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The loss of a child is an event that starts a lengthy and painful process of grief to a family. When it comes to stillborn children, the studies of the mourning process of the ones who expected eagerly for a birth are still very scarce. The death of a baby and the break of positive expectations related to the pregnancy give place to a specific mourning process. Thus, this article had the intention to discuss the real and symbolic grief of a mother from the loss of a stillborn child, using semiotic-cultural psychology as theoretical framework. A multiple case study applying the narrative interview method was used in two attendees. The participants needed to fulfill the following criteria: have been a mother of a stillborn and passed by this experience by, at least, a year ago. This amount of time was established from studies that pointed this period as the most stressful for the parents. The results support the main findings of the literature reviews which state that this mourning process has its own peculiarities, and occurs in the real and symbolic spheres. The speech of the interviewed showed that the no recognition of the grief by social environment and the lack of institutional support were the main factors that turned the experience even more painful. However, the therapy was an important resource to help them handle the loss. Further studies are suggested that also include the narratives of parents and the support network regarding the experience of having a stillborn baby, in order to deepen the repercussions of the loss for the entire context that involves it. [ABSTRACT FROM AUTHOR]

This qualitative and exploratory study sought to investigate the experience of women who had a new experience of motherhood after a pregnancy loss (PG) that occurred after 20 weeks of gestation. Two women (aged 24 and 27) participated in this research, and they completed a sociodemographic data form, two clinical data forms (referring to the deceased baby and the subsequent child), and a semi-structured interview about the new experience of motherhood after experiencing the PG. Through content analysis of the interviews, it was possible to verify that the PG experience was characterized as a traumatic event, establishing a melancholic reaction in women in the face of this loss. The impact of PG on the emotional investment in the new pregnancy and the relationship with the subsequent child was also found. It is considered necessary to highlight this phenomenon, reducing its invisibility, by developing interventions to assist in the management of these pregnant women, enabling adequate reception and sensitive listening to their pain. [ABSTRACT FROM AUTHOR]

Objectives. To determine the prevalence of maternal death, stillbirth and low birthweight in women with (pre-) eclampsia and complicated pregnancies or deliveries in Centre de Références des Urgences Obstétricales, an obstetric emergency hospital in Port-au-Prince, Haiti, and to identify the main risk factors for these adverse pregnancy outcomes. Methods. We conducted a retrospective cohort study of pregnant women admitted to Centre de Référence des Urgences Obstétricales between 2013 and 2018 using hospital records. Risk factors investigated were age group, type of pregnancy (singleton, multiple), type of delivery and use of antenatal care services. Results. A total of 31 509 women and 24 983 deliveries were included in the analysis. Among these, 204 (0.6%) maternal deaths (648 per 100 000 women giving birth), 1962 (7.9%) stillbirths and 11 008 (44.1%) low birthweight neonates were identified. Of all admissions, 10 991 (34.9%) were women with (pre-)eclampsia. Caesarean section significantly increased the risk of maternal death in the women with a complicated pregnancy and women with (pre-)eclampsia, but reduced the risk of stillbirth in such women. Not attending antenatal care was associated with a significantly higher risk of stillbirth (odds ratio (OR) 4.82; 95% confidence interval (CI) 3.55–6.55) and low birthweight (OR 1.40; 95% CI 1.05–1.86) for women with complicated pregnancies. Conclusion. To prevent and treat pregnancy complications as early as possible, antenatal care attendance is crucial. Improving the quality of and access to antenatal care services and providing it free to all pregnant women in Haiti is recommended.

