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OBJECTIVE: Educational inequality in stillbirth has been documented in high-income countries and the province of Quebec, Canada, but temporal trends are poorly understood. Our objective was to determine time trends in inequality related to maternal education for all-cause and cause-specific stillbirth over the past three decades in Quebec. METHODS: We included 2,397,971 live births and 9,983 stillbirths from 1981 through 2009 using Quebec vital statistics. For each decade, we computed measures of inequality capturing relative (relative index of inequality, RII) and absolute (slope index of inequality, SII) differences between the least- and most-educated mothers for all-cause and cause-specific stillbirth, adjusting for maternal characteristics. RESULTS: Stillbirth rates decreased over time for all education levels. Absolute educational inequality (SII 2.5 per 1000 births, 95% CI 2.1-2.8; all periods combined) was stable over time, whereas relative inequality increased ([RII.sub.1981-1989] 1.8 vs. [RII.sub.2000-2009] 2.3). Absolute inequality decreased for stillbirths caused by placental abruption ([SII.sub.1981-1989] 0.6 vs. [SII.sub.2000-2009] 0.3), but increased for unspecified causes ([SII.sub.1981-1989] 0.2 vs. [SII.sub.2000-2009] 0.7). CONCLUSIONS: Absolute educational inequality in stillbirth persisted and relative inequality increased over the past three decades, despite an overall decrease in stillbirth rates. The decrease in absolute inequality for placental abruption was countered by an increase for unspecified causes. A better understanding of the underlying components of unspecified causes is needed to further address educational inequality in stillbirth. KEY WORDS: Cause of death; educational status; fetal death; socioeconomic factors; stillbirth; trend, temporal OBJECTIF: Des inegalites de scolarite maternelle pour les mortinaissances ont ete documentees dans plusieurs pays industrialises, mais leurs tendances temporelles sont moins connues. Notre objectif etait d'etudier les tendances temporelles des inegalites de scolarite pour les mortinaissances, toutes causes et par cause, pour les trois dernieres decennies au Quebec, Canada. METHODES: Nous avons inclus 2 397 971 naissances vivantes et 9 983 mortinaissances du Quebec de 1981 a 2009. Pour chaque decennie, nous avons obtenu un indice d'inegalite relatif (<< relative index of inequality >>, RII) et un indice d'inegalite absolu (<< slope index of inequality >>, SII) pour l'association entre la scolarite maternelle et les mortinaissances, toutes causes et par cause, en ajustant pour les caracteristiques maternelles. RESULTATS: Les taux de mortinaissance ont diminue pour tous les niveaux de scolarite. L'inegalite absolue de scolarite est demeuree stable (SII 2,5 pour 1 000 naissances, intervalle de confiance a 95 % 2,1-2,8; periodes combinees), tandis que l'inegalite relative a augmente (RII 1,8 a 2,3). L'inegalite absolue a diminue pour les mortinaissances causees par un decollement placentaire (SII 0,6 a 0,3), mais a augmente pour les causes non-specifiees (SII 0,2 a 0,7). CONCLUSIONS: L'inegalite absolue de scolarite pour les mortinaissances a persiste et l'inegalite relative a augmente au cours des trois dernieres decennies, malgre une diminution des taux de mortinaissance. Malgre une diminution de l'inegalite pour les decollements placentaires, on observe une augmentation pour les causes non-specifiees. Une meilleure comprehension des composantes contribuant a ces dernieres est necessaire pour mieux apprehender les inegalites de scolarite pour les mortinaissances. MOTS CLES: cause de deces; facteurs socioeconomiques; mort foetale; mortinaissance; scolarite; tendances temporelles, Stillbirth, an important contributor to perinatal mortality, (1) is unequally distributed across socio-economic groups. (2) Educational inequality in stillbirth has been documented in many high-income countries (2-4) and the province [...]

Byline: Sherry Lipsky (1), Victoria L. Holt (1), Thomas R. Easterling (2), Cathy W. Critchlow (1) Keywords: domestic violence; pregnancy; hospitalization; mental health; substance abuse Abstract: Objectives: Intimate partner violence (IPV) is a significant public health problem and the abuse of women during pregnancy is of particular concern. Few studies have addressed the relationship between IPV and antenatal hospitalization. This study utilized a novel approach to examine the impact of IPV during pregnancy on antenatal hospitalization not associated with delivery. Methods: This retrospective cohort study included Seattle women residents 16--49 years of age. Exposed subjects were women with a police-reported IPV incident during pregnancy in the years 1995 through 1998 and who subsequently had a singleton live birth or fetal death. The unexposed group was composed of randomly selected residents with a singleton birth or fetal death and without a police-reported IPV incident during the study period. Linked hospital discharge files and birth records were utilized to determine study outcomes. Logistic regression was used to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI). Results: Women reporting any IPV during pregnancy were twice as likely as unexposed women to experience an antenatal hospitalization not associated with delivery (aAOR 2.39, CI 1.77, 3.24). Women with IPV were more likely to have been hospitalized with a substance abuse-related diagnosis (aOR 2.70, CI 1.52, 4.78) or a mental health-related diagnosis (aOR 1.93, CI 0.96, 3.91). Physical IPV was more strongly associated with antenatal hospitalization than nonphysical IPV or IPV overall. Conclusion: This study suggests that women hospitalized during pregnancy, particularly those with substance abuse and mental health-related conditions, may be at high risk for concurrent IPV. Author Affiliation: (1) Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, Washington (2) Department of Obstetrics and Gynecology, School of Medicine, University of Washington, Seattle, Washington Article History: Registration Date: 18/10/2004

