Search

Fetal anaemia is a relatively rare occurrence, but it carries a risk of significant fetal morbidity and mortality. The most common causes of fetal anaemia are haemolytic disease of fetus and newborn and parvovirus B19 infection. The only diagnostic test for fetal anaemia is fetal blood sampling, but this is an invasive test with associated risk of miscarriage, preterm membrane rupture or intrauterine fetal death. Therefore it is only performed if there is a strong suspicion of fetal anamia based on the patient's history and ultrasound findings of raised peak systolic velocity in middle cerebral artery and/or fetal hydrops. The treatment for fetal anaemia is symptomatic rather than curative in most of the cases. In severely anaemic fetuses intrauterine blood transfusion is undertaken which corrects the anaemia but does not deal with the underlying cause. The aim of this intervention is to reach the gestation when the delivery is safer. [ABSTRACT FROM AUTHOR]

Background: Stillbirths are a global public health challenge, predominantly affecting low- and middle-income countries. The causes of most stillbirths are preventable. Objectives: this study reviewed perinatal clinical audit data from Kgapane Hospital over a 4-year period with a special focus on the factors associated with stillbirths. Methods: File audits were done for all stillbirths occurring at Kgapane Hospital and its catchment area from 2018 to 2021. The data from these audits were analysed to identify factors associated with stillbirths. Results: A total of 392 stillbirths occurred during the study period at Kgapane Hospital and its surrounding clinics, resulting in a stillborn rate of 19.06/1000 births. Of the 392 stillbirths recorded, audits were conducted on 354 of the maternal case records. The five most common causes of stillbirths identified were: hypertensive disorders in pregnancy (HDP) (29.7%), intrauterine growth restriction without HDP (11.6%), birth asphyxia (7.1%), premature labour (< 1000 g) (6.5%) and maternal infections (5.9%) including HIV with unsuppressed VL, intrauterine infection, coronavirus disease (COVID) and syphilis. Modifiable factors that can form the basis of improvement strategies should include training, timeous referral, plus improved resources and staffing. Conclusion: Understanding the causes of stillbirths can guide improvement strategies to reduce this heart-breaking complication of pregnancy. Contribution: Family physicians working in rural hospitals are also responsible for perinatal care. Understanding the factors associated with stillbirths will guide them to develop improvement strategies to reduce these preventable deaths. [ABSTRACT FROM AUTHOR]

Availability of skilled birth attendant (SBA) is a crucial factor in reducing mortality rates among mothers and children. The lower- and middle-income countries show low use of these service causing increased risk of maternal and child mortality. While there has been a remarkable improvement in the coverage of SBA-monitored deliveries in India, its impact on outcome indicators such as perinatal and neonatal mortality rates have not been significant. Although the country performs better than the world average in the former, its performance is poor in the latter. This raises question on the quality of SBA services in India. The present study examines SBA services in the context of availability of attendants, infrastructural support and level of training of the SBAs in the rural areas of the four large states in India—Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh. The findings are that SBA lack sufficient training to provide the services effectively. The effectiveness of their services is also hampered by the absence of the essential infrastructure at public health facilities. Moreover, there is congestion and overcrowding at the higher level of facilities such as PHCs and CHCs as compared to village level sub-centres. [ABSTRACT FROM AUTHOR]

A primary goal of obstetrical practice is the optimization of maternal and perinatal health. This goal translates into a seemingly simple assessment with regard to considerations of the timing of delivery: delivery should occur when the benefits are greater than those of continued pregnancy. In the absence of an indication for cesarean delivery, planned delivery is initiated with induction of labor. When medical or obstetrical complications exist, they may guide recommendations regarding the timing of delivery. In the absence of these complications, gestational age also has been used to guide delivery timing, given its association with both maternal and perinatal adverse outcomes. If there is no medical indication, delivery before 39 weeks has been discouraged, given its association with greater chances of adverse perinatal outcomes. Conversely, it has been recommended that delivery occur by 42 weeks of gestation, given the perinatal risks that accrue in the post-term period. Historically, a 39-week induction of labor, particularly for individuals with no previous birth, has not been routinely offered in the absence of medical or obstetrical indications. That approach was based on numerous observational studies that demonstrated an increased risk of cesarean delivery and other adverse outcomes among individuals who underwent labor induction compared to those in spontaneous labor. However, from a management and person-centered-choice perspective, the relevant comparison is between those undergoing planned labor induction at a given time vs those planning to continue pregnancy beyond that time. When individuals have been compared using that rubric—either in observational studies or randomized trials that have been performed in a wide variety of locations and populations— there has not been evidence that induction increases adverse perinatal or maternal outcomes. Conversely, even when the only indication for delivery is the achievement of a full-term gestational age, evidence suggests that multiple different outcomes, including cesarean delivery, hypertensive disorders of pregnancy, neonatal respiratory impairment, and perinatal mortality, are less likely when induction is performed. This information underscores the importance of making the preferences of pregnant individuals for different birth processes and outcomes central to the approach to delivery timing. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: The present study investigated experiences of traumatic perinatal events, the provision of related education, and educational needs of nurses working in the labor and delivery room (LDR). Methods: Nurses working in the LDRs of six institutions and two nurse portal sites were invited to participate in the survey, delivered on paper or online. The data were collected from October 1 to November 25, 2022. Data from 129 nurses were analyzed using frequency, the chi-square test, the Fisher exact test, the t-test, and analysis of variance. Results: Virtually all participants (98.6%) reported having experienced at least one traumatic perinatal event (dystocia, postpartum hemorrhage, neonatal congenital anomalies, severe maternal or neonatal injury, stillbirth, and maternal or neonatal death) while working in the LDR. The most shocking traumatic perinatal event experienced was the maternal or neonatal death (40.3%), but 24.8% of participants did not recall ever receiving education on the topic. About 63% of participants experienced traumatic perinatal events within a year of working in the LDR. The average score for education needs regarding traumatic perinatal events was 3.67±0.37 out of 4, and participants preferred simulation education as the most effective educational method. Conclusion: Since most of the participants had experienced various traumatic perinatal events in the early stages of working in the LDR and expressed a high level of need for education on traumatic perinatal events, it is necessary to provide more effective stimulation education programs in the early period of work in the LDR. [ABSTRACT FROM AUTHOR]

Perinatal death results in long-lasting intense grief for bereaved mothers with a potential to negatively impact on their short- and long-term outcomes and quality of life if inadequately supported in coping with and managing their experience. This study aimed at exploring the lived experience of women, of care and support following perinatal death in South-Western, Nigeria. A qualitative methodology using Heideggerian phenomenology was used. Fourteen women who had experienced perinatal death in South-Western Nigeria within the last (5) five years were interviewed, and Van Manen's approach to hermeneutic phenomenology was used in data analysis. Four main themes were identified: "they did not tell me the baby died", "response of health care professionals after the baby died", "moving on from hospital", and "support from family". The physical health status of mothers determined how they were informed of perinatal death. Health care professionals were distant, rude, nonempathetic and did not offer emotional support, in some cases. Mothers were given opportunity to see and hold their babies. There was no routine follow-up support in the community, besides a postnatal check-up appointment offered to all mothers regardless of their birth outcome. Family provided emotional support for mothers on discharge. This study was the first to explore the lived experience of women of the care and support following perinatal death in South-Western, Nigeria. There is a need for healthcare systems to review bereavement care and support provisions for women who experience perinatal death. [ABSTRACT FROM AUTHOR]

