15 results on '"Fetal Mortality"'
Search Results
2. Effect of HELLP syndrome on acute kidney injury in pregnancy and pregnancy outcomes: a systematic review and meta-analysis
- Author
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Yi-juan Chen, Shao-quan Zhang, Wen-qing Zhai, Guan-jun Ling, and Qiang Liu
- Subjects
medicine.medical_specialty ,HELLP Syndrome ,HELLP syndrome ,Reproductive medicine ,lcsh:Gynecology and obstetrics ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,AKI ,Pregnancy ,Risk Factors ,medicine ,Humans ,030212 general & internal medicine ,lcsh:RG1-991 ,Pregnancy outcomes ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics ,Incidence (epidemiology) ,Incidence ,Acute kidney injury ,Pregnancy Outcome ,Obstetrics and Gynecology ,Acute Kidney Injury ,medicine.disease ,Meta-analysis ,Fetal Mortality ,Maternal Death ,Maternal death ,Female ,business ,Cohort study ,Research Article - Abstract
Background HELLP syndrome may increase adverse pregnancy outcomes, though the incidence of it is not high. At present, the impact of HELLP syndrome on P-AKI (acute kidney injury during pregnancy) and maternal and infant outcomes is controversial. Thus, we conducted a meta-analysis to find out more about the relationship between HELLP syndrome and P-AKI and pregnancy outcomes. Methods We systematically searched PubMed, Embassy and Cochrane Databases for cohort studies and RCT to assess the effect of HELLP syndrome on P-AKI and maternal and infant outcomes. Study-specific risk estimates were combined by using fixed-effect or random-effect models. Results This meta-analysis included 11 cohort studies with a total of 6333 Participants, including 355 cases of pregnant women with HELLP syndrome and 5979 cases that without. HELLP syndrome was associated with relatively higher risk of P-AKI (OR4.87 95% CI 3.31 ~ 7.17, P Conclusions HELLP syndrome is associated with relatively higher risk of P-AKI, fetal mortality and maternal death.
- Published
- 2020
3. Pregnancy outcomes in patients with acute kidney injury during pregnancy: a systematic review and meta-analysis
- Author
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Xinxin Ma, Jie Zheng, Xiangchun Liu, Tiekun Yan, and Youxia Liu
- Subjects
Adult ,Kidney outcome ,medicine.medical_specialty ,HELLP syndrome ,medicine.medical_treatment ,030232 urology & nephrology ,030204 cardiovascular system & hematology ,urologic and male genital diseases ,Lower risk ,lcsh:Gynecology and obstetrics ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,medicine ,Humans ,lcsh:RG1-991 ,Dialysis ,Pregnancy outcomes ,Eclampsia ,Placental abruption ,Obstetrics ,business.industry ,Pregnancy Outcome ,Obstetrics and Gynecology ,Gestational age ,Delivery, Obstetric ,medicine.disease ,female genital diseases and pregnancy complications ,Acute kidney injury ,Pregnancy Complications ,Meta-analysis ,Maternal Mortality ,Fetal Mortality ,Female ,Maternal death ,business ,Research Article - Abstract
Background Presently, the matter of pregnancy outcomes of patients with pregnancy related AKI (PR-AKI) were disputed. Thus, we conducted a meta-analysis to evaluate the impact of PR-AKI on pregnancy outcomes. Method We systematically searched MEDLINE, Embase, VIP, CNKI and Wanfang Databases for cohort or case-control studies in women with PR-AKI and those without AKI as a control group to assess the influence of PR-AKI on pregnancy outcomes and kidney outcome. Reduction of odd ratio (OR) was calculated by a random-effects model. Results One thousand one hundred fifty two articles were systematically reviewed, of those 11 studies were included, providing data of 845 pregnancies in 834 women with PR-AKI and 5387 pregnancies in 5334 women without AKI. In terms of maternal outcomes, women with PR-AKI had a greater likelihood of cesarean delivery (OR, 1.49; 95% confidence interval [CI], 1.37 to 1.61), hemorrhage (1.26; 1.02 to 1.56), HELLP syndrome (1.86; 1.41 to 2.46), placental abruption (3.13; 1.96 to 5.02), DIC (3.41; 2.00 to 5.84), maternal death (4.50; 2.73 to 7.43), but had a lower risk of eclampsia (0.53; 0.34 to 0.83). Women with PR-AKI also had a longer stay in ICU (weighted mean difference, 2.13 day [95% CI 1.43 to 2.83 day]) compared with those without PR-AKI. As for fetal outcomes, higher incidence of stillbirth/perinatal death (3.39, 2.76 to 4.18), lower mean gestational age at delivery (−0.70 week [95% CI -1.21 to −0.19 week]) and lower birth weight (−740 g [95% CI -1180 to 310 g]) were observed in women with PR-AKI. The occurrence of kidney outcome, defined as ESRD requiring dialysis, in women with PR-AKI was 2.4% (95% CI 1.3% to 4.2%). Conclusions PR-AKI remains a grave complication and has been associated with increased maternal and fetal mortality. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1402-9) contains supplementary material, which is available to authorized users.
