/o madres, en 2 de ellos con el de profesionales de la salud y en otro con el padres, madres y médicos, y un estudio de cohortes prospectivo realizado sobre 26 madres que sufrieron una muerte perinatal. Los profesionales de la salud tienden a centrarse en el cuidado físico; los padres agradecen ser preguntados por su estado emocional, dar identidad al bebé, considerarlo un miembro más de la familia y crear memorias del mismo. Conclusiones: A pesar de la falta de formación del personal sanitario, tratar el aspecto emocional y animar a crear memorias del bebé pueden ayudar en el proceso de duelo., [EN] Background and objective: Perinatal death is an unexpected event that triggers different emotions and a grieving process in families and also in health care professionals. The aims of this systematic review are to assess nursing ability to cope with perinatal death and determine effective interventions to make a bearable grief in parents who have suffered perinatal death. Methods: A PRISMA-based Systematic Review was performed. A search protocol was developed to be used in 4 databases (Medline, Web of Science, Scopus and Cochrane Library). Observational studies published between January 2009 and January 2020 were included. Results: The review was done from one prospective cohort study and 11 cross-sectional descriptive studies with limited methodological quality: in 8 testimonies of fathers and/or mothers who have suffered perinatal death were used, in 2 others healthcare professionals’ testimonies and in another one fathers’, mothers’ and professionals’ testimonies were used. Health care professionals tend to focus on physical care; parents appreciate being asked about their emotional state, giving an identity to the baby, considering him or her as a family member and creating baby’s memories. Conclusions: Despite the lack of training of health care professionals, treating the emotional aspect and encouraging parents creating baby’s memories can help in the grieving process.

Objective To investigate the association between mirtazapine exposure in pregnancy and risk of specific adverse pregnancy outcomes.Methods A register-based nationwide cohort study was conducted including all registered pregnancies in Denmark from 1997 to 2016. Mirtazapine-exposed pregnancies were compared with mirtazapine unexposed pregnancies in a 1:4 ratio matched according to propensity scores. Outcomes were major congenital malformations analyzed using log binomial models, and spontaneous abortion, stillbirth and neonatal death analyzed using Cox proportional hazard regression.Results From a source population of 1,650,649 pregnancies, the propensity score-matched cohort included 4475 pregnancies (895 mirtazapine exposed) in the analysis of major congenital malformations. The analyses of spontaneous abortion included 9 500 pregnancies (1900 mirtazapine exposed), and for the analyses of stillbirths and neonatal deaths 9725 (1 945 mirtazapine-exposed) and 4485 pregnancies (897 mirtazapine-exposed) were included, respectively. Thirty-one (3.5%) children were diagnosed with major congenital malformation among the mirtazapine exposed compared with 152 (4.3%) among the unexposed pregnancies (OR=0.81, 95% CI 0.55-1.20). Spontaneous abortion occurred in 237 (12.5%) of the mirtazapine exposed compared with 931 (12.3%) of the unexposed pregnancies (HR = 1.04%, 95% CI 0.91-1.20). The analyses revealed no increased risk of stillbirth (HR = 0.88%, 95% CI 0.34-2.29) or neonatal death (HR = 0.60%, 95% CI 0.18-2.02).Conclusions In this nationwide Danish register study, mirtazapine exposure in pregnancy was not associated with major congenital malformations, spontaneous abortion, stillbirth, or neonatal death. Clinicians and patients can be reassured that mirtazapine is safe in pregnancy.

Using provisional or opportunistic data, three nationwide studies (The Netherlands, the USA and Denmark) have identified a reduction in preterm or extremely preterm births during periods of COVID-19 restrictions. However, none of the studies accounted for perinatal deaths. To determine whether the reduction in extremely preterm births, observed in Denmark during the COVID-19 lockdown, could be the result of an increase in perinatal deaths and to assess the impact of extended COVID-19 restrictions, we performed a nationwide Danish register-based prevalence proportion study. We examined all singleton pregnancies delivered in Denmark during the COVID-19 strict lockdown calendar periods (March 12-April 14, 2015-2020, N = 31,164 births) and the extended calendar periods of COVID-19 restrictions (February 27-September 30, 2015-2020, N = 214,862 births). The extremely preterm birth rate was reduced (OR 0.27, 95% CI 0.07 to 0.86) during the strict lockdown period in 2020, while perinatal mortality was not significantly different. During the extended period of restrictions in 2020, the extremely preterm birth rate was marginally reduced, and a significant reduction in the stillbirth rate (OR 0.69, 0.50 to 0.95) was observed. No changes in early neonatal mortality rates were found.Conclusion: Stillbirth and extremely preterm birth rates were reduced in Denmark during the period of COVID-19 restrictions and lockdown, respectively, suggesting that aspects of these containment and control measures confer an element of protection. The present observational study does not allow for causal inference; however, the results support the design of studies to ascertain whether behavioural or social changes for pregnant women may improve pregnancy outcomes. What is Known: • The aetiologies of preterm birth and stillbirth are multifaceted and linked to a wide range of socio-demographic, medical, obstetric, foetal, psychosocial and environmental factors. • The COVID-19 lockdown saw a red

One in seven COVID-19 cases had at least one preexisting condition; most reported conditions were chronic. Pulmonary disease, hypertension, and diabetes were the most commonly reported chronic conditions. The proportion of hospitalized COVID-19 cases was highest among those with pre-existing conditions including chronic pulmonary disease, hypertention, and diabetes. This publication also includes: 1) Spotlights: Emergency Department Visits by Race and Ethnicity; and 2) Monthly Health Indicators Report.