Reliability studies of placental examination have shown differing interobserver agreement for certain pathological features, a lack of uniform reporting criteria and variable experience among pathologists. In previous analyses we have shown that placental pathology differs by ethnicity. This validation study was performed to investigate whether bias related to ethnicity is a feature of placental pathology reporting in New Zealand (NZ). 199 of 1726 eligible perinatal death cases between 2008 and 2017 were selected at random for this audit-type study, including 51 cases from South Asian, Māori and NZ European ethnicity and 46 cases from Pacific mothers. Stored histology slides were blinded and re-examined by an experienced perinatal pathologist, and linked to the corresponding original pathology report. Interobserver agreement (overall, by ethnicity and by gestational age) was described by proportional differences and kappa coefficients. Total interobserver agreement between original placental reporting and the validation review was 89.7 %, which differed by pathological feature. There was generally more underreporting than overreporting (3.6 % and 6.7 %, respectively). There was little disagreement by ethnicity (decidual vasculopathy [p = 0.03]), although there were more differences by gestational age (villous morphology [p < 0.01], chorioamnionitis [p = 0.03], high-grade villitis of unknown etiology [p < 0.01], and placental haemorrhage [p = 0.03]). No systematic bias in placental pathology reporting in NZ was identified by ethnicity or gestational age, as observed differences could be related to the underlying prevalence of pathology. We identified more underreporting than overreporting of pathology in the original reports, emphasizing the importance of placental investigation by specialised perinatal pathologists. • Placental pathology reporting is not biased by knowledge of ethnicity in New Zealand. • Placental pathology reporting is not biased by gestation in New Zealand. • More under-than overreporting occurred with placental histology slides re-reading. • Histological slide quality explained some differences in discrepant reporting. • Placental investigation by specialised perinatal pathologists is highlighted. [ABSTRACT FROM AUTHOR]

This study aimed to estimate the perinatal mortality associated with prenatally diagnosed vasa previa and to determine what proportion of those perinatal deaths are directly attributable to vasa previa. The following databases have been searched from January 1, 1987, to January 1, 2023: PubMed, Scopus, Web of Science, and Embase. Our study included all studies (cohort studies and case series or reports) that had patients in which a prenatal diagnosis of vasa previa was made. Case series or reports were excluded from the meta-analysis. All cases in which prenatal diagnosis was not made were excluded from the study. The programming language software R (version 4.2.2) was used to conduct the meta-analysis. The data were logit transformed and pooled using the fixed effects model. The between-study heterogeneity was reported by I 2 . The publication bias was evaluated using a funnel plot and the Peters regression test. The Newcastle-Ottawa scale was used to assess the risk of bias. Overall, 113 studies with a cumulative sample size of 1297 pregnant individuals were included. This study included 25 cohort studies with 1167 pregnancies and 88 case series or reports with 130 pregnancies. Moreover, 13 perinatal deaths occurred among these pregnancies, consisting of 2 stillbirths and 11 neonatal deaths. Among the cohort studies, the overall perinatal mortality was 0.94% (95% confidence interval, 0.52–1.70; I 2 =0.0%). The pooled perinatal mortality attributed to vasa previa was 0.51% (95% confidence interval, 0.23–1.14; I 2 =0.0%). Stillbirth and neonatal death were reported in 0.20% (95% confidence interval, 0.05–0.80; I 2 =0.0%) and 0.77% (95% confidence interval, 0.40–1.48; I 2 =0.0%) of pregnancies, respectively. Perinatal death is uncommon after a prenatal diagnosis of vasa previa. Approximately half of the cases of perinatal mortality are not directly attributable to vasa previa. This information will help in guiding physicians in counseling and will provide reassurance to pregnant individuals with a prenatal diagnosis of vasa previa. [ABSTRACT FROM AUTHOR]

The term perinatal mortality refers to antepartum and intrapartum stillbirths, and early neonatal deaths. Although the overall rate of perinatal mortality is falling in high-income countries, a slower rate of reduction in stillbirths has been seen. In high income countries antenatal stillbirth contributes to a large proportion of overall stillbirths. This article explores the causes of perinatal mortality and the recent evidence and interventions and their impacts on reducing perinatal mortality in the high-income settings. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Trauma in pregnancy can range from a mild injury, such as a fall from standing height, to a major injury, involving a penetrating injury or a high force motor vehicle collision. Providing care to a pregnant patient with trauma presents a unique challenge as 2 patients are at risk for complications, that is, the mother and the fetus. both of whom require evaluation and management. Health care professionals should be aware of and be prepared to manage complications of trauma in pregnancy, given its significant associated morbidity and mortality This article details the epidemiology, etiology, assessment, diagnosis, and management of trauma in pregnancy. [ABSTRACT FROM AUTHOR]

Purpose Nurses must stay close to couples if a baby is stillborn, share their thoughts, provide nursing care for stillbirths, and provide continuous nursing care to grieving parents. The purpose of this study was to develop a prototype grief care tool through which nurses can record their experiences related to the events. It will help them clarify their feelings when dealing with couples experiencing a stillbirth and providing nursing care from pregnancy to the post-partum period. Methods This is a qualitative descriptive study. The participants were 13 nurses (midwives/nurses) who dealt with natural or induced stillbirths after 12 weeks of pregnancy. A prototype grief care tool provided the most unusual cases of stillbirth nursing, and data were obtained through semi-structured interviews about nurses' feelings when dealing with stillbirths. The obtained data were analyzed qualitatively and inductively. Results Nurses' feelings about stillbirth were collated into four categories. "Sense of mission toward stillbirth nursing" was about sincerity and the sense of responsibility as a caregiver toward couples who had experienced stillbirth. In contrast, "difficulties caring for a couple with a stillborn child" dealt with difficulties in understanding and talking about the couple's feelings and anxieties about the stillbirth. Further, "inquiring minds about stillbirth nursing" was about looking back at the nursing provided, searching for better stillbirth nursing for couples, and wanting to learn more about stillbirth nursing. "Expectations for team medical care" was about being involved with couples as a team and supporting each other. Conclusion Midwives and nurses involved in stillbirths felt both a sense of mission in stillbirth nursing and a sense of difficulty in dealing with the parents. In addition, they looked back on their experiences in stillbirth nursing and searched for better stillbirth nursing methods. The findings suggested that using the grief care tool prototyped in this study to record the nursing experience of stillbirth will help nurses to recollect their thoughts on the couple and the stillborn at each stage of nursing. It would provide an opportunity to reflect on the nursing provided and feelings experienced, leading to an inquiry into stillbirth nursing. [ABSTRACT FROM AUTHOR]

