Search

Monkeypox virus, which causes mpox, is the most medically concerning member of the genus Orthopoxvirus. Monkeypox virus is related to the variola virus, the etiologic agent of smallpox before its [...]

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 [...]

Objective: To describe the rate of and demographic factors associated with fetal postmortem investigation and to classify the cause of all fetal deaths that underwent postmortem investigation. To compare the proportion of deaths remaining unexplained after postmortem investigation with estimates derived from death certificates. Method: All fetal deaths in Western Australia (WA) from 1990 to 1999 were identified. These data were used to calculate postmortem rates and describe the characteristics of women consenting to postmortems. A multidisciplinary team classified the cause of all deaths that underwent postmortem investigation using the Perinatal Society of Australia and New Zealand Perinatal Death Classification System. The proportion of deaths that were unexplained was compared with estimates based on death certificates. Results: Of the 1,619 fetal deaths recorded for 1990 to 1999, 49% (n=789) underwent complete postmortem investigation, Based on investigations, 22% of the 789 fetal deaths were unexplained and a further 18% were identified as having fetal growth restriction. Based on death certificates, 42% were unexplained and 65% were later explained by postmortem investigation. Conclusion and Implications: Postmortem investigation rates are low. They reveal a cause of death for the majority of cases that are unexplained clinically. Epidemiological investigations of unexplained fetal death based on cases not subject to complete postmortem investigation may lead to inaccurate conclusions. A standardised definition for unexplained fetal deaths that distinguishes between cases with detailed investigation and those with limited or no investigation is needed. Key words: Fetal death; death certificate; cause of death; autopsy; epidemiology; classification.

Objective To assess the rates, timing and causes of neonatal deaths and the burden of stillbirths in rural Uttar Pradesh, India. We discuss the implications of our findings for neonatal interventions. Methods We used verbal autopsy interviews to investigate 1048 neonatal deaths and stillbirths. Findings There were 430 stillbirths reported, comprising 41% of all deaths in the sample. Of the 618 live births, 32% deaths were on the day of birth, 50% occurred during the first 3 days of life and 71% were during the first week. The primary causes of death on the first day of life (i.e. day 0) were birth asphyxia or injury (31%) and preterm birth (26%). During aays 1-6, the most frequent causes of death were preterm birth (30%) and sepsis or pneumonia (25%). Half of all deaths caused by sepsis or pneumonia occurred during the first week of life. The proportion of deaths attributed to sepsis or pneumonia increased to 45% and 36% during days 7-13 and 14-27, respectively. Conclusion Stillbirths and deaths on the clay of birth represent a large proportion of perinatal and neonatal deaths, highlighting an urgent need to improve coverage with skilled birth attendants and to ensure access to emergency obstetric care. Health interventions to improve essential neonatalcare and care-seeking behavior are also needed, particularly for preterm neonates in the early postnatal period. Objectivo Evaluar las taux, la repartition dans le temps et les causes des deces neonataux et de la charge de mortinatalite dans une population rurale de l&apos;Uttar Pradesh, en Inde. Les implications des resultats de l&apos;etude pour les interventions en sante neonatale sont ensuite examinees. Methodes On a analyse 1048 cas d&apos;enfants mort-nes ou decedes pendant la periode neonatale a partir des interrogatoires realises dans le cadre des autopsies verbales. Resultats Le nombre de cas d&apos;enfants mort-nes notifies s&apos;elevait a 430, soit 41% de l&apos;ensemble des deces dans l&apos;echantillon. Sur les 618 enfants nes vivants, 32 % sont morts le jour de la naissance, 50 % au cours des 3 premiers jours de vie et 71% pendant la premiere semaine. Les principales causes de deces au premier jour de vie (appele jour 0) etaient l&apos;asphyxie ou les traumatismes a la naissance (31%) et la naissance avant terme (26 %). Pendant les jours 1 a 6, les causes de deces les plus frequentes etaient la naissance avant terme (30 %) et la presence d&apos;une infection grave ou d&apos;une pneumonie (25 %). La moitie des deces par infection grave ou par pneumonie se produisaient pendant la premiere semaine de vie. La proportion de deces attribuables a une infection grave ou a une pneumonie passait a 45 % et a 36 % pour les periodes allant du 7e au 13e jours et du 14e au 27e jours respectivement. Conclusion La mortinatalite et les deces intervenant le jour de la naissance representent une fraction importante des deces perinataux et neonataux, ce qui met en lumiere la necessite urgente d&apos;ameliorer la couverture des naissances par des accoucheurs competents et de garantir l&apos;acces a des soins obstetricaux d&apos;urgence. Des interventions sanitaires visant a ameliorer les soins neonataux essentiels et les comportements en matiere de recours aux soins, en particulier pour les nouveaux-nes prematures au debut de la periode postnatale, s&apos;imposent egalement. Objetivo Evaluar las tasas, el momento y las causas de la mortalidad neonatal y la carga de mortinatalidad en zonas rurales de Uttar Pradesh (India). Consideramos aqui las implicaciones de nuestros resultados para las intervenciones neonatales. Metodos Utilizamos entrevistas de autopsias verbales para investigar 1048 defunciones neonatales y prenatales. Resultados Se notificaron 430 casos de muerte prenatal, que suponian el 41% de todas las defunciones de la muestra. Entre los 618 nacidos vivos, el 32% de las defunciones se produjeron en el mismo dia de nacimiento, el 50% se produjeron durante los 3 primeros dias de vida, y el 71% se registraron durante la primera semana. Las causas principales de defuncion en el primer dia de vida (dia O) fueron la asfixia y los traumatismos (31%) y la prematuridad (26%). Durante los dias 1 a 6, las causas mas frecuentes de muerte fueron la prematuridad (30%) y una septicemia o neumonia (25%). La mitad de todas las defunciones por septicemia o neumonia se produjeron durante la primera semana de vida. La proporcion de defunciones atribuidas a septicemia o neumonia aumento al 45% y el 36% durante los dias 7-13 y 14-27, respectivamente. Conclusion Las muertes prenatales o en el primer dia de vida representan una gran proporcion de las defunciones perinatales y neonatales, lo que pone de manifiesto la necesidad urgente de mejorar la cobertura con parteras calificadas y de garantizar el acceso a la atencion obstetrica de urgencia. Tambien es necesario implementar intervenciones de salud que mejoren la atencion neonatal basica y el comportamiento de busqueda de atencion, en particular para los recien nacidos prematuros en el periodo posnatal temprano., Introduction Every year, there are an estimated 4 million neonatal deaths, accounting for almost 40% of deaths in children younger than 5 years. (l,2) About a quarter of global neonatal [...]