- Published
- 2017
4. Effect of HELLP syndrome on acute kidney injury in pregnancy and pregnancy outcomes: a systematic review and meta-analysis.
- Author
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Liu Q, Ling GJ, Zhang SQ, Zhai WQ, and Chen YJ
- Subjects
- Acute Kidney Injury etiology, Female, Humans, Incidence, Pregnancy, Pregnancy Outcome, Risk Assessment, Risk Factors, Acute Kidney Injury epidemiology, Fetal Mortality, HELLP Syndrome epidemiology, Maternal Death
- Abstract
Background: HELLP syndrome may increase adverse pregnancy outcomes, though the incidence of it is not high. At present, the impact of HELLP syndrome on P-AKI (acute kidney injury during pregnancy) and maternal and infant outcomes is controversial. Thus, we conducted a meta-analysis to find out more about the relationship between HELLP syndrome and P-AKI and pregnancy outcomes., Methods: We systematically searched PubMed, Embassy and Cochrane Databases for cohort studies and RCT to assess the effect of HELLP syndrome on P-AKI and maternal and infant outcomes. Study-specific risk estimates were combined by using fixed-effect or random-effect models., Results: This meta-analysis included 11 cohort studies with a total of 6333 Participants, including 355 cases of pregnant women with HELLP syndrome and 5979 cases that without. HELLP syndrome was associated with relatively higher risk of P-AKI (OR4.87 95% CI 3.31 ~ 7.17, P<0.001), fetal mortality (OR1.56 95% CI 1.45 ~ 2.11, P<0.001) and Maternal death (OR3.70 95% CI 1.72 ~ 7.99, P<0.001)., Conclusions: HELLP syndrome is associated with relatively higher risk of P-AKI, fetal mortality and maternal death.
- Published
- 2020
- Full Text
- View/download PDF
5. Retrospective study 2005-2015 of all cases of fetal death occurred at ≥23 gestational weeks, in Friuli Venezia Giulia, Italy.
- Author
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Monasta L, Giangreco M, Ancona E, Barbone F, Bet E, Boschian-Bailo P, Cacciaguerra G, Cagnacci A, Canton M, Casarotto M, Comar M, Contardo S, De Agostini M, De Seta F, Del Ben G, Di Loreto C, Driul L, Facchin S, Giornelli R, Ianni A, La Valle S, Londero AP, Manfè M, Maso G, Mugittu R, Olivuzzi M, Orsaria M, Pecile V, Pinzano R, Pirrone F, Quadrifoglio M, Ricci G, Ronfani L, Salviato T, Sandrigo E, Smiroldo S, Sorz A, Stampalija T, Urriza M, Vanin M, Verardi G, and Alberico S
- Subjects
- Adult, Female, Fetal Growth Retardation epidemiology, Gestational Age, Humans, Infant, Newborn, Infant, Small for Gestational Age, Italy epidemiology, Live Birth epidemiology, Maternal Age, Pregnancy, Retrospective Studies, Stillbirth epidemiology, Fetal Death etiology, Fetal Mortality
- Abstract
Background: Intrauterine fetal death (IUFD) is a tragic event and, despite efforts to reduce rates, its incidence remains difficult to reduce. The objective of the present study was to examine the etiological factors that contribute to the main causes and conditions associated with IUFD, over an 11-year period in a region of North-East Italy (Friuli Venezia Giulia) for which reliable data in available., Methods: Retrospective analysis of all 278 IUFD cases occurred between 2005 and 2015 in pregnancies with gestational age ≥ 23 weeks., Results: The incidence of IUFD was 2.8‰ live births. Of these, 30% were small for gestational age (SGA), with immigrant women being significantly over-represented. The share of SGA reached 35% in cases in which a maternal of fetal pathological condition was present, and dropped to 28% in the absence of associated pathology. In 78 pregnancies (28%) no pathology was recorded that could justify IUFD. Of all IUFDs, 11% occurred during labor, and 72% occurred at a gestational age above 30 weeks., Conclusion: The percentage of IUFD cases for which no possible cause can be identified is quite high. Only the adoption of evidence-based diagnostic protocols, with integrated immunologic, genetic and pathologic examinations, can help reduce this diagnostic gap, contributing to the prevention of future IUFDs.