Introduction: Involuntary pregnancy loss is a relatively common event, especially in the clinical practice of midwives and nurses. The care provided by health professionals, and especially nurses and midwives, is crucial for the short- and long-term well-being of parents. However, health personnel report how unprepared they are and how stressful and demanding it is the care for these losses. In order to know the experiences of nurses and midwives in the care of involuntary pregnancy loss, two studies were developed, one with a meta-ethnographic methodology (qualitative meta-synthesis), and another inspired by the phenomenological hermeneutic design (empirical study), methodologically triangulating the general objective. Goals: This manuscript intends to show and reflect on the use of methodological triangulation, between a meta-ethnographic study and an empirical one, to know the experiences of care in pregnancy losses. Methods: The development of metaethnography followed the seven phases described by Noblit and Hare (1988), and the phenomenological hermeneutic study was inspired by the work of Lindseth and Norberg (2004). Results: Nurses and midwives who cared for parents who have suffered an involuntary pregnancy loss, faced difficulties that required leaving their comfort zone. This caused them not to get emotionally involved with parents and that, if they did, the care was based on their intuition. Conclusions: The methodological triangulation has allowed us to have greater confidence in the credibility of the study findings. Both studies informed the body of knowledge in nursing sciences and promote a change in clinical practice, since the results show the complexity of the experience of nursing and midwifery care in involuntary pregnancy loss. [ABSTRACT FROM AUTHOR]

ABSTRACT: Causes of abortion, stillbirth, and perinatal mortality in horses were investigated in the Department of Veterinary Pathology of the Federal University of Rio Grande do Sul (SPV-UFRGS) from 2000 to 2015. In this period, 107 cases were analyzed using macroscopic, microscopic, and complementary tests. Of these, 77 were aborted fetuses, 16 were stillbirths, and 14 were perinatal deaths. Conclusive diagnosis was established in 42.8% of the fetuses analyzed, with 28.6% classified as infectious origin, 9.1% as non-infectious, and 5.1% as other. Bacterial infections, especially those related to Streptococcus spp. were the most frequently observed. In stillborn foals, diagnosis was established in 62.5% of cases, and 50% of these were related to non-infectious causes, such as dystocia and birth traumas. As for perinatal mortality, a conclusive diagnosis was reached in 78.57% of cases, and infectious causes associated with bacterial infections accounted for 64.1% of these diagnoses.

Objective. To assess the incidence of obstetric complications—eclampsia, dystocia, cesarean section, postpartum hemorrhage, and stillbirths—in hospitals in southern Haiti in 2013 – 2016 and to discuss implications for improvements to the surveillance of birth outcomes. Methods. This was a cross-sectional, retrospective study of data for 32 442 deliveries recorded in 2013 – 2016 by the Integrated Monitoring, Evaluation, and Surveillance System for facilities across three departments and one high-volume hospital in southern Haiti. Annual incidence rates of eclampsia, dystocia, cesarean section, postpartum hemorrhage, and stillbirths (both macerated and fresh) were calculated. Results. The incidence of eclampsia in the study sample was 2% – 3% and of dystocia approximately 5%, comparable to elsewhere in Haiti and other low-income countries. Cesarean delivery rates averaged about 15% annually. Postpartum hemorrhage rates were lower than published data from similar settings. Stillbirth rates ranged from 30 – 62 per 1 000 births at all facilities, higher than previously recorded by the country’s population surveys. The rates of macerated stillbirths were remarkably high, close to 50% of total stillbirths, indicating severe delays in seeking or receiving emergency obstetric care. Conclusions. This study provides important benchmarks for the current burden of preventable labor- and delivery-related complications in Haiti. Surveillance data suggest an urgent need for the management of hypertensive disorders during pregnancy, timely cesarean sections for dystocia, and management and treatment of postpartum hemorrhage in Haiti. Frequent data reviews may help address facility-specific bottlenecks.

Introduction: Syphilis is a disease of high incidence in Brazil and when it occurs during pregnancy, it has important public health implications, as it is responsible for high rates of perinatal fetal mortality and morbidity. Objective: To verify the prevalence of gestational syphilis, the epidemiological profile of the pregnant woman and outcomes such as congenital syphilis. Methods: Descriptive and retrospective study of maternal and newborn data, obtained from the notification forms of SINAN, medical records, and delivery book of the HEAC maternity ward, from January 2017 to December 2019. Results: Four hundred and eighteen pregnant women with syphilis had a pregnancy outcome at HEAC. Seroprevalence for syphilis in pregnant women was 3.95% in 2017, 4.92% in 2018, and 4.73% in 2019. 204 (48.8%) women received adequate treatment before delivery. Among the outcomes, all were reported as congenital syphilis, with 45 (10.7%) having abortions or stillbirths and among live births, 58 (15.54%) were premature and 67 (17.9%) had some manifestation clinic. Conclusion: The number of pregnant women admitted to HEAC who were notified with gestational syphilis was higher than the average notification for these conditions found in Brazil in the years studied, but it was similar to the average found in the State of Rio de Janeiro. Over-reporting of congenital syphilis was identified, and newborns exposed to syphilis were included in this diagnosis, without criteria for congenital syphilis. Our reporting system proved to be fragile and unable to assess the real situation of congenital syphilis in HEAC.