Stillbirth describes the delivery of a baby with no signs of life in relation to thresholds of either gestational age or birthweight. In the UK, a stillbirth is legally defined as the delivery of a baby at or after 24 weeks' gestation or 500 g where gestation is unknown. A history of previous stillbirth remains one of the strongest risk factors for subsequent stillbirth and other adverse outcomes in a subsequent pregnancy. According to World Health Organization (WHO), there are nearly 2 million stillbirths globally every year. There is a drive to reduce the rate of stillbirths by 50% in England by 2025 and a global target of 12 or fewer stillbirths per 1000 total births in every country by 2030. The significant psychological burden placed on parents following a stillbirth and the associated increased risk of complications in subsequent pregnancies need appropriate management. This article covers the investigation and management of stillbirth reflecting current UK practice. [ABSTRACT FROM AUTHOR]

Approximately 6 million neonatal deaths occur globally, with approximately 99 percent of them occurring in developing countries. This study is an attempt to examine the prevalence and influence of non-biological factors on perinatal mortality in India. National Family Health Survey (2015-2016) data and bivariate and multivariate techniques have been used to fulfill the aforesaid objectives. Findings suggest that approximately 47 perinatal deaths occurred per 1,000 pregnancies lasting seven or more months during the last five years preceding the survey in Uttar Pradesh. Parental education, wealth status, variables related to pregnancy and delivery, mother's demographic factors, mother's height, and child characteristics have shown significant impact on perinatal mortality. For a policy point of view, more emphasis is needed on quality of care of National Health Mission (NHM) strategy at times of greater risk—that is, birth and the first few days of life—which could be the way forward for reducing high perinatal deaths. [ABSTRACT FROM AUTHOR]

Pathologies associated with uteroplacental hypoxia, such as preeclampsia are among the leading causes of maternal and perinatal morbidity in the world. Its fundamental mechanisms are yet poorly understood due to a lack of good experimental models. Here we report an in vitro model of the placental barrier, based on co-culture of trophoblasts and endothelial cells against a collagen extracellular matrix in a microfluidic platform. The model yields a functional syncytium with barrier properties, polarization, secretion of relevant extracellular membrane components, thinning of the materno-fetal space, hormone secretion, and transporter function. The model is exposed to low oxygen conditions and perfusion flow is modulated to induce a pathological environment. This results in reduced barrier function, hormone secretion, and microvilli as well as an increased nuclei count, characteristics of preeclamptic placentas. The model is implemented in a titer plate-based microfluidic platform fully amenable to high-throughput screening. We thus believe this model could aid mechanistic understanding of preeclampsia and other placental pathologies associated with hypoxia/ischemia, as well as support future development of effective therapies through target and compound screening campaigns. The human placenta is a unique organ sustaining fetal growth but is also the source of severe pathologies, such as preeclampsia. Though leading cause of perinatal mortality in the world, preeclampsia remains untreatable due to a lack of relevant in vitro placenta models. To better understand the pathology, we have developed 3D placental barrier models in a microfluidic device. The platform allows parallel culture of 40 perfused physiological miniaturized placental barriers, comprising a differentiated syncytium and endothelium that have been validated for transporter functions. Exposure to a hypoxic and ischemic environment enabled the mimicking of preeclamptic characteristics in high-throughput, which we believe could lead to a better understanding of the pathology as well as support future effective therapies development. [Display omitted] [ABSTRACT FROM AUTHOR]

Amniotic fluid abnormalities are caused by perinatal death and morbidity. Foetal growth and development are examples of parameters that must be accessible. Ultrasound technology is used to make an image of the uterus. Main aim of this work is to reduce the mortality and morbidity. Because, every year, 30 million new-borns have growth limitation, and there is a link between oligohydramnios (lack of amniotic fluid) and perinatal death. AFI can be measured with the assistance of ultrasound images. It is divided into four equal quadrants, with the Amniotic Fluid Index being the average of these quadrants (AFI). The performance of an Adaptive Neuro-Fuzzy Inference classifier is used for classification techniques. For the implementation of this research uses convolution neural network. During the second and third trimesters of pregnancy, this method is used to detect malformations using deep learning techniques. This strategy aims to reduce diagnostic time and risk factors in earlier stages of pregnancy. [ABSTRACT FROM AUTHOR]

India is trying to achieve the target of sustainable development goals of reducing maternal mortality ratio to 70/1,00,000 live births by the year 2030. The maternal mortality in Uttarakhand is 89/100,000 live birth (2015–2017), against the national average of 122. Daley in the care during the labour process, poor transport system, and inadequate health care facilities for maternal care leading to maternal and infant mortality are not well understood, including other contributing factors. In Uttarakhand, maternal haemorrhage (22.9%), eclampsia (14.6%), sepsis (10.6%), rupture of the uterus (6.2%), ectopic pregnancy (2.1%), and pulmonary embolism (2.1%) were the direct causes for maternal mortality; the indirect causes were anaemia (16.6%), jaundice (12.5%), heart diseases during pregnancy (6.2%), and other communicable diseases (6.3%). Age at pregnancy, not having health schemes, health care accessibility, presence of complications, and residing in a rural area were additional risk factors. Being multigravida adds to a higher risk for women to die (66.7%). Common causes of neonatal mortality were birth asphyxia (20.4%) and preterm birth (15.4%), whereas pneumonia (26.1%), septicaemia (12.5%), diarrhoeal and acute gastroenteritis (19%) were common causes for post-neonatal deaths. It was also reported that prematurity with respiratory distress syndrome (37.7%), septicaemia (16.8%), and perinatal asphyxia (13.9%) were the leading causes in Uttarakhand, while neonatal seizures (3.54%), congenital anomalies (3.23%), intrauterine growth restriction (IUGR) (2.6%), and neonatal jaundice (2.3%) were fewer common causes reported. Multidirectional contributing factors had been reported for maternal and infant mortality, so it needs a multidimensional approach to address the issue. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: This systematic review and meta-analysis investigated whether the use of low-dose aspirin during pregnancy by women with chronic hypertension reduces the odds of superimposed preeclampsia and poor perinatal outcomes.Data Sources: In September 2021, the following sources were searched: Embase, MEDLINE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, and EU Clinical Trials Register. Only human studies were included, with no time or language restrictions.Study Eligibility Criteria: Cohort, case-control, and randomized controlled studies reporting women with chronic hypertension pregnant with a singleton were included. Eligible studies compared low-dose aspirin use during pregnancy with a control arm.Methods: Risk of bias was assessed using the RoB 2 and ROBINS-I tools. A meta-analysis was performed using a random-effects model, estimating odds ratios and 95% confidence and prediction intervals, and the quality of data was assessed with the GRADE approach. Heterogeneity was investigated in regard to study methodology, timing of commencement of aspirin, and the outcome of preterm preeclampsia.Results: Nine studies (3 retrospective cohort studies and 6 randomized trials) including 2150 women with chronic hypertension were included. Low-dose aspirin prophylaxis did not significantly reduce the odds of superimposed preeclampsia in the randomized controlled trials (odds ratio, 0.83; 95% confidence interval, 0.55-1.25; prediction interval, 0.27-2.56; low-quality evidence) or observational studies (odds ratio, 1.21; 95% confidence interval, 0.78-1.87; prediction interval, 0.07-20.80; very low-quality evidence). Low-dose aspirin also did not reduce the odds of preterm preeclampsia (odds ratio, 1.17; 95% confidence interval, 0.74-1.86), and early aspirin initiation had no significant impact. There was no significant effect on small-for-gestational-age neonates or perinatal mortality; however, there was a significant reduction in preterm birth (odds ratio, 0.63; 95% confidence interval, 0.45-0.89; moderate-quality evidence). The quality of the evidence is limited by heterogeneity and risk of bias.Conclusion: This meta-analysis was unable to demonstrate a significant change in the odds of superimposed preeclampsia, small-for-gestational-age infants, or perinatal mortality with the use of low-dose aspirin in women with chronic hypertension. However, significant reduction in preterm birth justifies the continued use of aspirin prophylaxis. This work was prospectively registered on the International Prospective Register of Systematic Reviews (registration number CRD42021285921). [ABSTRACT FROM AUTHOR]