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- 2020
- Full Text
- View/download PDF
6. Perinatal mortality following assisted reproductive technology treatment in Australia and New Zealand, a public health approach for international reporting of perinatal mortality
- Author
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Cindy Farquhar, Georgina M. Chambers, Yueping Alex Wang, Abrar Ahmad Chughtai, Elizabeth A. Sullivan, and Robert J. Norman
- Subjects
Research Report ,medicine.medical_specialty ,medicine.medical_treatment ,Reproductive medicine ,MEDLINE ,Gestational Age ,Pregnancy ,Assisted reproductive technology treatment ,Terminology as Topic ,Environmental health ,Obstetrics and Gynaecology ,Infant Mortality ,medicine ,Birth Weight ,Humans ,Obstetrics & Reproductive Medicine ,Perinatal Mortality ,Neonatal mortality ,Perinatal mortality ,Assisted reproductive technology ,Obstetrics ,business.industry ,Public health ,Australia ,Infant, Newborn ,Obstetrics and Gynecology ,Embryo transfer ,Benchmarking ,Stillbirth ,Embryo Transfer ,medicine.disease ,Infant mortality ,Fetal Mortality ,Pregnancy, Twin ,Female ,InformationSystems_MISCELLANEOUS ,business ,New Zealand ,Research Article - Abstract
Background: There is a need to have uniformed reporting of perinatal mortality for births following assisted reproductive technology (ART) treatment to enable international comparison and benchmarking of ART practice.Methods: The Australian and New Zealand Assisted Reproduction Database was used in this study. Births of ≥ 20 weeks gestation and/or ≥ 400 grams of birth weight following embryos transfer cycles in Australia and New Zealand during the period 2004 to 2008 were included. Differences in the mortality rates by different perinatal periods from a gestational age cutoff of ≥ 20, ≥ 22, ≥ 24, or ≥ 28 weeks (wks) to a neonatal period cutoff of either < 7 or < 28 days after birth were assessed. Crude and specific (number of embryos transferred and plurality) rates of perinatal mortality were calculated for selected gestational and neonatal periods.Results: When the perinatal period is defined as ≥ 20 wks gestation to < 28 days after birth, the perinatal mortality rate (PMR) was 16.1 per 1000 births (n = 630). A progressive contraction of the gestational age groups resulted in marked reductions in the PMR for deaths at < 28 days (22 wks 11.0; 24 wks 7.7; 28 wks 5.6); and similarly for deaths at < 7 days (20 wks 15.6, 22 wks 10.5; 24 wks 7.3; 28 wks 5.3). In contrast, a contraction of the perinatal period from < 28 to < 7 days after birth only marginally reduced the PMR from 16.2 to 15.6 per 1000 births which was consistent across all gestational ages.The PMR for single embryo transfer (SET) births (≥ 20 weeks gestation to < 7 days post-birth) was significantly lower (12.8 per 1000 SET births) compared to double embryo transfer (DET) births (PMR 18.3 per 1000 DET births; p < 0.001, Fisher's Exact Test). Similarly, the PMR for SET births (≥ 22 weeks gestation to < 7 days post-birth) was significantly lower (8.8 per 1000 SET births, p < 0.001, Fisher's Exact Test) when compared to DET births (12.2 per 1000 DET births). The highest PMR (50.5 per 1000 SET births, 95% CI 36.5-64.5) was for twins following SET births (≥ 20 weeks gestation to < 7 days post-birth) compared to twins following DET (23.9 per 1000 DET births, 95% CI 20.8-27.1).Conclusion: Reporting of perinatal mortality of ART births is an essential component of quality ART practice. This should include measures that monitor the impact on perinatal mortality of multiple embryo transfer. We recommend that reporting of perinatal deaths following ART treatment, should be stratified for three gestation-specific perinatal periods of ≥ 20, ≥ 22 and ≥ 28 completed weeks to < 7 days post-birth; and include plurality specific rates by SET and DET. This would provide a valuable international evidence-base of PMR for use in evaluating ART policy, practice and new research. © 2013 Sullivan et al.; licensee BioMed Central Ltd.