Objective: Brazil is a large, heterogeneous, and diverse country, marked by social, economic, and regional inequalities. Stillbirth is a global concern, especially in low‐ and middle‐income countries. This study investigated the prevalence and possible determinants of stillbirth in different regions of Brazil. Methods: This is a cross‐sectional study including all women of reproductive age who had had a pregnancy in the last five years, enrolled in the most recent Brazilian Demographic and Health Survey (DHS/PNDS‐2006/07). Logistic regression was used to assess the association between region and other maternal characteristics and stillbirth risk. Results: The prevalence of stillbirth in Brazil was 14.82 per 1000 births, with great variation by region of the country, and a higher prevalence among the most deprived. The North and Northeast regions had the highest odds of stillbirth compared to the Center‐West, which persisted after adjustment for multiple confounders – including deprivation level and ethnicity. Low maternal age and maternal obesity were also related to higher odds of stillbirth. Conclusion: In Brazil, the region influences stillbirth risk, with much higher risk in the North and Northeast. Variation in socioeconomic level does not explain this finding. Further research on the subject should explore other possible explanations, such as antenatal care and type of delivery, as well as the role of the private and public health systems in determining stillbirth. Preventive strategies should be directed to these historically disadvantaged regions, such as guaranteeing access and quality of care during pregnancy and around the time of birth.

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Secular trends in rates of low birth weight in Brazilian state capital cities were evaluated for the period 1996 to 2010 using joinpoint regression models. The rates were calculated using data from the Live Births Information System. Newborns weighing less than 500g were excluded. Only data for capital cities was included since under-registration of births in these cities is lower and new trends can be detected earlier. There was a significant increase in the rate of low birth weight in the Brazilian capitals of the North Region, Northeast Region, South Region and Southeast Region up to 2003/2004, stabilizing thereafter. In the capitals of the Center-west Region the rate increased throughout the whole study period. The rate of low birth weight was higher in the capitals of the more developed regions. The rate of multiple births increased significantly in all Brazilian capitals, while the stillbirth rate decreased and showed a negative correlation with the rate of low birth weight. The increase in the rate of low birth weight may be partially explained by the increase in multiple births, an increase in the birth of infants weighing 500 to 999g and by the reduction in the stillbirth rate.