Stillbirths (fetal deaths at ≥20 weeks of gestation) are associated with devastating and long-lasting adverse effects on parents, families, the health care system, and society. In 2017, the national rate of stillbirth was 5.89 stillbirths per 1000 live births and stillbirths. In Utah, 244 stillbirths occurred in 2019, for a rate of 5.21 stillbirths per 1000 live births and stillbirths. Although stillbirths are one of the most common adverse pregnancy outcomes, little is known about the experiences, perspectives, and needs of bereaved parents after a stillbirth. This publication also includes: 1) Spotlights: Medicaid Members with Hepatitis C Treatment Initiative; 2) Role of Interactive Dashboard Development in COVID-19 Response; and 3) Monthly Health Indicators Report.

One in seven COVID-19 cases had at least one preexisting condition; most reported conditions were chronic. Pulmonary disease, hypertension, and diabetes were the most commonly reported chronic conditions. The proportion of hospitalized COVID-19 cases was highest among those with pre-existing conditions including chronic pulmonary disease, hypertention, and diabetes. This publication also includes: 1) Spotlights: Emergency Department Visits by Race and Ethnicity; and 2) Monthly Health Indicators Report.

Stillbirths (fetal deaths at ≥20 weeks of gestation) are associated with devastating and long-lasting adverse effects on parents, families, the health care system, and society. In 2017, the national rate of stillbirth was 5.89 stillbirths per 1000 live births and stillbirths. In Utah, 244 stillbirths occurred in 2019, for a rate of 5.21 stillbirths per 1000 live births and stillbirths. Although stillbirths are one of the most common adverse pregnancy outcomes, little is known about the experiences, perspectives, and needs of bereaved parents after a stillbirth. This publication also includes: 1) Spotlights: Medicaid Members with Hepatitis C Treatment Initiative; 2) Role of Interactive Dashboard Development in COVID-19 Response; and 3) Monthly Health Indicators Report.

BackgroundSome scholars posit that attempts to avert stillbirth among extremely preterm gestations may result in a live birth but an early neonatal death. The literature, however, reports no empirical test of this potential form of left truncation. We examine whether annual cohorts delivered at extremely preterm gestational ages show an inverse correlation between their incidence of stillbirth and early neonatal death.MethodsWe retrieved live birth and infant death information from the California Linked Birth and Infant Death Cohort Files for years 1989 to 2015. We defined the extremely preterm period as delivery from 22 to < 28 weeks of gestation and early neonatal death as infant death at less than 7 days of life. We calculated proportions of stillbirth and early neonatal death separately by cohort year, race/ethnicity, and sex. Our correlational analysis controlled for well-documented declines in neonatal mortality over time.ResultsCalifornia reported 89,276 extremely preterm deliveries (live births and stillbirths) to Hispanic, non-Hispanic (NH) Black, and NH white mothers from 1989 to 2015. Findings indicate an inverse correlation between stillbirth and early neonatal death in the same cohort year (coefficient: -0.27, 95% CI of - 0.11; - 0.42). Results remain robust to alternative specifications and falsification tests.ConclusionsFindings support the notion that cohorts with an elevated risk of stillbirth also show a reduced risk of early neonatal death among extremely preterm deliveries. Results add to the evidence base that selection in utero may influence the survival characteristics of live-born cohorts.

La mort a finals del segle XIX es va anar silenciant, amagant les emocions i sentiments que sorgien d'aquesta i es va anar creant, fins el dia d'avui, un entramat de tabús i prejudicis. En aquest treball es pretén investigar la mort gestacional i perinatal, analitzant la intersecció entre un fet aparentment "individual" (nomenament d'un/a fill/a; els entrebancs legals que suposa fer-ho i la pràctica de fotografiar al nonat difunt com un element clau pel duel) amb un de social (la desinformació social sobre les morts gestacionals i perinatals derivada del context legal espanyol). Així doncs, el component important és l'encreuament que es deriva entre el nom, la imatge i el verb recordar, que lligarà amb força la intersecció entre les dos vessants principals de la composició. És en aquest punt on entra la importància dels rituals que calen per digerir el procés psicològic que suposa la pèrdua d'un ésser estimat, desxifrant la importància de donar un lloc a la persona absent., La muerte a finales del siglo XIX se fue silenciando, escondiendo las emociones y sentimientos que surgían de ésta y se fue creando, hasta el día de hoy, un entramado de tabúes y prejuicios. En este trabajo se pretende investigar la muerte gestacional y perinatal, analizando la intersección entre un hecho aparentemente "individual" (nombramiento de un/a hijo/a, los obstáculos legales que supone hacerlo y la práctica de fotografiar al nonato difunto como un elemento clave para el duelo) con uno social (la desinformación social sobre las muertes gestacionales y perinatales derivada del contexto legal español). Así entonces, el componente importante es el cruce que se deriva entre el nombre, la imagen y el verbo recordar, que ligará con fuerza la intersección entre las dos vertientes principales de la composición. Es en este punto donde entra la importancia de los rituales que se necesitan para digerir el proceso psicológico que supone la pérdida de un ser querido, descifrando la importancia de dar un lugar a la persona ausente., Death in the late nineteenth century was silenced, hiding the emotions and feelings that arose from it and was created, to this day, a web of taboos and prejudices. This work aims to investigate gestational and perinatal death, analyzing the intersection between a seemingly "individual" event (naming a child; the legal obstacles involved in doing so and the practice of photographing the deceased unborn child as a key element for the duel) with a social one (social misinformation about gestational and perinatal deaths arising from the Spanish legal context). Thus, the important component is the cross between the noun, the image and the verb remember, which will strongly link the intersection between the two main aspects of the composition. It is at this point that the importance of the rituals needed to digest the psychological process of losing a loved one comes into play, deciphering the importance of giving a place to the absent person.