- Published
- 2013
7. Home birth attendants in low income countries: who are they and what do they do?
- Author
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Carl L. Bose, Robert L. Goldenberg, Linda L. Wright, Sherri Bucher, Elizabeth M. McClure, K. M. Hambidge, Waldemar A. Carlo, Elwyn Chomba, Adrien Lokangaka, Patricia L. Hibberd, Ryan Whitworth, Omrana Pasha, Antoinette Tshefu, Archana Patel, Marion Koso-Thomas, Fabian Esamai, Edward A. Liechty, Shivaprasad S. Goudar, and Ana Garces
- Subjects
Health Knowledge, Attitudes, Practice ,medicine.medical_specialty ,education ,Population ,Reproductive medicine ,Developing country ,Midwifery ,lcsh:Gynecology and obstetrics ,Professional Competence ,Nursing ,Infant Mortality ,Obstetrics and Gynaecology ,medicine ,Humans ,Childbirth ,Traditional birth attendants ,Developing Countries ,Poverty ,lcsh:RG1-991 ,Home Childbirth ,Community Health Workers ,Perinatal mortality ,education.field_of_study ,business.industry ,Infant ,Obstetrics and Gynecology ,Infant mortality ,Obstetrics ,Maternal Mortality ,Gynecology ,Family medicine ,Home births ,Fetal Mortality ,business ,Home birth ,Research Article - Abstract
Background Nearly half the world’s babies are born at home. We sought to evaluate the training, knowledge, skills, and access to medical equipment and testing for home birth attendants across 7 international sites. Methods Face-to-face interviews were done by trained interviewers to assess level of training, knowledge and practices regarding care during the antenatal, intrapartum and postpartum periods. The survey was administered to a sample of birth attendants conducting home or out-of-facility deliveries in 7 sites in 6 countries (India, Pakistan, Guatemala, Democratic Republic of the Congo, Kenya and Zambia). Results A total of 1226 home birth attendants were surveyed. Less than half the birth attendants were literate. Eighty percent had one month or less of formal training. Most home birth attendants did not have basic equipment (e.g., blood pressure apparatus, stethoscope, infant bag and mask manual resuscitator). Reporting of births and maternal and neonatal deaths to government agencies was low. Indian auxilliary nurse midwives, who perform some home but mainly clinic births, were far better trained and differed in many characteristics from the birth attendants who only performed deliveries at home. Conclusions Home birth attendants in low-income countries were often illiterate, could not read numbers and had little formal training. Most had few of the skills or access to tests, medications and equipment that are necessary to reduce maternal, fetal or neonatal mortality.
- Published
- 2012
8. Thinking outside the curve, part II: modeling fetal-infant mortality
- Author
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Russell S. Kirby, Tony LoBianco, Lorie W Chesnut, and Richard Charnigo
- Subjects
Population ,Risk Assessment ,lcsh:Gynecology and obstetrics ,White People ,Odds ,Pregnancy ,Infant Mortality ,Obstetrics and Gynaecology ,Covariate ,Statistics ,Confidence Intervals ,Birth Weight ,Humans ,Medicine ,education ,lcsh:RG1-991 ,education.field_of_study ,business.industry ,Singleton ,Smoking ,Infant, Newborn ,Obstetrics and Gynecology ,Odds ratio ,Infant, Low Birth Weight ,Mixture model ,United States ,Confidence interval ,Infant mortality ,Logistic Models ,Technical Advance ,Fetal Mortality ,Female ,business ,Demography - Abstract
Background Greater epidemiologic understanding of the relationships among fetal-infant mortality and its prognostic factors, including birthweight, could have vast public health implications. A key step toward that understanding is a realistic and tractable framework for analyzing birthweight distributions and fetal-infant mortality. The present paper is the second of a two-part series that introduces such a framework. Methods We propose estimating birthweight-specific mortality within each component of a normal mixture model representing a birthweight distribution, the number of components having been determined from the data rather than fixed a priori. Results We address a number of methodological issues related to our proposal, including the construction of confidence intervals for mortality risk at any given birthweight within a component, for odds ratios comparing mortality within two different components from the same population, and for odds ratios comparing mortality within analogous components from two different populations. As an illustration we find that, for a population of white singleton infants, the odds of mortality at 3000 g are an estimated 4.15 times as large in component 2 of a 4-component normal mixture model as in component 4 (95% confidence interval, 2.04 to 8.43). We also outline an extension of our framework through which covariates could be probabilistically related to mixture components. This extension might allow the assertion of approximate correspondences between mixture components and identifiable subpopulations. Conclusions The framework developed in this paper does not require infants from compromised pregnancies to share a common birthweight-specific mortality curve, much less assume the existence of an interval of birthweights over which all infants have the same curve. Hence, the present framework can reveal heterogeneity in mortality that is undetectable via a contaminated normal model or a 2-component normal mixture model.