OBJETIVO: Identificar as causas dos óbitos fetais (OF) e avaliar as causas deste desfecho. Propor o emprego do sistema Relevant Condition of Death (ReCoDe) na elucidação das causas de OF para minimizar o número de causas desconhecidas. MÉTODOS: Estudo transversal relacionado às mortes fetais atendidas em um hospital universitário especializado do Sul do Brasil, de Janeiro de 2000 a dezembro de 2009. Os dados foram coletados das Declarações de Óbito, dos prontuários maternos e dos laudos de estudo dos fetos e anexos, sendo os achados comparados. A análise dos dados foi realizada pelo programa SPSS versão 17.0. RESULTADOS: Foram incluídos neste estudo 111 fetos e suas respectivas mães. A comparação entre o diagnóstico das causas encontradas nos laudos do exame dos fetos e anexos e o diagnóstico clínico foi de 74 (66,7%) e 73 (65,8%), respectivamente. Em 48,7% dos casos, ambas encontraram uma potencial causa e 16,2% permaneceram desconhecidas. Utilizando-se a classificação ReCoDe, somente 9,9% dos OFs ficaram como "não classificados". CONCLUSÕES: Os laudos da autópsia fetal e exame anatomopatológico e as avaliações clínicas não apresentaram diferenças significativas na identificação da causa do OF. Ao se comparar os resultados do ReCoDe com as causas de óbito da clínica/patologia, verificou-se que ela é uma ferramenta importante no esclarecimento da causa mortis, reduzindo a quantidade daqueles OFs que permaneceram sem uma possível etiologia.PURPOSE: To identify the causes of fetal death in the studied population and to measure their contribution in identifying the cause of this outcome. To propose the use of the system Relevant Condition of Death (ReCoDe) in elucidating the causes of fetal death to minimize the number of unknown causes. METHODS: Cross-sectional study related to fetal deaths seen at a specialized academic hospital in the South of Brazil, from January 2000 to December 2009. The data were collected in the death certificates, maternal medical records and the reports of study of fetuses and attachments, and the findings were compared. Data analysis was performed using SPSS version 17.0. RESULTS: Were included 111 fetuses and their respective mothers in this study. The comparison between the diagnostic causes in the pathology and clinical evaluation showed 74 (66.7%) and 73 (65.8%), respectively. Together, they found a potential cause in 48.7% of cases, while 16.2% remained unknown. When analyzing both together with the ReCoDe system, only 9.9% of stillbirths remained as "unclassified." CONCLUSIONS: The proportion of diagnoses in the cause of death among the pathological and clinical evaluation showed no significant difference. When comparing the results of the cause of death suggested by the clinic/pathology with the use of the ReCoDe system, it appears that this tool has helped to clarify the cause by reducing the amount of those that remained without a possible etiology.

OBJETIVO: Descrever as características de gestações complicadas por sífilis materna e óbito fetal. MÉTODOS: Foi feito um estudo retrospectivo descritivo conduzido por revisão de prontuários de 48 gestantes com sífilis materna e desfecho de óbito fetal, admitidas no período 2005-2008, no Hospital Geral de Nova Iguaçu, Baixada Fluminense, Estado do Rio de Janeiro. O peso ao nascer >500 g e o óbito fetal documentado por declaração de óbito foram os critérios de inclusão. Os seguintes aspectos foram analisados: sociodemográficos, antecedentes reprodutivos, aspectos da gestação atual, cuidados de pré-natal, realização e resultados do teste Venereal Disease Research Laboratory (VDRL), presença de intercorrências na gestação, além da sífilis, sendo as mortes fetais classificadas como materna, placentária ou fetal. Os resultados foram apresentados por porcentagem, média, desvio padrão (DP) e valor máximo e mínimo. RESULTADOS: A média de idade materna foi de 22,7 anos (DP=0,9 anos) e pelo menos metade das pacientes tinham baixo grau de escolaridade. Na admissão hospitalar, 68,8% do grupo se encontrava no terceiro trimestre e com média de idade gestacional de 29,2 semanas (DP=0,5); mais de 50% estava em trabalho de parto. A grande maioria dos casos de óbito fetal (93%) ocorreu antes da hospitalização materna. Entre as pacientes que frequentaram o pré-natal (54,2%), 30,8% não realizaram o VDRL, 30,8 e 15,4% tiveram resultado reativo e não-reativo, respectivamente e nenhuma teve mais de um VDRL no pré-natal. No momento do parto, a maioria das pacientes (95,8%) realizou o VDRL. No geral, a titulação do VDRL variou de 1:1 a 1:512, predominando titulações >1:4 (91,7%). Em 23% dos casos foram encontradas outras condições relacionadas ao óbito fetal, além da sífilis. CONCLUSÕES: A infecção foi a principal causa clinicamente identificada do decesso fetal nesta série de casos. O desfecho de feto morto ocorreu no pré-termo e na presença de títulos altos de infecção materna, sugestivos de sífilis recente.PURPOSE: To describe the characteristics of pregnancies complicated by maternal syphilis and fetal death. METHODS: Retrospective descriptive study performed by reviewing the medical records of 48 pregnant women with maternal syphilis and fetal death outcome admitted to Hospital Geral de Nova Iguaçu, Baixada Fluminense, State of Rio de Janeiro, during the period from 2005 to 2008. Birth weight >500 g and fetal death documented by Death Certificate were the inclusion criteria. The following aspects were analyzed: sociodemographic factors, reproductive history, aspects of the current pregnancy, prenatal care, Venereal Disease Research Laboratory (VDRL) testing, and other gestational conditions, in addition to syphilis. The fetal deaths were classified as maternal, placental or fetal. Percentage, mean, standard deviation (SD), maximum and minimum values were reported. RESULTS: The mean maternal age was 22.7 years (SD=0.9 years), and at least 50% of the patients had low educational level. At hospital admission, 68.8% of the subjects were in the third trimester, with a mean gestational age of 29.2 weeks (SD=0.5), and more than 50% were in labor. The vast majority of fetal deaths (93%) occurred before maternal hospitalization. Among the patients who received prenatal care (54.2%), 30.8% had no VDRL test, 30.8 and 15.4% had a reactive and non-reactive result, respectively, and none had more than one prenatal VDRL test. At the time of childbirth, most of the mothers (95.8%) carried out VDRL testing. Overall, the VDRL titers varied from 1:1 to 1:512, with predominant values >1:4 (91.7%). In 23% of cases other clinical conditions related to fetal death, in addition to syphilis, were found. CONCLUSIONS: The infection was the main clinically identified cause of fetal death in this patient series. Fetal death occurred during the preterm period and in the presence of high titers of maternal infection, suggesting recent syphilis infection.