A case-control study was carried out to estimate risk factors for perinatal mortality in a referral hospital for high-risk pregnancies in Curitiba-PR. Sociodemographic, maternal, pregnancy and concept characteristics data were obtained from the hospital records of 316 cases and 316 controls from 2013 to 2017. A hierarchical multiple logistic regression analysis was performed, remaining in the final model variables with p < 0.05. The results show an increased risk of perinatal death in mothers with blood type B (OR = 2.82; 95%CI: 1.07-7.43), who did not undergo prenatal care (OR = 30.78; 95%CI: 4.23-224.29), fetuses with congenital malformations (OR = 63.90; 95%CI: 27.32-149.48), born under 28 (OR = 24.21; 95%CI: 1, 10-531.81) and between 28-31 weeks of gestation (OR = 6.03; 95%CI: 1.34-27.17) and birth weight below 1,000g (OR = 51.94; 95%CI: 4.31-626.46), between 1,000-1,499g (OR = 11.17; 95%CI: 2.29-54.41) and between 1,500-2,499g (OR = 2.75; 25-6.06). Concepts of pregnancies with premature outcome, low birth weight and the presence of congenital malformations are the main risk factors for perinatal death. On the other hand, adequate prenatal care is an important protective factor. [ABSTRACT FROM AUTHOR]

Objectives The study investigated the ability of mothers to overcome their grief following a stillbirth or neonatal death, and elucidated their experience of the next pregnancy. Subjects and Methods The participants in the study were mothers who experienced a stillbirth or neonatal death, and subsequently gave birth to a live baby at full term. Unstructured interviews were held, followed by analysis using Giorgi's descriptive phenomenological approach. Results The study participants were six mothers who had experienced a stillbirth or neonatal death between 16 and 37 weeks of gestation, and subsequently had their first live birth. During the next pregnancy, the mothers who had experienced a stillbirth or neonatal death were unable to avoid "doubts and negativity about their own physical conditions as mothers" as a result of their stillbirth or neonatal death experience. The mothers frequently experienced anxiety or fear because of the "trauma of reliving the death in the next pregnancy." Several of the mothers had regrets about their previous pregnancies and felt that they will "accept the life as it actually is," they also felt "connections with the life of the lost child." When the gestational week when they experienced a stillbirth or neonatal death in their previous pregnancy passed, the mothers felt that "as the weeks progressed, I gradually became reassured that I was actually going to have the baby." As the pregnancy progressed, their past and present experiences interacted and the mothers developed a strong desire to "accept the life as it actually is," despite their anxiety or fear. Although the mothers had the painful experience of feeling unable to share their grief and distress about losing a child, they also had the positive experience of being emotionally rescued by the existence of people who they can be close to, physically and emotionally and "share the existence of the lost child." Conclusions Six themes were representative of the mothers who experienced a stillbirth or neonatal death and subsequently became pregnant again. These mothers appreciated the miraculous nature and dignity of life from their experience of having lost a precious child. They discovered a way of living as mothers who "accept the life as it actually is." The mothers felt that they wanted to continue walking the path of life together with the lost child through the next pregnancy. Nurses need to support the women as being mothers of the lost child and the new child through their process of growth, while acknowledging and embracing their experience of trauma. [ABSTRACT FROM AUTHOR]

Objective: Under-5 mortality has declined globally; however, proportion of under-5 deaths occurring within the first 28 days after birth has increased significantly. This study aims to determine the impact of an educational intervention on neonatal care and survival rates in Nigeria. Methods: This was a sequential exploratory mixed-methods design involving 21 health workers in the preintervention phase, while 15 health workers and 30 mother-baby dyads participated in the postintervention phase. Data were collected using semistructured interviews and nonparticipatory observation. Qualitative data were analyzed using thematic analysis, while quantitative data were analyzed using descriptive and inferential statistics. Results: Healthy newborns were routinely separated from their mothers in the preintervention period. During this time, non-evidence-based practices, such as routine nasal and oral suctioning, were performed. Skin-to-skin contact and early initiation of breastfeeding were frequently interrupted. After the intervention, 80.6% were placed in skin-to-skin contact with their mothers, and 20 of these babies maintained contact with the mother until breastfeeding was established. There was decline in neonatal deaths post-intervention. Independent t -test analysis of the day of neonatal death demonstrates a significant difference in mean (P =.00, 95% confidence interval −5.629; −7.447 to −4.779). Conclusion: Newborn survival can be improved through regular training of maternity health workers in evidence-based newborn care. [ABSTRACT FROM AUTHOR]

This study aimed to systematically assess perinatal outcomes of pregnancies complicated by maternal cardiomyopathy. PubMed, Ovid Embase, Ovid MEDLINE, the Cochrane Library, and ClinicalTrials.gov were systematically searched from inception to August 25, 2022. Observational cohort, case-control, and case-cohort studies in human populations were included if they reported predefined perinatal outcomes in pregnant women with cardiomyopathy (any subtype) and an appropriate control population (either pregnant women with no known cardiac disease or pregnant women with noncardiomyopathy cardiac disease). Of note, 2 reviewers independently assessed the articles for eligibility and risk of bias, and conflicts were resolved by a third reviewer. Data were extracted and synthesized according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analysis of Observational Studies in Epidemiology guidelines. Here, 13 studies (representing 2,291,024 pregnancies) were eligible for inclusion. Perinatal death was more likely in neonates born to women with cardiomyopathy than in (1) neonates born to women with no cardiac disease (stillbirth: odds ratio, 20.82; 95% confidence interval, 6.68–64.95; I 2 = not available; P <.00001; neonatal mortality: odds ratio, 6.75; 95% confidence interval, 3.54–12.89; I 2 =0%; P <.00001) and (2) neonates born to women with other forms of cardiac disease (stillbirth: odds ratio, 3.75; 95% confidence interval, 1.86–7.59; I 2 =0%; P =.0002; neonatal mortality: odds ratio, 2.42; 95% confidence interval, 1.39–4.21; I 2 =0%; P =.002). Pregnancies affected by maternal cardiomyopathy were significantly more likely to result in preterm birth (odds ratio, 2.21; 95% confidence interval, 1.31–3.73; I 2 =77%; P =.003) and small-for-gestational-age neonates (odds ratio, 2.97; 95% confidence interval, 2.38–3.70; I 2 =47%; P <.00001), both major causes of short- and long-term morbidities, than pregnancies affected by other forms of cardiac disease. There was an increased likelihood of adverse perinatal outcomes in pregnancies affected by maternal cardiomyopathy compared with both pregnancies affected by noncardiomyopathy cardiac disease and pregnancies without cardiac disease. Women with cardiomyopathy who plan to get pregnant should receive detailed counseling regarding these risks and have their pregnancies managed by experienced multidisciplinary teams that can provide close fetal monitoring and neonatology expertise. [ABSTRACT FROM AUTHOR]