- Published
- 2010
9. Pregnancy outcomes in patients with acute kidney injury during pregnancy: a systematic review and meta-analysis.
- Author
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Liu Y, Ma X, Zheng J, Liu X, and Yan T
- Subjects
- Adult, Female, Fetal Mortality, Humans, Pregnancy, Pregnancy Outcome, Acute Kidney Injury mortality, Delivery, Obstetric statistics & numerical data, Maternal Mortality, Pregnancy Complications mortality
- Abstract
Background: Presently, the matter of pregnancy outcomes of patients with pregnancy related AKI (PR-AKI) were disputed. Thus, we conducted a meta-analysis to evaluate the impact of PR-AKI on pregnancy outcomes., Method: We systematically searched MEDLINE, Embase, VIP, CNKI and Wanfang Databases for cohort or case-control studies in women with PR-AKI and those without AKI as a control group to assess the influence of PR-AKI on pregnancy outcomes and kidney outcome. Reduction of odd ratio (OR) was calculated by a random-effects model., Results: One thousand one hundred fifty two articles were systematically reviewed, of those 11 studies were included, providing data of 845 pregnancies in 834 women with PR-AKI and 5387 pregnancies in 5334 women without AKI. In terms of maternal outcomes, women with PR-AKI had a greater likelihood of cesarean delivery (OR, 1.49; 95% confidence interval [CI], 1.37 to 1.61), hemorrhage (1.26; 1.02 to 1.56), HELLP syndrome (1.86; 1.41 to 2.46), placental abruption (3.13; 1.96 to 5.02), DIC (3.41; 2.00 to 5.84), maternal death (4.50; 2.73 to 7.43), but had a lower risk of eclampsia (0.53; 0.34 to 0.83). Women with PR-AKI also had a longer stay in ICU (weighted mean difference, 2.13 day [95% CI 1.43 to 2.83 day]) compared with those without PR-AKI. As for fetal outcomes, higher incidence of stillbirth/perinatal death (3.39, 2.76 to 4.18), lower mean gestational age at delivery (-0.70 week [95% CI -1.21 to -0.19 week]) and lower birth weight (-740 g [95% CI -1180 to 310 g]) were observed in women with PR-AKI. The occurrence of kidney outcome, defined as ESRD requiring dialysis, in women with PR-AKI was 2.4% (95% CI 1.3% to 4.2%)., Conclusions: PR-AKI remains a grave complication and has been associated with increased maternal and fetal mortality.