Perinatal death is the death of a baby that occurs between the 22nd week of pregnancy (or when the baby weighs more than 500 g) and 7 days after birth. After perinatal death, parents experience the process of perinatal grief. Midwives and nurses can develop interventions to improve the perinatal grief process. The aim of this review was to determine the efficacy of nursing interventions to facilitate the process of grief as a result of perinatal death. A systematic review of the literature was carried out. Studies that met the selection criteria underwent a quality assessment using the Joanna Briggs Institute critical appraisal tool. Four articles were selected out of the 640 found. Two are quasi-experimental studies, and two are randomized controlled clinical studies. The interventions that were analyzed positively improve psychological self-concept and role functions, as well as mutual commitment, depression, post-traumatic stress and symptoms of grief. These interventions are effective if they are carried out both before perinatal loss and after it has occurred. The support of health professionals for affected parents, their participation in the loss, expressing feelings and emotions, using distraction methods, group sessions, social support, physical activity, and family education are some of the effective interventions.

Background: Mechanical methods were the first methods developed to ripen the cervix and induce labour. During recent decades they have been substituted by pharmacological methods. Potential advantages of mechanical methods, compared with pharmacological methods may include reduction in side effects that could improve neonatal outcomes. This is an update of a review first published in 2001, last updated in 2012. Objective(s): To determine the effectiveness and safety of mechanical methods for third trimester (> 24 weeks' gestation) induction of labour in comparison with prostaglandin E2 (PGE2) (vaginal and intracervical), low-dose misoprostol (oral and vaginal), amniotomy or oxytocin. Search Method(s): For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP), and reference lists of retrieved studies (9 January 2018). We updated the search in March 2019 and added the search results to the awaiting classification section of the review. Selection Criteria: Clinical trials comparing mechanical methods used for third trimester cervical ripening or labour induction with pharmacological methods. Mechanical methods include: (1) the introduction of a catheter through the cervix into the extra-amniotic space with balloon insufflation; (2) introduction of laminaria tents, or their synthetic equivalent (Dilapan), into the cervical canal; (3) use of a catheter to inject fluid into the extra-amniotic space (EASI). This review includes the following comparisons: (1) specific mechanical methods (balloon catheter, laminaria tents or EASI) compared with prostaglandins (different types, different routes) or with oxytocin; (2) single balloon compared to a double balloon; (3) addition of prostaglandins or oxytocin to mechanical methods compared with prostaglandins or oxytocin alone. Data Collection and Analysis: Two review authors independently assessed trials for inclusion and as

Background: Mechanical methods were the first methods developed to ripen the cervix and induce labour. During recent decades they have been substituted by pharmacological methods. Potential advantages of mechanical methods, compared with pharmacological methods may include reduction in side effects that could improve neonatal outcomes. This is an update of a review first published in 2001, last updated in 2012. Objective(s): To determine the effectiveness and safety of mechanical methods for third trimester (> 24 weeks' gestation) induction of labour in comparison with prostaglandin E2 (PGE2) (vaginal and intracervical), low-dose misoprostol (oral and vaginal), amniotomy or oxytocin. Search Method(s): For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP), and reference lists of retrieved studies (9 January 2018). We updated the search in March 2019 and added the search results to the awaiting classification section of the review. Selection Criteria: Clinical trials comparing mechanical methods used for third trimester cervical ripening or labour induction with pharmacological methods. Mechanical methods include: (1) the introduction of a catheter through the cervix into the extra-amniotic space with balloon insufflation; (2) introduction of laminaria tents, or their synthetic equivalent (Dilapan), into the cervical canal; (3) use of a catheter to inject fluid into the extra-amniotic space (EASI). This review includes the following comparisons: (1) specific mechanical methods (balloon catheter, laminaria tents or EASI) compared with prostaglandins (different types, different routes) or with oxytocin; (2) single balloon compared to a double balloon; (3) addition of prostaglandins or oxytocin to mechanical methods compared with prostaglandins or oxytocin alone. Data Collection and Analysis: Two review authors independently assessed trials for inclusion and as