Stillbirth is a recognized complication of COVID-19 in pregnant women that has recently been demonstrated to be caused by SARS-CoV-2 infection of the placenta. Multiple global studies have found that the placental pathology present in cases of stillbirth consists of a combination of concurrent destructive findings that include increased fibrin deposition that typically reaches the level of massive perivillous fibrin deposition, chronic histiocytic intervillositis, and trophoblast necrosis. These 3 pathologic lesions, collectively termed SARS-CoV-2 placentitis, can cause severe and diffuse placental parenchymal destruction that can affect >75% of the placenta, effectively rendering it incapable of performing its function of oxygenating the fetus and leading to stillbirth and neonatal death via malperfusion and placental insufficiency. Placental infection and destruction can occur in the absence of demonstrable fetal infection. Development of SARS-CoV-2 placentitis is a complex process that may have both an infectious and immunologic basis. An important observation is that in all reported cases of SARS-CoV-2 placentitis causing stillbirth and neonatal death, the mothers were unvaccinated. SARS-CoV-2 placentitis is likely the result of an episode of SARS-CoV-2 viremia at some time during the pregnancy. This article discusses clinical and pathologic aspects of the relationship between maternal COVID-19 vaccination, SARS-CoV-2 placentitis, and perinatal death. [ABSTRACT FROM AUTHOR]

The experiences of women in low and middle-income countries following perinatal death remains difficult and challenging, thereby increasing their susceptibility to negative psychological impact particularly with insufficient bereavement care and support. Perinatal death invariably brings intense grief which significantly impacts women, and requires adequate bereavement care to limit negative outcomes in the short and long-term. To develop deeper understanding of women's experience of care and support following perinatal death in high burden settings. Six electronic databases were searched with relevant terms established using the SPIDER tool, supplemented by hand search of reference lists. Studies were independently screened for inclusion by all authors. Meta-ethnography (Noblit and Hare,1988) was used to synthesise existing qualitative studies. Eight studies conducted in Sub-Saharan African and South Asian countries namely South Africa, Uganda, Ghana, Kenya, India and Malawi were included, and three main themes were identified; mothers' reaction to their baby's death, care and support after perinatal death, and coping strategies in the absence of care and support. Perinatal death was not appropriately acknowledged therefore care and support was inadequate and, in some cases, non-existent. Consequently, mothers resorted to adopting coping strategies as they were unable to express their grief. There is insufficient care and support for women following perinatal death in high burden settings. Further research is required into the care and support being given by healthcare professionals and families in high burden settings, thereby ultimately aiding the development of guidance on perinatal bereavement care. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To evaluate the role of angiogenic biomarkers in predicting severe adverse materno-fetal outcome (SAO) among women at high risk of preeclampsia (PE).Method: All antenatal women at high risk of PE underwent MAP estimation, sFlt-1/PlGF ratio, uterine artery evaluation at 20-22, 28-30 and 34-36 weeks of gestation and were followed until delivery. The severe adverse outcome included severe PE, severe fetal growth restriction with Doppler changes and intrauterine death or early neonatal death. Those who developed SAO were cases and rest were controls, the cases and controls were compared using univariate and multivariate logistic regression analysis.Results: In 54/287(18.8 %) SAO was observed, and they comprised of severe PE (21/287, 7.3 %), FGR with absent or reverse diastolic flow on Doppler (23/287, 8.0 %) and intrauterine death or early neonatal death (10/287, 3.5 %). For detecting complications up to 30 weeks, the sFLT-1/PlGF ratio at 20 weeks (cut off ≥ 38) was the best test (accuracy- 97.6 %) followed by MAP and uterine artery Doppler PI. For detecting complications up to 34 weeks, prediction was good (accuracy -80.4 %) when sFLT-1/PlGF ratio was combined with uterine artery PI. The predictive value of the complications before 34 weeks was far superior to that after 34 weeks. Combining the sFLT-1/PlGF ratio with the uterine artery PI improved the accuracy of the test (79 % to 87 %).Conclusion: Increased sFlt-1/PlGF ratio, was a good predictive marker for SAO in the study population. The accuracy of prediction was better for those who developed the complications before 34 weeks. [ABSTRACT FROM AUTHOR]

It is widely acknowledged that midwives are essential in providing care for mothers experiencing perinatal death. However, midwifery students lack the knowledge and skills needed to deal with perinatal death, and. There is limited research on perinatal bereavement care training for midwifery students. To investigate undergraduate midwifery students' experiential learning of perinatal bereavement care and serve as a reference for future perinatal bereavement care teaching and training. Qualitative descriptive design. University in Guangzhou, China. Undergraduate midwifery students at a university in Guangzhou, China. This research was conducted at a university in Guangzhou, China. The participants were recruited using purposeful sampling. Semi-structured, in-depth interviews were conducted with 11 midwifery students who participated in perinatal bereavement care training from May to June 2023. The Colalizzi 7-step data analysis method was used for data analysis. From the data, five themes emerged: 1) immersive experience of perinatal bereavement care, 2) formation of perspectives on perinatal bereavement care, 3) clarification of the service boundaries and internalization of the professional service spirit, 4) emotional impact and coping strategies, and 5)) factors influencing practice optimization. Experiential learning is an effective teaching strategy. However, participants continued to feel unprepared to provide perinatal bereavement care. Implementing relevant training, disseminating perinatal bereavement care knowledge and skills, and enhancing the ability of midwifery students to manage and cope with the psychological impact of perinatal death are important. • Undergraduate midwifery (MW) students' perinatal bereavement care (PBC) experience was analyzed. • The first study published regarding MW students' learning experiences in reformed education program in a Chinese university. • Study findings can facilitate MW educators with PBC teaching. [ABSTRACT FROM AUTHOR]