- Published
- 2017
- Full Text
- View/download PDF
10. Thinking outside the curve, part I: modeling birthweight distribution
- Author
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Tony LoBianco, Lorie W Chesnut, Russell S. Kirby, and Richard Charnigo
- Subjects
medicine.medical_specialty ,Distribution (economics) ,lcsh:Gynecology and obstetrics ,Residual distribution ,Statistics ,Obstetrics and Gynaecology ,Infant Mortality ,Econometrics ,medicine ,Confidence Intervals ,Birth Weight ,Humans ,Computer Simulation ,lcsh:RG1-991 ,Models, Statistical ,business.industry ,Maternal and child health ,Public health ,Infant, Newborn ,Uncertainty ,Obstetrics and Gynecology ,Infant newborn ,Infant mortality ,Technical Advance ,Fetal Mortality ,business ,Statistical Distributions - Abstract
Background Greater epidemiologic understanding of the relationships among fetal-infant mortality and its prognostic factors, including birthweight, could have vast public health implications. A key step toward that understanding is a realistic and tractable framework for analyzing birthweight distributions and fetal-infant mortality. The present paper is the first of a two-part series that introduces such a framework. Methods We propose describing a birthweight distribution via a normal mixture model in which the number of components is determined from the data using a model selection criterion rather than fixed a priori. Results We address a number of methodological issues, including how the number of components selected depends on the sample size, how the choice of model selection criterion influences the results, and how estimates of mixture model parameters based on multiple samples from the same population can be combined to produce confidence intervals. As an illustration, we find that a 4-component normal mixture model reasonably describes the birthweight distribution for a population of white singleton infants born to heavily smoking mothers. We also compare this 4-component normal mixture model to two competitors from the existing literature: a contaminated normal model and a 2-component normal mixture model. In a second illustration, we discover that a 6-component normal mixture model may be more appropriate than a 4-component normal mixture model for a general population of black singletons. Conclusions The framework developed in this paper avoids assuming the existence of an interval of birthweights over which there are no compromised pregnancies and does not constrain birthweights within compromised pregnancies to be normally distributed. Thus, the present framework can reveal heterogeneity in birthweight that is undetectable via a contaminated normal model or a 2-component normal mixture model.
- Published
- 2010
11. A case-control study of risk factors for fetal and early neonatal deaths in a tertiary hospital in Kenya.
- Author
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Yego F, D'Este C, Byles J, Nyongesa P, and Williams JS
- Subjects
- Case-Control Studies, Delivery, Obstetric methods, Female, Gestational Age, Humans, Infant, Infant, Newborn, Kenya, Logistic Models, Male, Midwifery, Pregnancy, Prenatal Care statistics & numerical data, Risk Factors, Tertiary Care Centers, Fetal Mortality, Infant Mortality
- Abstract
Background: It is important to understand the risk factors for fetal and neonatal mortality which is a major contributor to high under five deaths globally. Fetal and neonatal mortality is a sensitive indicator of maternal health in society. This study aimed to examine the risk factors for fetal and early neonatal mortality at the Moi Teaching and Referral Hospital in Kenya., Methods: This was a case-control study. Cases were fetal and early neonatal deaths (n = 200). The controls were infants born alive immediately preceding and following the cases (n = 400). Bivariate comparisons and multiple logistic regression analyses were undertaken., Results: The odds of having 0-1 antenatal visits relative to 2-3 visits were higher for cases than controls (Adjusted Odds Ratio (AOR) = 4.5; 95% CI: 1.2-16.7; p = 0.03)). There were lower odds among cases of having a doctor rather than a midwife as a birth attendant (AOR = 0.2; 95% CI: 0.1-0.6; p < 0.01). The odds of mothers having Premature Rupture of Membranes (AOR = 4.1; 95% CI: 1.4-12.1; p = 0.01), haemorrhage (AOR = 4.8; 95% CI: 1.1-21.9; p = 0.04) and dystocia (AOR = 3.6; 95% CI: 1.2-10.9; p = 0.02) were higher for the cases compared with the controls. The odds of gestational age less than 37 weeks (AOR = 7.0; 95% CI 2.4-20.4) and above 42 weeks (AOR = 16.2; 95% CI 2.8-92.3) compared to 37-42 weeks, were higher for cases relative to controls (p < 0.01). Cases had higher odds of being born with congenital malformations (AOR = 6.3; 95% CI: 1.2-31.6; p = 0.04) and with Apgar scores of below six at five minutes (AOR = 26.4; 95% CI: 6.1-113.8; p < 0.001)., Conclusion: Interventions that focus on educating mothers on antenatal attendance, screening, monitoring and management of maternal conditions during the antenatal period should be strengthened. Doctor attendance at each birth and for emergency admissions is important to ensure early neonatal survival and avert potential risk factors for mortality.
- Published
- 2014
- Full Text
- View/download PDF
12. Perinatal mortality following assisted reproductive technology treatment in Australia and New Zealand, a public health approach for international reporting of perinatal mortality.