Objective To report stillbirth and early neonatal mortality and to quantify the relative importance of different primary obstetric causes of perinatal mortality in 171 perinatal deaths from 7993 pregnancies that ended after 28 weeks in nulliparous women. Methods A review of all stillbirths and early newborn deaths reported in the WHO calcium supplementation trial for the prevention of pre-eclampsia conducted at seven WHO collaborating centres in Argentina, Egypt, India, Peru, South Africa and Viet Nam. We used the Baird--Pattinson system to assign primary obstetric causes of death and classified causes of early neonatal death using the International classification of diseases and related health problems, Tenth revision (ICD-10). Findings Stillbirth rate was 12.5 per 1000 births and early neonatal mortality rate was 9.0 per 1000 live births. Spontaneous preterm delivery and hypertensive disorders were the most common obstetric events leading to perinatal deaths (28.7% and 23.6%, respectively). Prematurity was the main cause of early neonatal deaths (62%). Conclusions Advancements in the care of premature infants and prevention of spontaneous preterm labour and hypertensive disorders of pregnancy could lead to a substantial decrease in perinatal mortality in hospital settings in developing countries. Objectif Faire etat de la mortinatalite et de la mortalite neonatale precoce et quantifier l&apos;importance relative des principales causes obstetricales de mortalite perinatale observees pour 171 deces perinatals lies a 7993 grossesses interrompues apres la 28eme semaine chez des femmes nullipares. Methodes L&apos;examen a porte sur tous les cas de mortinatalite et deces neonatals precoces signales dans l&apos;essai OMS de supplementation calcique pour la prevention de la preeclampsie mene dans sept centres collaborateurs situes en Afrique du Sud, en Argentine, en Egypte, en Inde, au Perou et au Vietnam. On a utilise le systeme de Baird-Pattinson pour attribuer les principales causes obstetricales de deces et classe les causes des deces neonatals precoces sur la base de la Classification internationale des maladies et des problemes de sante connexes, dixieme revision (CIM 10). Resultats Le taux de mortinatalite est de 12,5 pour 1000 naissances et le taux de mortalite neonatale precoce de 9,0 pour 1000 naissances vivantes. L&apos;accouchement premature spontane et l&apos;hypertension gravidique sont les problemes obstetricaux les plus frequemment a l&apos;origine d&apos;un deces perinatal (respectivement 28,7% et 23,6 %). La prematurite est la principale cause de deces neonatal precoce (62 %). Conclusion Des progres dans les soins aux prematures et la prevention du travail premature spontane et de l&apos;hypertension gravidique permettraient d&apos;obtenir une diminution sensible de la mortalite perinatale en milieu hospitalier dans les pays en developpement. Objetivo Informar sobre la mortinatalidad y la mortalidad neonatal precoz y cuantificar la importancia relativa de diferentes causas obstetricas primarias de mortalidad perinatal en 171 defunciones perinatales correspondientes a 7993 embarazos de mas de 28 semanas en mujeres nuliparas. Metodos Se examinaron todos los casos de mortinatalidad y defuncion precoz de recien nacidos notificados en un ensayo OMS de administracion de suplementos de calcio para la prevencion de la preeclampsia, llevado a cabo en siete centros colaboradores de la OMS en la Argentina, Egipto, la India, el Peru, Sudafrica y Viet Nam. Usamos el sistema de Baird-Pattinson para asignar causas obstetricas primarias de muerte y causas clasificadas de mortalidad neonatal precoz mediante la Clasificacion Estadistica Internacional de Enfermedades y Problemas de Salud Conexos, decima revision (CIE-10). Resultados La tasa de mortinatalidad fue del 12,5 por 1000 nacimientos, y la tasa de mortalidad neonatal precoz, de 9,0 por 1000 nacidos vivos. EI parto pretermino espontaneo y los trastornos hipertensivos fueron los casos obstetricos mas comunes asociados a las defunciones perinatales (28,7% y 23,6%, respectivamente). La prematuridad fue la causa principal de las defunciones neonatales precoces (62%). Conclusiones Los progresos de la atencion a los lactantes prematuros y la prevencion del parto pretermino espontaneo y de los trastornos hipertensivos del embarazo podrian propiciar una disminucion sustancial de la mortalidad perinatal en los entornos hospitalarios en los paises en desarrollo., Introduction A two-thirds reduction of mortality in children less than 5 years old by 2015 is one of the UN Millennium Development Goals. (1) Despite a decline in mortality in [...]