No fetal growth standard is currently endorsed for universal use in the United States. Newer standards improve upon the methodologic limitations of older studies; however, before adopting into practice, it is important to know how recent standards perform at identifying fetal undergrowth or overgrowth and at predicting subsequent neonatal morbidity or mortality in US populations. To compare classification of estimated fetal weight that is <5th or 10th percentile or >90th percentile by 6 population-based fetal growth standards and the ability of these standards to predict a composite of neonatal morbidity and mortality. We used data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be cohort, which recruited nulliparous women in the first trimester at 8 US clinical centers (2010–2014). Estimated fetal weight was obtained from ultrasounds at 16 to 21 and 22 to 29 weeks of gestation (N=9534 women). We calculated rates of fetal growth restriction (estimated fetal weight <5th and 10th percentiles; fetal growth restriction<5 and fetal growth restriction<10) and estimated fetal weight >90th percentile (estimated fetal weight>90) from 3 large prospective fetal growth cohorts with similar rigorous methodologies: INTERGROWTH-21, World Health Organization-sex-specific and combined, Eunice Kennedy Shriver National Institute of Child Health and Human Development race-ethnic-specific and unified, and the historic Hadlock reference. To determine whether differential classification of fetal growth restriction or estimated fetal weight >90 among standards was clinically meaningful, we then compared area under the curve and sensitivity of each standard to predict small for gestational age or large for gestational age at birth, composite perinatal morbidity and mortality alone, and small for gestational age or large for gestational age with composite perinatal morbidity and mortality. The standards classified different proportions of fetal growth restriction and estimated fetal weight>90 for ultrasounds at 16 to 21 (visit 2) and 22 to 29 (visit 3) weeks of gestation. At visit 2, the Eunice Kennedy Shriver National Institute of Child Health and Human Development race-ethnic-specific, World Health Organization sex-specific and World Health Organization-combined identified similar rates of fetal growth restriction<10 (8.4%–8.5%) with the other 2 having lower rates, whereas Eunice Kennedy Shriver National Institute of Child Health and Human Development race-ethnic-specific identified the highest rate of fetal growth restriction<5 (5.0%) compared with the other references. At visit 3, World Health Organization sex-specific classified 9.2% of fetuses as fetal growth restriction<10, whereas the other 5 classified a lower proportion as follows: World Health Organization-combined (8.4%), Eunice Kennedy Shriver National Institute of Child Health and Human Development race-ethnic-specific (7.7%), INTERGROWTH (6.2%), Hadlock (6.1%), and Eunice Kennedy Shriver National Institute of Child Health and Human Development unified (5.1%). INTERGROWTH classified the highest (21.3%) as estimated fetal weight>90 whereas Hadlock classified the lowest (8.3%). When predicting composite perinatal morbidity and mortality in the setting of early-onset fetal growth restriction, World Health Organization had the highest area under the curve of 0.53 (95% confidence interval, 0.51–0.53) for fetal growth restriction<10 at 22 to 29 weeks of gestation, but the areas under the curve were similar among standards (0.52). Sensitivity was generally low across standards (22.7%–29.1%). When predicting small for gestational age birthweight with composite neonatal morbidity or mortality, for fetal growth restriction<10 at 22 to 29 weeks of gestation, World Health Organization sex-specific had the highest area under the curve (0.64; 95% confidence interval, 0.60–0.67) and INTERGROWTH had the lowest (area under the curve=0.58; 95% confidence interval 0.55–0.62), though all standards had low sensitivity (7.0%–9.6%). Despite classifying different proportions of fetuses as fetal growth restriction or estimated fetal weight>90, all standards performed similarly in predicting perinatal morbidity and mortality. Classification of different percentages of fetuses as fetal growth restriction or estimated fetal weight>90 among references may have clinical implications in the management of pregnancies, such as increased antenatal monitoring for fetal growth restriction or cesarean delivery for suspected large for gestational age. Our findings highlight the importance of knowing how standards perform in local populations, but more research is needed to determine if any standard performs better at identifying the risk of morbidity or mortality. [ABSTRACT FROM AUTHOR]

Introduction: Placental pathology and pregnancy complications are associated with unfavorable regulation of the maternal immune system. Although much research has been performed towards the role of immune cells like macrophages and T cells in this context, little is known about the presence and function of mast cells (MC). MC can be sub classified in tryptase-positive (MCT) and tryptase- and chymase-positive (MCTC). This study investigates the presence of MC in the decidua of pregnancies complicated by fetal growth restriction (FGR) and stillbirth (SB).Methods: Placental tissue from FGR (n = 250), SB (n = 64) and healthy pregnancies (n = 42) was included. Histopathological lesions were classified according to the Amsterdam Placental Workshop Group criteria. Tissue sections were stained for tryptase and chymase. Decidual MC were counted manually, and the results were expressed as number of cells/mm2 decidual tissue.Results: A significant lower median number of MCTC was found in the decidua of FGR (0.40 per mm2; p < 0.001) and SB (0.51 per mm2; p < 0.05) compared to healthy controls (1.04 per mm2). No difference in MCT number (1.19 per mm2, 1.88 per mm2 and 1.37 per mm2 respectively) was seen between the groups. There was no difference in number of MCT and MCTC between placental pathological lesions.Discussion: Our findings suggest a shift in decidual MC balance towards MCT in pregnancy complications. No difference in numbers of MC subtypes was found to be related to histopathologic lesions. [ABSTRACT FROM AUTHOR]

Introduction: Autopsy is regarded as the "gold standard" to determine probable causes of stillbirths. However, autopsy is expensive and not readily available in low- and middle-income countries. Therefore, we assessed how the clinical cause of death is modified by adding placental histology and autopsy findings.Method: Data from the Safe Passage Study was used where 7060 pregnant women were followed prospectively. Following a stillbirth, each case was discussed and classified at weekly perinatal mortality meetings. This classification was later adapted to the WHO ICD PM system. Clinical information was presented first, and a possible cause of death decided upon and noted. The placental histology was then presented and, again, a possible cause of death, using the placental and clinical information, was decided upon and noted, followed by autopsy information. Diagnoses were then compared to determine how often the additional information changed the initial clinical findings.Results: Clinical information, placental histology, and autopsy results were available in 47 stillbirths. There were major amendments from the clinical only diagnoses when placental histology was added. Forty cases were classified as due to M1: complications of placenta, cord, and membranes, when placental histology was added compared to 7 cases with clinical classification only, and M5: No maternal condition identified decreased from 30 cases to 3 cases. Autopsy findings confirmed the clinical and placental histology findings.Discussion: Clinical information together with examination of the placenta revealed sufficient information to diagnose the most probable cause of death in 40 of 47 cases of stillbirth (85%). [ABSTRACT FROM AUTHOR]

Introduction: Placental vascular disease, characterized by Maternal Vascular Malperfusion (MVM) lesions, is considered to be the underlying cause of pregnancy complications. Aim is to evaluate the relationship between the cumulative number of MVM lesion types, and adverse pregnancy- and neonatal outcomes.Methods: This retrospective cohort study included 272 women with singleton gestations who gave birth at a Dutch tertiary hospital between 2017 and 2018 with available placental histopathology reports. Analyzed according to the Amsterdam Placental Workshop Group Consensus Statement, placentas were divided into groups based on the cumulative number of MVM lesions: no lesions (n = 124), 1-2 types (n = 124) and 3-5 types of lesions (n = 24).Results: The proportion of placenta syndrome (PS) was highest (95.8%) in the 3-5 MVM lesions group (p < 0.001). The presence of MVM lesions was highly associated with PS during pregnancy (aOR 6.81, 95% CI 3.76-12.33). Furthermore, every additional type of MVM lesion corresponded with a threefold increased odds for the occurrence of PS (aOR 3.00, 95% CI 2.10-4.29). The group with 3-5 types of MVM lesions showed the highest incidence of adverse neonatal outcomes, lower mean birth weight, prolonged hospitalization, NICU admissions and neonatal deaths (aOR 6.47, 95% CI 0.33-127.68), corresponding with a fourfold increased odds for the occurrence of neonatal death for every additional MVM lesion (aOR 4.19, 95% CI 1.39-12.68).Discussion: A higher number of MVM lesion types is strongly associated with an increased incidence of adverse pregnancy- and neonatal outcomes, indicating that guidelines should focus also on the amount of MVM lesion types for the monitoring/management of subsequent pregnancies. [ABSTRACT FROM AUTHOR]