- Author
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Sullivan EA, Wang YA, Norman RJ, Chambers GM, Chughtai AA, and Farquhar CM
- Subjects
- Australia epidemiology, Birth Weight, Embryo Transfer methods, Female, Fetal Mortality, Humans, Infant Mortality, Infant, Newborn, New Zealand epidemiology, Pregnancy, Pregnancy, Twin statistics & numerical data, Stillbirth, Terminology as Topic, Embryo Transfer mortality, Gestational Age, Perinatal Mortality, Research Report standards
- Abstract
Background: There is a need to have uniformed reporting of perinatal mortality for births following assisted reproductive technology (ART) treatment to enable international comparison and benchmarking of ART practice., Methods: The Australian and New Zealand Assisted Reproduction Database was used in this study. Births of ≥ 20 weeks gestation and/or ≥ 400 grams of birth weight following embryos transfer cycles in Australia and New Zealand during the period 2004 to 2008 were included. Differences in the mortality rates by different perinatal periods from a gestational age cutoff of ≥ 20, ≥ 22, ≥ 24, or ≥ 28 weeks (wks) to a neonatal period cutoff of either < 7 or < 28 days after birth were assessed. Crude and specific (number of embryos transferred and plurality) rates of perinatal mortality were calculated for selected gestational and neonatal periods., Results: When the perinatal period is defined as ≥ 20 wks gestation to < 28 days after birth, the perinatal mortality rate (PMR) was 16.1 per 1000 births (n = 630). A progressive contraction of the gestational age groups resulted in marked reductions in the PMR for deaths at < 28 days (22 wks 11.0; 24 wks 7.7; 28 wks 5.6); and similarly for deaths at < 7 days (20 wks 15.6, 22 wks 10.5; 24 wks 7.3; 28 wks 5.3). In contrast, a contraction of the perinatal period from < 28 to < 7 days after birth only marginally reduced the PMR from 16.2 to 15.6 per 1000 births which was consistent across all gestational ages.The PMR for single embryo transfer (SET) births (≥ 20 weeks gestation to < 7 days post-birth) was significantly lower (12.8 per 1000 SET births) compared to double embryo transfer (DET) births (PMR 18.3 per 1000 DET births; p < 0.001, Fisher's Exact Test). Similarly, the PMR for SET births (≥ 22 weeks gestation to < 7 days post-birth) was significantly lower (8.8 per 1000 SET births, p < 0.001, Fisher's Exact Test) when compared to DET births (12.2 per 1000 DET births). The highest PMR (50.5 per 1000 SET births, 95% CI 36.5-64.5) was for twins following SET births (≥ 20 weeks gestation to < 7 days post-birth) compared to twins following DET (23.9 per 1000 DET births, 95% CI 20.8-27.1)., Conclusion: Reporting of perinatal mortality of ART births is an essential component of quality ART practice. This should include measures that monitor the impact on perinatal mortality of multiple embryo transfer. We recommend that reporting of perinatal deaths following ART treatment, should be stratified for three gestation-specific perinatal periods of ≥ 20, ≥ 22 and ≥ 28 completed weeks to < 7 days post-birth; and include plurality specific rates by SET and DET. This would provide a valuable international evidence-base of PMR for use in evaluating ART policy, practice and new research.
- Published
- 2013
- Full Text
- View/download PDF
13. Home birth attendants in low income countries: who are they and what do they do?
- Author
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Garces A, McClure EM, Chomba E, Patel A, Pasha O, Tshefu A, Esamai F, Goudar S, Lokangaka A, Hambidge KM, Wright LL, Koso-Thomas M, Bose C, Carlo WA, Liechty EA, Hibberd PL, Bucher S, Whitworth R, and Goldenberg RL
- Subjects
- Fetal Mortality, Home Childbirth, Humans, Infant, Infant Mortality, Maternal Mortality, Poverty, Professional Competence, Community Health Workers, Developing Countries, Health Knowledge, Attitudes, Practice, Midwifery
- Abstract
Background: Nearly half the world's babies are born at home. We sought to evaluate the training, knowledge, skills, and access to medical equipment and testing for home birth attendants across 7 international sites., Methods: Face-to-face interviews were done by trained interviewers to assess level of training, knowledge and practices regarding care during the antenatal, intrapartum and postpartum periods. The survey was administered to a sample of birth attendants conducting home or out-of-facility deliveries in 7 sites in 6 countries (India, Pakistan, Guatemala, Democratic Republic of the Congo, Kenya and Zambia)., Results: A total of 1226 home birth attendants were surveyed. Less than half the birth attendants were literate. Eighty percent had one month or less of formal training. Most home birth attendants did not have basic equipment (e.g., blood pressure apparatus, stethoscope, infant bag and mask manual resuscitator). Reporting of births and maternal and neonatal deaths to government agencies was low. Indian auxilliary nurse midwives, who perform some home but mainly clinic births, were far better trained and differed in many characteristics from the birth attendants who only performed deliveries at home., Conclusions: Home birth attendants in low-income countries were often illiterate, could not read numbers and had little formal training. Most had few of the skills or access to tests, medications and equipment that are necessary to reduce maternal, fetal or neonatal mortality.