Byline: Sanne J. Gordijn (), Jan Jaap H.M. Erwich (), T. Yee Khong () Abstract: In consenting to a perinatal autopsy, the primary motive of parents may be to find the exact cause of death. A critical review on the value of perinatal autopsies was performed to see whether parents could be counseled regarding their main motive. A literature search was performed in MEDLINE, EXCERPTA MEDICA, and the Cochrane library. We evaluated the value of the autopsy by comparing the clinical and autopsy diagnoses in stillbirths, neonatal deaths, and therapeutic terminations. Clinicopathologic concordance was divided into four categories: (1) change in diagnosis, (2) additional findings, (3) complete confirmation, and (4) inconclusive. We sought information on factors that may influence the value of perinatal autopsies: the type and definitions of perinatal loss autopsy rate level of hospital expertise of pathologists autopsy protocol used whether patients were inborn or referred and antenatal diagnosis. From the 27 articles that met our review criteria, the autopsy revealed a change in diagnosis or additional findings in 22% to 76% of cases. If confirmation of clinical findings is included, then the value of the perinatal autopsy was as high as up to 100%. Factors that could influence this rate were reported variably by investigators. When centers report their experience of the value of the perinatal autopsy, information on the factors that may influence their reports should be provided as well. Clinicians can confidently advise parents of the usefulness of the perinatal autopsy in ascertaining the cause of death or for counseling their future pregnancies. Author Affiliation: () Department of Histopathology, Women's and Children's Hospital, 72, King William Road, North Adelaide, South Australia, Australia, AU () Department of Obstetrics and Gynaecology, University Hospital Groningen, Groningen, The Netherlands, NL Article History: Received Date: 15/08/2001 Accepted Date: 11/04/2002

Byline: Maria M. Rodriguez (), Fernando Chaves (), Rita L. Romaguera (), Peter L. Ferrer (), Claudia de la Guardia (), Jocelyn H. Bruce () Abstract: Nonimmune hydrops fetalis (NIHF) is used to describe fetuses and newborns with generalized edema and cavity effusions. It is helpful to alert physicians about the presence of anemia, heart failure, and/or hypoproteinemia, but this diagnosis is frequently overlooked. We reviewed the autopsy files from 1990 to 2000, selected all cases with NIHF including clinical information (with maternal laboratory tests and ultrasound), and classified patients by etiology. Among 840 stillborn autopsies during the 11-year period, we found 51 with NIHF (6.07%). The clinical summary had mentioned hydrops in 14 patients and the etiology in another 7 by fetal ultrasonography, but without addressing the possibility of hydrops. In the remaining 30 cases neither hydrops nor an etiology was mentioned. Other pertinent diagnoses were maternal diabetes mellitus (4), congenital heart disease (3), and cystic hygroma (2). The following diagnoses were made in one instance each: cardiac tumor, twin transfusion syndrome, congenital adenomatoid malformation, syphilis, Turner syndrome, and cerebral arteriovenous malformation. Postmortem and placental examination confirmed the following etiologies: congenital infections (17) placental pathology significant enough to explain NIHF (10) cardiovascular diseases (8) (further classified as congenital heart disease [3], rhabdomyoma [1], and vascular malformations [4]) chromosomal abnormalities (6) uncontrolled maternal diabetes (4) intrathoracic lesions (2) prune-belly syndrome (2) and idiopathic NIHF (2). Only 3.9% of the cases studied had no identifiable etiology. The cause of hydrops was confirmed by autopsy in 47 fetuses (92%), which further supports the importance of performing an autopsy. Thirty-two cases (62.74%) had placental abnormalities helpful to the etiology (parvovirus, syphilis, Turner's syndrome, etc.). In 20 instances, the clinical summary had no mention of either hydrops or any of the diseases leading to it. The autopsy in conjunction with placental examination and fetal ultrasound represent the best combination to determine the etiology of NIHF among stillborn fetuses. Author Affiliation: () Department of Pathology, Division of Pediatric Pathology, University of Miami/Jackson Memorial Hospital, Holtz Center 2142, 1611 NW 12th Avenue, Miami, FL 33136, USA, US () Departments of Pediatrics, Radiology, and Obstetrics, Division of Pediatric Cardiology, University of Miami/Jackson Memorial Hospital, Miami, FL, USA, US Article History: Received Date: 26/11/2001 Accepted Date: 17/03/2002

Byline: Robert W. Bendon (1) Keywords: Key words: stillbirth, hydrops, asphyxia, cerebral palsy, mortality review Abstract: Stillborn fetuses commonly demonstrate three mechanisms of death: hydrops, asphyxia, or shock. For each mechanism, the autopsy can discover any of multiple etiologies. This paper reviews the etiologies and pathogeneses of fetal death from that perspective. Author Affiliation: (1) Department of Pathology, Kosair Children's Hospital, P.O. Box 35070, Louisville, KY 40232-5070, USA, US Article note: Received November 3, 2000 accepted April 19, 2001.

Byline: J.F. Magee (1) Keywords: Key words: stillbirth, autopsy techniques, significant findings Abstract: The pathologic investigation of stillbirth is often frustrating, and may be viewed as unrewarding, because the reason for death of the infant frequently is not identifiable. This outline attempts to identify an approach to the examination of the stillborn and accompanying placenta, with appropriate use of ancillary studies that may uncover the cause of death and/or identify factors that could prejudice future pregnancies. Author Affiliation: (1) Department of Pathology and Laboratory Medicine, Children's and Women's Health Centre of British Columbia, 4480 Oak Street, Vancouver, British Columbia, V6H 3N1, Canada, CA Article note: Received March 10, 2000 accepted August 4, 2000.