Background: Aboriginal infants have poorer birth outcomes than non-Aboriginal infants. Harmful use of tobacco, alcohol, and other substances is higher among Aboriginal women, as is violence, due to factors such as intergenerational trauma and poverty. We estimated the proportion of small for gestational age (SGA) births, preterm births, and perinatal deaths that could be attributed to these risks. Methods: Birth, hospital, mental health, and death records for Aboriginal singleton infants born in Western Australia from 1998 to 2010 and their parents were linked. Using logistic regression with a generalized estimating equation approach, associations with birth outcomes and population attributable fractions were estimated after adjusting for demographic factors and maternal health during pregnancy. Results: Of 28,119 births, 16% of infants were SGA, 13% were preterm, and 2% died perinatally. 51% of infants were exposed in utero to at least one of the risk factors and the fractions attributable to them were 37% (SGA), 16% (preterm) and 20% (perinatal death). Conclusions: A large proportion of adverse outcomes were attributable to the modifiable risk factors of substance use and assault. Significant improvements in Aboriginal perinatal health are likely to follow reductions in these risk factors. These results highlight the importance of identifying and implementing risk reduction measures which are effective in, and supported by, Aboriginal women, families, and communities.

BackgroundIntrahepatic cholestasis of pregnancy is associated with adverse perinatal outcomes, but the association with the concentration of specific biochemical markers is unclear. We aimed to quantify the adverse perinatal effects of intrahepatic cholestasis of pregnancy in women with increased serum bile acid concentrations and determine whether elevated bile acid concentrations were associated with the risk of stillbirth and preterm birth.MethodsWe did a systematic review by searching PubMed, Web of Science, and Embase databases for studies published from database inception to June 1, 2018, reporting perinatal outcomes for women with intrahepatic cholestasis of pregnancy when serum bile acid concentrations were available. Inclusion criteria were studies defining intrahepatic cholestasis of pregnancy based upon pruritus and elevated serum bile acid concentrations, with or without raised liver aminotransferase concentrations. Eligible studies were case-control, cohort, and population-based studies, and randomised controlled trials, with at least 30 participants, and that reported bile acid concentrations and perinatal outcomes. Studies at potential higher risk of reporter bias were excluded, including case reports, studies not comprising cohorts, or successive cases seen in a unit; we also excluded studies with high risk of bias from groups selected (eg, a subgroup of babies with poor outcomes were explicitly excluded), conference abstracts, and Letters to the Editor without clear peer review. We also included unpublished data from two UK hospitals. We did a random effects meta-analysis to determine risk of adverse perinatal outcomes. Aggregate data for maternal and perinatal outcomes were extracted from case-control studies, and individual patient data (IPD) were requested from study authors for all types of study (as no control group was required for the IPD analysis) to assess associations between biochemical markers and adverse outcomes using logistic and step

La muerte perinatal desde el ámbito institucional es un hecho de difícil confrontación tanto para los padres quienes experimentan la pérdida, como para el personal de salud que presencia el evento.La teoría de Kristen Swanson, considera que la meta de la enfermería es brindar cuidado a la mujer y su núcleo familiar, de manera significativa para ayudarla en la aceptación de la muerte de un ser querido. El apoyo que el personal de salud brinda a los padres y la familia, es significativa en la aceptación de la pérdida y la elaboración del duelo. El presente artículo relata la experiencia de una enfermera en su interacción con una mujer que afronto la muerte de su hija al momento de nacer. Se analiza con base en la teoría de los cuidados de Kristen Swanson y se centra en los elementos metaparadigmáticos y los procesos o categorías del cuidado de enfermería., Perinatal death from an institutional view is a matter of difficult confrontation for both, parents who experience the loss, as for the health personnel present at the event. Kristen Swanson theory considers that the goal of nursing is to provide care, for women and her family, significantly to help in the acceptance of the death of a loved one. The support health personnel provide for parents and their family, is significant in the acceptance of the loss and the development of the grieving process. This article tells the experience of a nurse in her interaction with a woman who faced the death of his daughter at the time of birth. It is analyzed based on the Kristen Swanson Care Theory, focuses on the meta-paradigmatics elements and processes or categories of care., Morte perinatal a partir de uma visão institucional é uma questão de confronto difícil para ambos, os pais que sofrem a perda, como para os profissionais de saúde presentes no evento. Teoria Kristen Swanson considera que a meta da enfermagem é a prestação de cuidados, para as mulheres e sua família, de forma significativa para ajudar na aceitação da morte de um ente querido. Os profissionais de saúde de apoio fornecer aos pais e sua família, é significativa na aceitação da perda e para o desenvolvimento do processo de luto. Este artigo conta a experiência de uma enfermeira em sua interação com uma mulher que enfrentou a morte de sua filha no momento do nascimento. Analisou baseia-se na Teoria do Cuidado Swanson Kristen, incide sobre os elementos e processos ou categorias de cuidados de meta-paradigmáticas.