Objetivo. Descrever os fatores de risco para mortalidade fetal na cidade de Pato Branco (Brasil). Metodologia. Realizou-se um estudo descritivo, no qual foram analisados os casos de nascidos mortos de 2000 a 2008 na cidade de Pato Branco. A informação foi obtida do Sistema de Informação de Mortalidade. Resultados. Registraram-se 91 mortes fetais no período estudado para uma taxa média de 9.27 por mil nascidos vivos. Os principais fatores de risco de origem maternos foram: placenta prévia (38.5%), hipertensão induzida na gravidez (13.2%), idade de 21 a 30 anos (40.7%), ter três e menos anos de escolaridade (25.7%) e a ocupação de dona de casa (34.1%). Para os fetos, o único fator de risco registrado foi o sexo, no que o masculino contribuiu o 52.7% das mortes. Conclusão. Identificaram-se alguns fatores de risco previsíveis que é necessário intervir com o fim de reduzir a mortalidade fetal no município.Objetivo. Describir los factores de riesgo para natimortalidad en la ciudad de Pato Branco (Brasil). Metodología. Se realizó un estudio descriptivo, en el cual fueron analizados los casos de nacidos muertos de 2000 a 2008 en la ciudad de Pato Branco. La información fue obtenida del Sistema de Información de Mortalidad. Resultados. Se registraron 91 muertes fetales en el periodo estudiado para una tasa media de 9.27 por mil nacidos vivos. Los principales factores de riesgo de origen maternos fueron: placenta previa e hipertensión inducida en el embarazo como complicaciones del embarazo (38.5% y 13.2%), edad de 21 a 30 años (40.7%), baja escolaridad (25.7%) y como ocupación de ama de casa (34.1%). Para los fetos, el único factor de riesgo registrado fue el sexo: el masculino aportó el 52.7% de las muertes. Conclusión. Se identificaron algunos factores de riesgo prevenibles que merecen intervención con el fin de reducir la natimortalidad en el municipio.Objective. To describe risk factors for fetal mortality in the city of Pato Branco (Brazil). Methodology. Descriptive study. Cases of babies born dead in the city of Pato Branco from 2000 to 2008 were analyzed. The information was obtained from the Mortality Information System. Results. 91 fetal deaths were registered in the studied period, for a mean rate of 9.27 per thousand born alive. The main risk factors originated from the mother were: placenta previa (38.5%), pregnancy induced hypertension (38.5%), age under 20 years or over 30 years of age (40.7%), having three or less years of school (25.7%) and being a housewife (34.1%). For the fetus, the only risk factor registered was the sex, in which 52.7% of deaths were males. Conclusion. Some preventable risk factors were identified; it is necessary to intervene them to reduce fetal mortality in the city.