Introduction: Placental dysfunction is one of the most common causes of Intrauterine Fetal Demise (IUFD). Due to its characteristics, the placenta may be the target of molecular research aimed to investigate potential causes of IUFD. In the literature, there are no studies on human placentas that have investigated possible associations between somatic mutations and the occurrence of IUFD. The aim of this study was to identify the presence of gene mutations in placental tissues in a series of cases of IUFD and to evaluate potential correlations with placental microscopic findings.Materials and Methods: Thirty-seven samples of formalin-fixed and paraffin-embedded placental tissues were retrospectively selected from pregnancies ending in IUFD between 23rd to 40th week. Six control placentas of physiological pregnancies were included as controls. After sampling, made according to standardized protocol and conventional histopathological examination, placental tissues were subjected to DNA extraction and sequencing by means of Next Generation Sequencing with a 56-gene panel.Results: The most frequent mutation observed in 32/37 IUFD cases (86.5%) and absent in any of the 6 control placentas was in c-KIT gene, which is implicated in placental tissue differentiation. However, no significant correlation was found between the presence of individual gene mutations and placental histopatological findings.Discussion: As the present study found an elevated frequency of c-KIT mutation in IUFD, it further supports the hypothesis that c-KIT is involved in abnormal tissue differentiation leading to altered placental vascularization and function. [ABSTRACT FROM AUTHOR]

The health of women is dependent on midwifery workforce stability. Retaining new midwives is paramount, however without support, the early career can be a vulnerable time for midwives. Midwives care for women who experience poor perinatal outcomes like stillbirth and neonatal death. Midwifery care in these sentinel events is complex. There is limited understanding of early career midwives' experiences within these encounters. To understand the experiences of Australian early career midwives' clinical encounters with perinatal grief, loss and trauma. A qualitative descriptive/exploratory study using in-depth interviews. Four themes were identified from interview data: (1) all eyes on the skills; (2) support is of the essence; (3) enduring an emotional toll; (4) at all times, the woman. Most participants had minimal exposure to perinatal loss as a student. As a result, most felt unskilled and unprepared for this as a new midwife. Types and degrees of support varied in these encounters. Early career midwives who were well supported reflected positively on working with grief and loss. In contrast, inadequate or absent support had detrimental effects on participant wellbeing. Poorly supported encounters with death (intrapartum fetal, early neonatal, and maternal) in the early career period were significantly distressful, giving rise to mental and emotional distress. Pre-registration perinatal loss skill development and supported experiences are necessary for preparedness. Continued education, formalised debriefing and mentoring, institutional philosophies which promote collegial ethics of care, and the expansion of continuity of midwifery care models will improve new midwives' experiences. [ABSTRACT FROM AUTHOR]

Purpose: Grief after infant death is a common experience of bereaved parents often seen in the neonatal intensive care unit (NICU). The NICU staff tend to focus more on the mother's support, and fathers are often not treated equally as mothers. This study aimed to investigate the circumstance of caring for parents facing infant death in NICUs. Methods: Twenty-eight face-to-face in-depth interviews were conducted between March 2018 and April 2019 in the northwest of Iran. Participants were selected via purposive sampling. An inductive thematic approach was used for data analysis. Results: Three main themes and 7 subthemes were extracted. The main themes were: "the father—the missing piece of the puzzle in the mourning process," "restricted presence of fathers due to religious and traditional beliefs," and "the father—the patience stone." Conclusion: Due to cultural-religious backgrounds, traditional beliefs, structural problems, and organizational restrictions, fathers in NICUs do not receive adequate support, particularly when faced with their infant's death. Bereaved fathers need to receive more support and attention from healthcare providers. Therefore, there is a need for changing the care providers' attitudes regarding the role of fathers and the quality of support that fathers should receive in the Muslim populations. [ABSTRACT FROM AUTHOR]

Sudden unexpected death in epilepsy (SUDEP) is an increasingly recognized cause of death in children and young people with epilepsy. Although paediatric SUDEP is thought to be a rare event, it may be more common than previously thought, with incidence estimates ranging from 0.22 to 6 per 1000 person years. Limited clinician experience and knowledge about paediatric SUDEP has impaired the ability to inform children and their families about their individual risk and means to reduce it. Although many questions remain, in the past two decades our understanding of paediatric SUDEP has greatly increased. The pathophysiology of paediatric SUDEP remains poorly characterized, with distinct respiratory, cardiac, and central mechanisms all likely to be involved. Recent cohort studies have allowed major risk factors to be identified, including frequent generalized tonic-clonic seizures, nocturnal seizures, and lack of supervision. Optimizing seizure control, alongside the early detection and supervision of seizure activity, are possible risk reduction strategies. Evidenced-based discussions about paediatric SUDEP should form part of routine care for children and young people with epilepsy. [ABSTRACT FROM AUTHOR]

Objectives: The objectives were to compare the efficacy and safety of intravenous hydralazine and labetalol for acutely lowering severe hypertension in pregnancy.Study Design: This was a superiority parallel double-blinded randomized controlled trial conducted from October 2018 to June 2019 in two hospitals in Gombe, Nigeria. Pregnant women with a live singleton fetus at gestational age of at least 28 weeks with severe hypertension were randomized (60 per group) to receive incremental doses of either intravenous labetalol (20 mg; 40 mg; 80 mg; 80 mg; and 80 mg) or 10 mg of intravenous hydralazine - up to a maximum of 5 doses - until the target blood pressure was achieved or the study was terminated.Main Outcome Measures: The main outcome measures were the mean reduction in mean arterial blood pressure and occurrence of persistent hypertension. Other endpoints were maternal side-effects, perinatal death, Apgar score at birth and SCBU admission.Results: One hundred and thirteen patients' data were analyzed (fifty-six [56] in the hydralazine group and fifty-seven [57] in the labetalol group). There were no significant differences in the fall of the mean arterial blood pressure (labetalol; 24.19 mmHg/hydralazine; 27.68 mmHg) (p = 0.192), maternal side effects, perinatal deaths, Apgar scores and SCBU admission between the two groups. Hydralazine, however, produced a more marked reduction in diastolic blood pressure than labetalol (p = 0.012).Conclusion: Both labetalol and hydralazine are effective for acute blood pressure control in pregnancy with a similar safety profile. This study was self-funded and registered in the Pan African Clinical Trials Registry (www.pactr.orgPACTR202010738538062). [ABSTRACT FROM AUTHOR]

Continuous utero-placental circulation, and patent umbilical blood vessels ensure an uninterrupted transfer of oxygen and nutrients to the fetus as well as clearance of metabolic waste products. The onset of labour characterized by progressive and strong uterine contractions poses a threat to fetal oxygenation as a result of collapsing the spiral arterioles traversing the myometrium to supply the placental bed, and repetitive compression of the blood vessels within the umbilical cord. Human fetuses are equipped with compensatory mechanisms to cope with transient interruptions of blood supply during labour. The ability to compensate may be blunted in cases of poor fetal reserves, increased metabolic demand (macrosomia or maternal fever), and due to non-hypoxic pathways (e.g. chorioamniontis or fetal hypovolumia-hypotension syndrome). Intrapartum fetal surveillance involves prompt recognition of the features that signal the onset of fetal decompensation on the cardiotocograph (CTG) to ensure a timely intervention to avoid hypoxic-ischaemic encephalopathy (HIE) or perinatal deaths. This article summarises a 'physiological approach' to the interpretation of the CTG which, in places, conflicts with other current UK guidance. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

