Consanguinity and reproductive wastage in the Palestinian Territories

Many studies have found that consanguinity poses a threat to child mortality and health and can also pose a threat to offspring survival before birth. However, there are conflicting findings with some studies having found no increased risk on offspring survival associated with consanguinity. Data from a population-based survey conducted in 2004 in the Palestinian Territories was used to assess the risk of consanguinity on offspring survival. The analysis was conducted on 4418 women aged 15–49 who were asked whether or not they had experienced a stillbirth or a spontaneous abortion. These two outcomes were combined together for the analysis of reproductive wastage. Multivariable negative binomial regression was conducted to calculate the incidence risk ratios (IRR) for each region in the Palestinian Territories separately.
The strongest risk factors for reproductive wastage, after controlling for other variables, were found to be consanguinity, age and parity with age presenting the highest IRRs. Standard of living, locality type, education level, women's employment and past intrauterine device use were not found to be significant risk factors for reproductive wastage. In the West Bank only first cousin level of consanguinity was found to be significant and ' hamola ' level (or from same family clan) lost its significance after adjusting for other variables. In the Gaza Strip both the first cousin and ' hamola ' levels of consanguinity were significant and presented almost equal IRRs of 1.3. In conclusion, consanguinity was found to be a significant risk factor for reproductive wastage.     

Investigating factors associate to nurses' attitudes towards perinatal bereavement care

Aim. The purpose of this study was to explore nurses’ attitudes towards perinatal bereavement care and to identify factors associate with such attitudes. Background. Caring for and supporting parents whose infant has died is extremely demanding, difficult and stressful. It is likely that the attitude of nursing staff can influence recovery from a pregnancy loss and nurses with positive attitude to bereavement care can help bereaved parents to cope during their grieving period. Method. Data were collected through a structured questionnaire; 334 nurses were recruited (63% response rate) from the Obstetrics and Gynaecology unit in five hospitals in Hong Kong during May–August 2006. Outcome measures including attitudes towards perinatal bereavement care, importance on hospital policy and training support for bereavement care. Results. Majority of nurses in this study held a positive attitude towards bereavement care. Results showed that only 39·3% (n = 130) of nurses had bereavement related training. By contrast, about 89·8% of nurses (n = 300) showed they need to be equipped with relevant knowledge, skills and understanding in the care and support of bereaved parents and more than 88·0% (n = 296) would share experiences with colleagues and seek support when feeling under stress. Regression model showed that age, past experience in handling grieving parents and nurses’ perceived attitudes to hospital policy and training provided for bereavement cares were factors associate with nurses’ attitudes towards perinatal bereavement care. Conclusions. Hong Kong nurses emphasized their need for increased knowledge and experience, improved communication skills and greater support from team members and the hospital for perinatal bereavement care. Relevance to clinical practice. These findings may be used for health policy makers and nursing educators to ensure delivery of sensitive bereavement care in perinatal settings and to enhance nursing school curricula respectively.     

Smokeless tobacco consumption and stillbirth: Population‐based case–control study in rural Bangladesh

Introduction and Aims. To investigate the association between smokeless tobacco consumption (STC) during pregnancy and risk of stillbirth. Design and Methods. We conducted a population‐based case–control study of 253 cases and 759 randomly selected control women in Madaripur, Bangladesh. We conducted a survey of two rural local government areas, including 8082 women, and identified cases based on self‐report of a stillbirth outcome of each participant's first pregnancy. All were asked about STC during their first pregnancy and a range of risk markers and known confounders. Demographic and maternal variables associated either with stillbirth or STC were included in logistic regression models. Results. Of the 241 cases and 757 controls with complete exposure data, 32 cases (13.2%) and 18 controls (2.4%) reported STC during pregnancy [odds ratio 6.28; 95% confidence interval (CI) 3.45, 11.4]. After adjustment for education, household income, age at first pregnancy, vaccination during pregnancy, complications, exposure to arsenic in drinking water, place of delivery and antenatal care, excess risk was attenuated but remained significant [adjusted odds ratio (aOR) 2.87; 95% CI 1.36, 6.08]. There was a dose–effect association, with women who used smokeless tobacco >5 times daily during their first pregnancy at greater risk of having a stillbirth (aOR 5.89; 95% CI 1.70, 20.3) than less frequent users (aOR 1.67; 95% CI 0.65, 4.29). Estimates were robust to extreme assumptions about missing exposure data. Discussion and Conclusions. STC during pregnancy was associated with an increased risk of stillbirth. This finding adds to the urgency of need for smokeless tobacco control strategies to be implemented in South Asia. [Hossain MS, Kypri K, Rahman B,Milton AH. Smokeless tobacco consumption and stillbirth: Population‐based case–control study in rural Bangladesh.     