OBJECTIVE: To evaluate whether there is a differential benefit from planned cesarean delivery (CD) for women with a twin pregnancy and a cephalic-presenting first twin; depending on a pre-specified list of maternal and pregnancy characteristics (markers), and/or gestational age (GA) at delivery. METHOD(S): We performed a secondary analysis of the Twin Birth Study (TBS) including 2,804 women with a twin pregnancy with a cephalic-presenting first twin between GA of 32+0 and 38+6weeks in 106 centres in 25 countries. We built a separate logistic regression model for each marker to model the composite outcome as function of the specific marker, planned delivery mode, and marker-by-planned-delivery-mode-interaction, and furthermore performed multivariable logistic regression with backward variable elimination separately in each trial arm. Markers considered were maternal age, parity, history of previous CD, use of antenatal corticosteroids, estimated fetal weight (EFW) of twin A, EFW of twin B, >25% difference in EFW of the twins, presentation of twin B, chorionicity on ultrasound, method of conception, complications of pregnancy, ruptured membranes at randomization and GA at randomization. The main outcome measure was a composite adverse perinatal outcome (perinatal death or serious neonatal morbidity). RESULT(S): None of the studied baseline markers was associated with differential benefit from planned CD. GA at delivery was differentially associated with the outcome in the treatment arms (p for interaction 0.001). GA at delivery was differentially associated with the outcome in the treatment arms (p for interaction 0.001). For GA 32+0- 36+6weeks, VD was associated with fewer adverse outcomes compared to CD (OR 0.62; 95% CI 0.37-1.03). At >=37+0weeks, 10 (1%) newborns suffered the composite perinatal outcome after planned CD versus 23 (2%) after planned VD (OR 2.25; 95% CI 1.06-4.77). CONCLUSION(S): Neonatal outcomes of twin pregnancies with the first twin in cephalic p

OBJECTIVE: To evaluate whether there is a differential benefit from planned cesarean delivery (CD) for women with a twin pregnancy and a cephalic-presenting first twin; depending on a pre-specified list of maternal and pregnancy characteristics (markers), and/or gestational age (GA) at delivery. METHOD(S): We performed a secondary analysis of the Twin Birth Study (TBS) including 2,804 women with a twin pregnancy with a cephalic-presenting first twin between GA of 32+0 and 38+6weeks in 106 centres in 25 countries. We built a separate logistic regression model for each marker to model the composite outcome as function of the specific marker, planned delivery mode, and marker-by-planned-delivery-mode-interaction, and furthermore performed multivariable logistic regression with backward variable elimination separately in each trial arm. Markers considered were maternal age, parity, history of previous CD, use of antenatal corticosteroids, estimated fetal weight (EFW) of twin A, EFW of twin B, >25% difference in EFW of the twins, presentation of twin B, chorionicity on ultrasound, method of conception, complications of pregnancy, ruptured membranes at randomization and GA at randomization. The main outcome measure was a composite adverse perinatal outcome (perinatal death or serious neonatal morbidity). RESULT(S): None of the studied baseline markers was associated with differential benefit from planned CD. GA at delivery was differentially associated with the outcome in the treatment arms (p for interaction 0.001). GA at delivery was differentially associated with the outcome in the treatment arms (p for interaction 0.001). For GA 32+0- 36+6weeks, VD was associated with fewer adverse outcomes compared to CD (OR 0.62; 95% CI 0.37-1.03). At >=37+0weeks, 10 (1%) newborns suffered the composite perinatal outcome after planned CD versus 23 (2%) after planned VD (OR 2.25; 95% CI 1.06-4.77). CONCLUSION(S): Neonatal outcomes of twin pregnancies with the first twin in cephalic p

Objective: To examine the association between inter-twin delivery interval and short-term perinatal outcomes of the second twin after vaginal delivery of the first twin. Method(s): Retrospective cohort study including twin pregnancies with a vaginal delivery of the first twin between January 2011 and September 2017 in a tertiary hospital in Melbourne, Australia. The main outcome measure was a composite of adverse neonatal outcome (at least one of perinatal death, admission to neonatal intensive care unit (NICU), endotracheal intubation, Apgar <7 at five minutes and cord lactate >4.0 mmol/L). Proportions of adverse outcomes for the second twin were compared between groups of intervals <= or >10 and <= or >30 min. Result(s): The composite adverse neonatal outcome occurred in 201 (58.2%) and a caesarean section occurred in seven cases (2%) of the 345 pregnancies included. Delivery interval was associated with higher cord lactate. Low Apgar scores were more frequent with intervals >30 min (17.9% vs 6.6%, P = 0.03), as well as caesarean section for the second twin (10.7% vs 1.3%, P = 0.01). Composite adverse outcome and admission to NICU were not significantly influenced by the delivery interval. Predictors of adverse outcome were gestational age, abnormal cardiotocography and breech delivery of the second twin. Conclusion(s): The inter-twin delivery interval is associated with higher rates of low Apgar scores and higher cord lactate for the second twin. These associations do not translate into higher rates of admission to NICU and their long-term clinical implications are uncertain.Copyright © 2018 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists

Objective: To examine the association between inter-twin delivery interval and short-term perinatal outcomes of the second twin after vaginal delivery of the first twin. Method(s): Retrospective cohort study including twin pregnancies with a vaginal delivery of the first twin between January 2011 and September 2017 in a tertiary hospital in Melbourne, Australia. The main outcome measure was a composite of adverse neonatal outcome (at least one of perinatal death, admission to neonatal intensive care unit (NICU), endotracheal intubation, Apgar <7 at five minutes and cord lactate >4.0 mmol/L). Proportions of adverse outcomes for the second twin were compared between groups of intervals <= or >10 and <= or >30 min. Result(s): The composite adverse neonatal outcome occurred in 201 (58.2%) and a caesarean section occurred in seven cases (2%) of the 345 pregnancies included. Delivery interval was associated with higher cord lactate. Low Apgar scores were more frequent with intervals >30 min (17.9% vs 6.6%, P = 0.03), as well as caesarean section for the second twin (10.7% vs 1.3%, P = 0.01). Composite adverse outcome and admission to NICU were not significantly influenced by the delivery interval. Predictors of adverse outcome were gestational age, abnormal cardiotocography and breech delivery of the second twin. Conclusion(s): The inter-twin delivery interval is associated with higher rates of low Apgar scores and higher cord lactate for the second twin. These associations do not translate into higher rates of admission to NICU and their long-term clinical implications are uncertain.Copyright © 2018 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists

[Abstract] Aims: To synthesize research findings regarding the coping experiences of parents following perinatal loss. Design: Noblit and Hare's interpretive meta-ethnography was followed. Data sources: A comprehensive systematic search of the published literature (2013-2018) was undertaken in five databases, complemented by supplementary searches. Review methods: Fourteen studies met the research objective and inclusion criteria. Results: Five themes describe the coping strategies used by parents who experience perinatal loss. The themes were synthesized into the metaphor Staying afloat in the storm. Conclusion: Parents use coping strategies to manage perinatal loss and the use of these strategies is conditioned by cultural, social, and individual factors. This study has implications for evidence-based practice by showing care needs and the importance of implementing emotional and patient-centred care interventions. Impact: This meta-ethnography highlights the care needs of parents following perinatal loss, facilitating understanding of coping experiences. Increased knowledge about these experiences may contribute to the development and implementation of nursing and midwifery interventions that include emotional and patient-centred care.

BackgroundIntrahepatic cholestasis of pregnancy is associated with adverse perinatal outcomes, but the association with the concentration of specific biochemical markers is unclear. We aimed to quantify the adverse perinatal effects of intrahepatic cholestasis of pregnancy in women with increased serum bile acid concentrations and determine whether elevated bile acid concentrations were associated with the risk of stillbirth and preterm birth.MethodsWe did a systematic review by searching PubMed, Web of Science, and Embase databases for studies published from database inception to June 1, 2018, reporting perinatal outcomes for women with intrahepatic cholestasis of pregnancy when serum bile acid concentrations were available. Inclusion criteria were studies defining intrahepatic cholestasis of pregnancy based upon pruritus and elevated serum bile acid concentrations, with or without raised liver aminotransferase concentrations. Eligible studies were case-control, cohort, and population-based studies, and randomised controlled trials, with at least 30 participants, and that reported bile acid concentrations and perinatal outcomes. Studies at potential higher risk of reporter bias were excluded, including case reports, studies not comprising cohorts, or successive cases seen in a unit; we also excluded studies with high risk of bias from groups selected (eg, a subgroup of babies with poor outcomes were explicitly excluded), conference abstracts, and Letters to the Editor without clear peer review. We also included unpublished data from two UK hospitals. We did a random effects meta-analysis to determine risk of adverse perinatal outcomes. Aggregate data for maternal and perinatal outcomes were extracted from case-control studies, and individual patient data (IPD) were requested from study authors for all types of study (as no control group was required for the IPD analysis) to assess associations between biochemical markers and adverse outcomes using logistic and step

AIM: Perinatal death is often regarded as a critical incident for the healthcare personnel involved. How healthcare personnel respond to traumatic events in their work is a function of their level of awareness or exposure to the incident, as well as their genuine expectations, support, and trust. The aim of this study was to explore coping strategies of Norwegian healthcare professionals including midwifes, obstetricians, and assistant nurses when faced with perinatal death in a clinical setting. METHOD: Midwives, obstetricians, and assistant nurses in two public hospitals in Norway participated in an in-depth and semi-structured interview. The data was analyzed using Kvale's approach, which involves condensing and thematic analysis. FINDINGS: The results are divided into three categories with eight subcategories. Having the support of one's colleagues was described as an important factor for coping with these situations. Both immediate support in the situation and talking about their feelings later with colleagues were found to be important. Discussing and sharing responsibility were also mentioned. CONCLUSION: Informants in this study stated that talking with one another about the challenges they faced in these situations was important. Appropriate education and training programs, together with healthy coping and debriefing strategies must be implemented in maternity units.