One of the hallmarks of twin pregnancies is the slower rate of fetal growth when compared with singleton pregnancies during the third trimester. The mechanisms underlying this phenomenon and whether it represents pathology or benign physiological adaptation are currently unclear. One important implication of these questions relates to the type growth charts that should be used by care providers to monitor growth of twin fetuses. If the slower growth represents pathology (ie, intrauterine growth restriction caused uteroplacental insufficiency), it would be preferable to use a singleton growth chart to identify a small twin fetus that is at risk for perinatal mortality and morbidity. If, however, the relative smallness of twins is the result of benign adaptive mechanisms, it is likely preferable to use a twin-based charts to avoid overdiagnosis of intrauterine growth restriction in twin pregnancies. In the current review, we addressed this question by describing the differences in fetal growth between twin and singleton pregnancies, reviewing the current knowledge regarding the mechanisms responsible for slower fetal growth in twins, summarizing available empirical evidence on the diagnostic accuracy of the 2 types of charts for intrauterine growth restriction in twin pregnancies, and addressing the question of whether uncomplicated dichorionic twins are at an increased risk for fetal death when compared with singleton fetuses. We identified a growing body of evidence that shows that the use of twin charts can reduce the proportion of twin fetuses identified with suspected intrauterine growth restriction by up to 8-fold and can lead to a diagnosis of intrauterine growth restriction that is more strongly associated with adverse perinatal outcomes and hypertensive disorders than a diagnosis of intrauterine growth restriction based on a singleton-based chart without compromising the detection of twin fetuses at risk for adverse outcomes caused by uteroplacental insufficiency. We further found that small for gestational age twins are less likely to experience adverse perinatal outcomes or to have evidence of uteroplacental insufficiency than small for gestational age singletons and that recent data question the longstanding view that uncomplicated dichorionic twins are at an increased risk for fetal death caused by placental insufficiency. Overall, it seems that, based on existing evidence, the of use twin charts is reasonable and may be preferred over the use of singleton charts when monitoring the growth of twin fetuses. Still, it is important to note that the available data have considerable limitations and are primarily derived from observational studies. Therefore, adequately-powered trials are likely needed to confirm the benefit of twin charts before their use is adopted by professional societies. [ABSTRACT FROM AUTHOR]

Background: In South Africa (SA), approximately 16 000 stillbirths occur annually. Most are classified as unexplained and occur in district hospitals. Many of these deaths may be caused by undetected foetal growth restriction. Continuous wave Doppler ultrasound of the umbilical artery (CWDU-UmA) is a simple method for assessing placental function. This screening method may detect the foetus at risk of dying and growth-restricted foetuses, allowing for appropriate management. Methods: A cohort study was conducted across South Africa. Pregnant women attending primary health care clinics at 28--34 weeks gestation were screened using CWDU-UmA. Women not screened at those antenatal clinics served as control group 1. Control group 2 consisted of the subset of control group 1 with women detected with antenatal complications excluded. Women with foetuses identified with an abnormal CWDU-UmA test were referred and managed according to a standardised protocol. A comparison between the study and control groups was performed. Results: The study group consisted of 6536 pregnancies, and there were 66 stillbirths (stillbirth rate [SBR]: 10.1/1000 births). In control group 1, there were 193 stillbirths in 10 832 women (SBR: 17.8/1000 births), and in control group 2, 152 stillbirths in 9811 women (SBR: 15.5/1000 births) (risk ratio: 0.57, 95% confidence intervals: 0.29--0.85 and 0.65, 0.36--0.94, respectively). Conclusion: Screening a low-risk pregnant population identified the low-risk mother with a high-risk foetus, and acting on the information as described was associated with a significant reduction (35% -- 43%) in stillbirths. This demonstrates a step-change reduction in stillbirths and warrants screening in SA. [ABSTRACT FROM AUTHOR]

Preterm birth is a leading cause of perinatal morbidity and mortality. Antenatal corticosteroid administration before preterm birth reduces the risks of perinatal death, respiratory morbidity, necrotizing enterocolitis, and intraventricular hemorrhage and reduces the costs of perinatal care. Antenatal corticosteroids are optimally effective when administered within 7 days before preterm birth. However, only 20% to 40% of early preterm infants receive antenatal corticosteroids within 7 days before birth, in part because it is difficult to predict the precise timing of preterm birth. Until 2020, The Joint Commission had a Perinatal Care quality metric measuring the rate of antenatal corticosteroid administration at any time before early preterm birth. This metric incentivized providers to use antenatal corticosteroids liberally. The Joint Commission retired the metric in 2020 after the rate reached more than 97% in The Joint Commission-accredited hospitals. However, the metric did not evaluate whether the timing of antenatal corticosteroid administration was optimal, that is, within 7 days of birth. A 2016 multistakeholder Cooperative Workshop recommended the development of a new quality metric to assess the rate of optimally timed antenatal corticosteroids among early preterm births. In this statement, we outline proposed specifications for such a metric and discuss potential uses, advantages, limitations, and barriers. Furthermore, we propose a balancing metric that tracks the percentage of patients treated with antenatal corticosteroids who ultimately give birth at term. We suggest that the use of these new metrics may incentivize more conservative antenatal corticosteroid timing, which could, in turn, lead to meaningfully improved outcomes for preterm neonates. [ABSTRACT FROM AUTHOR]

Purpose: A descriptive correlational survey was conducted to examine nurses' attitudes and stress related to perinatal bereavement care (PBC) and their relationships, with the ultimate goal of improving nurses' capabilities related to PBC. Methods: Korean nurses (N=136) who had experienced perinatal death at least once were recruited from seven hospitals. Data were analyzed using descriptive statistics. The Korean version of Nurses' Attitudes towards Perinatal Bereavement Support was assessed in terms of three subdomains (attitudes to PBC, importance of policies related to PBC, and importance of training related to PBC), and nurses' stress was measured. Results: The participants gave high scores for the attitude-related items of "giving sufficient time to bereaved parents to mourn for their dead baby" (4.54 points) and "nurses should treat bereaved parents with respect and dignity" (4.51 points), and they perceived a high level of importance for the policy-related items of "every staff member in the hospital should understand the policies relevant for PBC" and "when nurses feel emotional exhaustion, they should seek support" (4.58 points). Nurses' attitude toward PBC was associated with the perceived importance of policies (r=.40, p<.001), the perceived importance of PBC-related training (r=.61, p<.001), and stress related to PBC (r=.29, p<.001). Nurses' perceived importance of PBC-related training was associated with stress related to PBC (r=.38, p<.001). Conclusion: Establishing hospital policies related to PBC and providing PBC training for nurses could positively affect nurses' attitudes toward PBC. A stress management program for nurses could reduce the stress caused by PBC. [ABSTRACT FROM AUTHOR]