Subsequent obstetrics outcomes after intrauterine death during the first pregnancy

Abstract

Objective: We aimed to determine whether the risks of adverse outcomes were greater in women who had pregnancies ending in stillbirth than in those with no previous history of stillbirth.

Methods: This retrospective cohort study included all women who had undergone their first and second deliveries at Bakirkoy Women’s and Children’s Education and Research Hospital between 2002 and 2011. Women who delivered following a previous stillbirth after 20 complete weeks of gestation were compared with those who had delivered but had no history of stillbirth after 20 weeks of gestation.

Results: We compared 201 subsequent births to women with previous histories of stillbirth with 402 live births to women with no such history. The rates of pre-eclampsia [odds ratio (OR), 3.4; 95% confidence interval (CI), 1.5–7.4], HELLP syndrome (OR, 3.1; 95% CI, 1.2–9.6), low birth weight (OR, 1.6; 95% CI, 0.7–3.5) and malpresentation (OR, 2.9; 95% CI, 1.6–4.8) were significantly higher in the case group. Howewer, the rates of stillbirth were similar between the groups.

Conclusion: We found increased rates of obstetric and perinatal complications in subsequent pregnancies in women with histories of stillbirth. Thus, the results of this study suggest that pregnant women with histories of stillbirth should be followed closely, beginning in the early gestational period.     

Pathologists Set Action Plan to Aid Missing Children Problem

Abstract

Intracellular crystalline deposits were observed in visceral adipose tissue in nearly one-third of stillborn autopsies reviewed. These spicular brown crystals are a frequent finding in stillbirth autopsies. The artifact, sometimes prominent and extensive, should be recognized as formalin pigment and without pathologic consequence. (The J Histotechnol 16:69,1993)     

High quality genomic DNA extraction from postmortem fetal tissue

Objective: We examined the yield and quality of genomic deoxyribonucleic acid (DNA) extracted from various postmortem fetal tissues. Methods: Fetal tissues were collected at the time of autopsy, and DNA was subsequently extracted. The yield and DNA quality was assessed using ultraviolet spectrometry and agarose gel electrophoresis. We used polymerase chain reaction (PCR) to assess the DNA extracted for genomic testing. Results: The median (range) gestation of the fetuses was 22 (16–41) weeks and the postmortem interval was 5.5 (2–10) days. Non-degraded genomic DNA was successfully extracted from all fetal tissues. Liver tissue had the lowest quality and muscle the highest quality. DNA yield or purity was not influenced by the postmortem interval. Conclusion: High quality genomic DNA can be extracted from fetal muscle, despite postmortem intervals of several days.     

Systematic multidisciplinary approach to reporting perinatal mortality: Lessons from a five-year regional review