AIM: Perinatal death is often regarded as a critical incident for the healthcare personnel involved. How healthcare personnel respond to traumatic events in their work is a function of their level of awareness or exposure to the incident, as well as their genuine expectations, support, and trust. The aim of this study was to explore coping strategies of Norwegian healthcare professionals including midwifes, obstetricians, and assistant nurses when faced with perinatal death in a clinical setting. METHOD: Midwives, obstetricians, and assistant nurses in two public hospitals in Norway participated in an in-depth and semi-structured interview. The data was analyzed using Kvale's approach, which involves condensing and thematic analysis. FINDINGS: The results are divided into three categories with eight subcategories. Having the support of one's colleagues was described as an important factor for coping with these situations. Both immediate support in the situation and talking about their feelings later with colleagues were found to be important. Discussing and sharing responsibility were also mentioned. CONCLUSION: Informants in this study stated that talking with one another about the challenges they faced in these situations was important. Appropriate education and training programs, together with healthy coping and debriefing strategies must be implemented in maternity units.

La muerte perinatal desde el ámbito institucional es un hecho de difícil confrontación tanto para los padres quienes experimentan la pérdida, como para el personal de salud que presencia el evento.La teoría de Kristen Swanson, considera que la meta de la enfermería es brindar cuidado a la mujer y su núcleo familiar, de manera significativa para ayudarla en la aceptación de la muerte de un ser querido. El apoyo que el personal de salud brinda a los padres y la familia, es significativa en la aceptación de la pérdida y la elaboración del duelo. El presente artículo relata la experiencia de una enfermera en su interacción con una mujer que afronto la muerte de su hija al momento de nacer. Se analiza con base en la teoría de los cuidados de Kristen Swanson y se centra en los elementos metaparadigmáticos y los procesos o categorías del cuidado de enfermería., Perinatal death from an institutional view is a matter of difficult confrontation for both, parents who experience the loss, as for the health personnel present at the event. Kristen Swanson theory considers that the goal of nursing is to provide care, for women and her family, significantly to help in the acceptance of the death of a loved one. The support health personnel provide for parents and their family, is significant in the acceptance of the loss and the development of the grieving process. This article tells the experience of a nurse in her interaction with a woman who faced the death of his daughter at the time of birth. It is analyzed based on the Kristen Swanson Care Theory, focuses on the meta-paradigmatics elements and processes or categories of care., Morte perinatal a partir de uma visão institucional é uma questão de confronto difícil para ambos, os pais que sofrem a perda, como para os profissionais de saúde presentes no evento. Teoria Kristen Swanson considera que a meta da enfermagem é a prestação de cuidados, para as mulheres e sua família, de forma significativa para ajudar na aceitação da morte de um ente querido. Os profissionais de saúde de apoio fornecer aos pais e sua família, é significativa na aceitação da perda e para o desenvolvimento do processo de luto. Este artigo conta a experiência de uma enfermeira em sua interação com uma mulher que enfrentou a morte de sua filha no momento do nascimento. Analisou baseia-se na Teoria do Cuidado Swanson Kristen, incide sobre os elementos e processos ou categorias de cuidados de meta-paradigmáticas.

BackgroundIntrahepatic cholestasis of pregnancy is associated with adverse perinatal outcomes, but the association with the concentration of specific biochemical markers is unclear. We aimed to quantify the adverse perinatal effects of intrahepatic cholestasis of pregnancy in women with increased serum bile acid concentrations and determine whether elevated bile acid concentrations were associated with the risk of stillbirth and preterm birth.MethodsWe did a systematic review by searching PubMed, Web of Science, and Embase databases for studies published from database inception to June 1, 2018, reporting perinatal outcomes for women with intrahepatic cholestasis of pregnancy when serum bile acid concentrations were available. Inclusion criteria were studies defining intrahepatic cholestasis of pregnancy based upon pruritus and elevated serum bile acid concentrations, with or without raised liver aminotransferase concentrations. Eligible studies were case-control, cohort, and population-based studies, and randomised controlled trials, with at least 30 participants, and that reported bile acid concentrations and perinatal outcomes. Studies at potential higher risk of reporter bias were excluded, including case reports, studies not comprising cohorts, or successive cases seen in a unit; we also excluded studies with high risk of bias from groups selected (eg, a subgroup of babies with poor outcomes were explicitly excluded), conference abstracts, and Letters to the Editor without clear peer review. We also included unpublished data from two UK hospitals. We did a random effects meta-analysis to determine risk of adverse perinatal outcomes. Aggregate data for maternal and perinatal outcomes were extracted from case-control studies, and individual patient data (IPD) were requested from study authors for all types of study (as no control group was required for the IPD analysis) to assess associations between biochemical markers and adverse outcomes using logistic and step

OBJECTIVE:The objective of this study was to determine the association of copy number variants (CNV) with perinatal outcomes among fetuses with sonographic abnormalities. METHODS:This was a retrospective cohort study of anomalous fetuses evaluated at a single fetal center, who underwent chromosomal microarray (CMA) testing. Pathogenic CNV or variants of uncertain significance were classified as abnormal. The primary outcome of perinatal death was compared among fetuses with normal vs abnormal CMA. Secondary outcomes included preterm birth, small for gestational age birth weight, and death prior to discharge. The odds ratio (OR) of perinatal death was determined, adjusting for potential confounders. RESULTS:Of 280 fetuses, 60 (21.4%) had abnormal CMA results-21 (35.0%) were classified as pathogenic, 39 (65.0%) were variants of uncertain significance. Among 212 (75.7%) continuing pregnancies, abnormal CMA was not associated with increased odds of perinatal death (adjusted OR 0.81, 95% CI 0.34-1.93), after adjustment for the presence of hydrops and specific anomalies. The overall frequency of perinatal death was 21.2%. No differences in secondary outcomes were observed. CONCLUSIONS:Abnormal CMA was not associated with increased odds of perinatal death in this cohort. Fetal CNV are common among fetal center patients; such fetuses are at high risk of perinatal death irrespective of CMA results.