- Published
- 2012
- Full Text
- View/download PDF
14. Thinking outside the curve, part II: modeling fetal-infant mortality.
- Author
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Charnigo R, Chesnut LW, Lobianco T, and Kirby RS
- Subjects
- Confidence Intervals, Female, Humans, Infant, Newborn, Logistic Models, Pregnancy, Risk Assessment, Smoking epidemiology, United States epidemiology, White People statistics & numerical data, Birth Weight, Fetal Mortality, Infant Mortality, Infant, Low Birth Weight
- Abstract
Background: Greater epidemiologic understanding of the relationships among fetal-infant mortality and its prognostic factors, including birthweight, could have vast public health implications. A key step toward that understanding is a realistic and tractable framework for analyzing birthweight distributions and fetal-infant mortality. The present paper is the second of a two-part series that introduces such a framework., Methods: We propose estimating birthweight-specific mortality within each component of a normal mixture model representing a birthweight distribution, the number of components having been determined from the data rather than fixed a priori., Results: We address a number of methodological issues related to our proposal, including the construction of confidence intervals for mortality risk at any given birthweight within a component, for odds ratios comparing mortality within two different components from the same population, and for odds ratios comparing mortality within analogous components from two different populations. As an illustration we find that, for a population of white singleton infants, the odds of mortality at 3000 g are an estimated 4.15 times as large in component 2 of a 4-component normal mixture model as in component 4 (95% confidence interval, 2.04 to 8.43). We also outline an extension of our framework through which covariates could be probabilistically related to mixture components. This extension might allow the assertion of approximate correspondences between mixture components and identifiable subpopulations., Conclusions: The framework developed in this paper does not require infants from compromised pregnancies to share a common birthweight-specific mortality curve, much less assume the existence of an interval of birthweights over which all infants have the same curve. Hence, the present framework can reveal heterogeneity in mortality that is undetectable via a contaminated normal model or a 2-component normal mixture model.
- Published
- 2010
- Full Text
- View/download PDF
15. Thinking outside the curve, part I: modeling birthweight distribution.
- Author
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Charnigo R, Chesnut LW, Lobianco T, and Kirby RS
- Subjects
- Computer Simulation, Confidence Intervals, Humans, Infant, Newborn, Models, Statistical, Uncertainty, Birth Weight, Fetal Mortality, Infant Mortality, Statistical Distributions
- Abstract
Background: Greater epidemiologic understanding of the relationships among fetal-infant mortality and its prognostic factors, including birthweight, could have vast public health implications. A key step toward that understanding is a realistic and tractable framework for analyzing birthweight distributions and fetal-infant mortality. The present paper is the first of a two-part series that introduces such a framework., Methods: We propose describing a birthweight distribution via a normal mixture model in which the number of components is determined from the data using a model selection criterion rather than fixed a priori., Results: We address a number of methodological issues, including how the number of components selected depends on the sample size, how the choice of model selection criterion influences the results, and how estimates of mixture model parameters based on multiple samples from the same population can be combined to produce confidence intervals. As an illustration, we find that a 4-component normal mixture model reasonably describes the birthweight distribution for a population of white singleton infants born to heavily smoking mothers. We also compare this 4-component normal mixture model to two competitors from the existing literature: a contaminated normal model and a 2-component normal mixture model. In a second illustration, we discover that a 6-component normal mixture model may be more appropriate than a 4-component normal mixture model for a general population of black singletons., Conclusions: The framework developed in this paper avoids assuming the existence of an interval of birthweights over which there are no compromised pregnancies and does not constrain birthweights within compromised pregnancies to be normally distributed. Thus, the present framework can reveal heterogeneity in birthweight that is undetectable via a contaminated normal model or a 2-component normal mixture model.
- Published
- 2010
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