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

A study is conducted to see if preterm infants are at a high risk of being stillborn. It is found that delivery of a previous small-for-gestational-age infant is an important predictor of the subsequent risk of stillbirth, particularly if the infant was delivered preterm.

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.

* Objective.--To define the epidemiology, to determine factors associated with transmission, and to describe the clinical and laboratory features of congenital syphilis. Design.--Retrospective chart review and prospective analysis. Setting.--Kings County Hospital Center, Brooklyn, NY. Patients.--A total of 403 pregnancies during a 23-month period associated with positive syphilis serological findings. Results.--Seventy-three pregnancies (18%) resulted in congenital syphilis (35 live-born and 40 stillborn neonates). Pregnancies associated with congenital syphilis were significantly associated with lack of prenatal care, lack of maternal therapy for syphilis, and a higher rapid plasma reagin titer, but not with a reporter history of 'crack' or cocaine use, although detection of cocaine in urine samples was more likely with positive syphilis serology. Conclusion.--Most live-born infants with congenital syphilis (23 of 35) lacked rash, hepatosplenomegaly, or adenopathy but were identified by laboratory tests (roentgenograms, cerebrospinal fluid VDRL test, conjugated bilirubin determination, or aspartate aminotransferase levels in serum samples). Half of the infant with congenital syphilis were stillborn. (AJDC. 1993;147:727-731), Congenital syphilis (CS) is on the rise, contributing to an increase in infant death and illness. CS is syphilis in infants, transmitted by an infected mother during pregnancy. Among 403 pregnancies in which syphilis was involved, 363 infants were live-born and 47 were stillborn. There were 75 cases of CS, 35 among the live-born infants and 40 among the stillborn. The 35 live-born infants with CS were evaluated for physical characteristics of CS and were given laboratory tests. Common physical findings such as rash and enlarged liver and spleen were present in only 12 of these infants, and the rest were diagnosed by abnormal laboratory results. Mothers were more likely to transmit syphilis to their infants if they had no prenatal care, were not treated for their own syphilis, or had a strong positive reaction to a blood test for syphilis, which may indicate a recent infection.

Byline: Amar. Taksande, Krishna. Vilhekar, Pushpa. Chaturvedi, Manish. Jain Objective: To study the incidence of congenital anomalies and the associated risk factors in Department of Pediatrics at Mahatma Gandhi Institute [...]

More than 50% of newborn deaths and stillbirths related to syphilis could be prevented with low-cost screening and treatment during pregnancy, according to research published in The Lancet Infectious Diseases. [...]

Self-Reported Exposure to Pesticides and Radiation Related to Pregnancy Outcome--Results from National Natality and Fetal Mortality Surveys GIVEN THE KNOWN VULNERABILITY of fetal development to environmental influences and experimental evidence […]