Background:  Because of differences in reporting criteria throughout the world, comparing perinatal mortality rates and identifying areas of concern can be complicated and imprecise.
Aims:  To detail the systematic approach to reporting perinatal deaths and to identify any significant differences in outcomes in the Australian Capital Territory (ACT).
Methods:  Review of perinatal deaths from 2001 to 2005 in the ACT using the Australian and New Zealand Antecedent Classification of Perinatal Mortality (ANZACPM) and the Australian and New Zealand Neonatal Death Classification (ANZNDC) systems.
Results:  ACT residents' perinatal mortality rate was 10.6 per 1000 total births, fetal death rate 7.5 per 1000 total births and neonatal death rate 3.2 per 1000 live births. The three leading antecedent causes of perinatal death were congenital anomalies, spontaneous preterm birth and unexplained antepartum death. The three leading causes of neonatal death were extreme prematurity, cardiorespiratory disorders and congenital anomalies. Multiple births attributed to 20% (65 of 321) of perinatal deaths. Perinatal autopsy was performed in 50% of cases, but in only 64% of unexplained antepartum deaths.
Conclusions:  Causes of perinatal death for the ACT and surrounding New South Wales region are similar to other states using this classification system. The following are considered important lessons to promote accurate perinatal mortality reporting: (i) a universal reporting system for Australia utilising a multidisciplinary team; (ii) a high perinatal autopsy rate, especially in the critical area of antepartum death with no identifiable cause; and (iii) standardised definitions for avoidability. Attention to these areas may prompt further research and changes in practice to further reduce perinatal mortality.     

327名围产儿死亡临床原因分析

本文总结与分析在两个附属医院分娩的围产儿死亡原因。1979～1983年内出生围产儿10,414名,死亡327名,围产儿死亡率为31.40‰,其中死胎占34.56%,死产43.73%和新生儿死亡21.71%。围产儿主要死因顺序为胎位异常,窒息,畸形,早产和病理妊娠等。死胎以畸形,死产以胎位异常,新生儿以窒息死亡占首位。如能详查死胎、死产原因;提高尸解率;应用妊娠图、产程图、产后随访加强孕期监护、产程监护与产后保健等方法可以降低围产儿死亡率。     

Prolonged pregnancy

Pregnancy that continues beyond 42 weeks of gestation (post-term) confers increased antepartum and intrapartum fetal risk. Maternal risk may also be associated with post-term pregnancy, for example via increased likelihood of delivery via emergency Caesarean section. The increased likelihood of adverse perinatal outcomes associated with post-term pregnancy derives mainly from increasing fetal size and placental ageing. The key intervention currently available to manage the risks associated with prolonged pregnancy is to offer delivery. In the UK, this is routinely offered from 41 weeks onwards, but timing differs up to 42 weeks across global settings. Although offering induction of labour to manage post-term pregnancy is routine and appears to minimize risk, women should feel supported by healthcare professionals for women if they opt for expectant management or decline induction of labour. Recent evidence suggests that elective induction of labour beyond 39 weeks in otherwise low-risk pregnancies is not associated with increased maternal or fetal risk, and may help to avoid Caesarean section.     

Perinatal Mortality and Associated Risk Factors: A Case Control Study

Background

Perinatal mortality is reported to be five times higher in developing than in developed nations. Little is known about the commonly associated risk factors for perinatal mortality in Southern Nations National Regional State of Ethiopia.

Methods

A case control study for perinatal mortality was conducted in University hospital between 2008 and 2010. Cases were stillbirths and early neonatal deaths. Controls were those live newborns till discharged from the hospital. Subgroup binary logistic regression analyses were done to identify associated risk factors for perinatal mortality, stillbirths and early neonatal deaths.

Results

A total of 1356 newborns (452 cases and 904 controls) were included in this analysis. The adjusted perinatal mortality rate was 85/1000 total delivery. Stillbirths accounted for 87% of total perinatal mortality. The proportion of hospital perinatal deaths was 26%. Obstructed labor was responsible for more than one third of perinatal deaths. Adjusted odds ratios revealed that obstructed labor, malpresentation, preterm birth, antepartum hemmorrhage and hypertensive disorders of pregnancy were independent predictors for high perinatal mortality. In the subgroup analysis, among others, obstructed labor and antepartum hemorrhage found to have independent association with both stillbirths and early neonatal deaths.

Conclusion

The perinatal mortality rate was more than two fold higher than the estimated national perinatal mortality;and obstructed labor, malpresentation, preterm birth, antepartum hemmorrhage and hypertensive disorders of pregnancy were independent predictors. The reason for the poor progress of labor and developing obstructed labor is an area of further investigation.