BACKGROUND: Preventable maternal and infant mortality continues to be significantly higher in Latin American indigenous regions compared to non-indigenous, with inequalities of race, gender and poverty exacerbated by deficiencies in service provision. Standard programmes aimed at improving perinatal health have had a limited impact on mortality rates in these populations, and state and national statistical data and evaluations of services are of little relevance to the environments that most indigenous ethnicities inhabit. This study sought a novel perspective on causes and solutions by considering how structural, cultural and relational factors intersect to make indigenous women and babies more vulnerable to morbidity and mortality. METHODS: We explored how structural inequalities and interpersonal relationships impact decision-making about care seeking during pregnancy and childbirth in Wixarika communities in Northwestern Mexico. Sixty-two women were interviewed while pregnant and followed-up after the birth of their child. Observational data was collected over 18 months, producing more than five hundred pages of field notes. RESULTS: Of the 62 women interviewed, 33 gave birth at home without skilled attendance, including 5 who delivered completely alone. Five babies died during labour or shortly thereafter, we present here 3 of these events as case studies. We identified that the structure of service provision, in which providers have several contiguous days off, combined with a poor patient-provider dynamic and the sometimes non-consensual imposition of biomedical practices acted as deterrents to institutional delivery. Data also suggested that men have important roles to play supporting their partners during labour and birth. CONCLUSIONS: Stillbirths and neonatal deaths occurring in a context of unnecessary lone and unassisted deliveries are structurally generated forms of violence: preventable morbidities or mortalities that are the result of systematic

BACKGROUND:Preterm birth (birth before 37 weeks of gestation) and its complications are the leading contributors to neonatal and under-5 mortality. The majority of neonatal deaths in Kenya and Uganda occur during the intrapartum and immediate postnatal period. This paper describes our study protocol for implementing and evaluating a package of facility-based interventions to improve care during this critical window. METHODS/DESIGN:This is a pair-matched, cluster randomized controlled trial across 20 facilities in Eastern Uganda and Western Kenya. The intervention facilities receive four components: (1) strengthening of routine data collection and data use activities; (2) implementation of the WHO Safe Childbirth Checklist modified for preterm birth; (3) PRONTO simulation training and mentoring to strengthen intrapartum and immediate newborn care; and (4) support of quality improvement teams. The control facilities receive both data strengthening and introduction of the modified checklist. The primary outcome for this study is 28-day mortality rate among preterm infants. The denominator will include all live births and fresh stillbirths weighing greater than 1000 g and less than 2500 g; all live births and fresh stillbirths weighing between 2501 and 3000 g with a documented gestational age less than 37 weeks. DISCUSSION:The results of this study will inform interventions to improve personnel and facility capacity to respond to preterm labor and delivery, as well as care for the preterm infant. TRIAL REGISTRATION:ClinicalTrials.gov, ID: NCT03112018 . Registered on 13 April 2017.

BackgroundGlobally, there were 2.7 million neonatal deaths in 2015. Significant mortality reduction could be achieved by improving care in low- and middle-income countries (LMIC), where the majority of deaths occur. Determining the physical readiness of facilities to identify and manage complications is an essential component of strategies to reduce neonatal mortality.MethodsWe developed clinical cascades for 6 common neonatal conditions then utilized these to assess 23 health facilities in Kenya and Uganda at 2 time-points in 2016 and 2017. We calculated changes in resource availability over time by facility using McNemar's test. We estimated mean readiness and loss of readiness for the 6 conditions and 3 stages of care (identification, treatment, monitoring-modifying treatment). We estimated overall mean readiness and readiness loss across all conditions and stages. Finally, we compared readiness of facilities with a newborn special care unit (NSCU) to those without using the two-sample test of proportions.ResultsThe cascade model estimated mean readiness of 26.3-26.6% across the 3 stages for all conditions. Mean readiness ranged from 11.6% (respiratory distress-apnea) to 47.8% (essential newborn care) across both time-points. The model estimated overall mean readiness loss of 30.4-31.9%. There was mild to moderate variability in the timing of readiness loss, with the majority occurring in the identification stage. Overall mean readiness was higher among facilities with a NSCU (36.8%) compared to those without (20.0%).ConclusionThe cascade model provides a novel approach to quantitatively assess physical readiness for neonatal care. Among 23 facilities in Kenya and Uganda, we identified a consistent pattern of 30-32% readiness loss across cascades and stages. This aggregate measure could be used to monitor and compare readiness at the facility-, health system-, or national-level. Estimates of readiness and loss of readiness may help guide strategies to improve car