OBJETIVOS: determinar os fatores associados à indução do trabalho de parto em gestantes com óbito fetal. MÉTODOS: estudo seccional, com 258 gestantes após a 20ª semana e diagnóstico ultrassonográfico de óbito fetal, no período de janeiro/2005 a dezembro/2008, na maternidade do Hospital Barão de Lucena, Recife, Brasil. Características sociodemográficas, causas e tipos de óbito fetal, antecedentes obstétricos e características do parto foram variáveis estudadas. Foram utilizados testes qui-quadrado, exato de Fisher e "t" de Student. Razão de prevalência e análise de regressão logística múltipla também foram realizados. O nível de significância foi de 5%. RESULTADOS: a indução do parto ocorreu em 83 (32,2%) gestantes. Após análise multivariada, observou-se que a idade gestacional acima da 40ª semana de gravidez (OR= 126,5; IC95%= 3,83-4.201,5) e óbito fetal tardio (OR= 6,86; IC95%= 2,55-18,47) foram fatores de risco que permaneceram associados à indução do parto. Cesariana (OR= 0,02; IC95%= 0,004-0,09), funiculopatias (OR= 0,12; IC95%= 0,02-0,68), presença de uma ou menos gestações anteriores (OR= 0,34; IC95%= 0,14-0,81) e uma ou mais cesáreas anteriores (OR= 0,16; IC95%= 0,04-0,71) foram negativamente associados à indução. CONCLUSÕES: idade gestacional acima da 40ª semana e óbito fetal tardio são fatores de risco que podem estar associados à indução do parto em gestantes com óbito fetal.OBJECTIVES: to determine the factors associated with induced delivery in pregnant women carrying a dead fetus. METHODS: a cross-sectional study with 258 pregnant women past the 20th week of gestation diagnosed by ultrasound as carrying a dead fetus, between January 2005 and December 2008, at the Hospital Barão de Lucena maternity hospital, in Recife, Brazil. Socio-demographic characteristics, causes and types of fetal death, prior obstetric data and characteristics of birth were the variables studied. The chi-square test, Fisher's exact test and Student's t test were used. The rate of prevalence was calculated and multiple logistic regression was carried out. The level of significance was 5%. RESULTS: birth was induced in 83 (32.2%) of the pregnant women. Following multivariate analysis, it was found that a gestational age of over 40 weeks (OR= 126.5; CI95%= 3.83-4,201.5) and late fetal death (OR= 6.86; CI95%= 2.55-18.47) were the risk factors that continued to be associated with induced delivery. Caesarian section (OR= 0.02; CI95%= 0.004-0.09), funiculopathy (OR= 0.12; CI95%= 0.02-0.68), having had one or more previous pregnancies (OR= 0.34; CI95%= 0.14-0.81) and one or more previous caesarian sections (OR= 0.16; IC95%= 0.04-0.71) were negatively associated with induced delivery. CONCLUSIONS: a gestational age of over 40 weeks and late fetal death are the risk factors that could be associated with induced delivery in pregnant women carrying a dead fetus.

Este artigo revisa dados relativos à realização de necropsia em fetos suínos abortados e natimortos. Aspectos descritos incluem coleta de material, procedimentos de necropsia, achados macroscópicos e histopatológicos alguns dos quais de pouco ou nenhum significado patológico são frequentemente observados numa rotina de diagnóstico e geralmente interpretados erroneamente como lesões reais ou de importância.This paper reviews information on necropsies in stillborn and aborted fetuses from swine. Aspects dealt with include sampling collection, necropsy procedures, gross and histopathological findings, some of which are of little or no pathological significance but often observed in the routine diagnostic work and misinterpreted as real or important lesions.

OBJETIVO: determinar os fatores associados à cesariana em gestantes com óbito fetal em uma maternidade-escola de Recife, Pernambuco, Brasil. MÉTODOS: realizou-se um estudo transversal, no qual se analisaram dados do sistema de informação sobre mortalidade e prontuários médicos, de Janeiro de 2005 a Dezembro de 2008, do Hospital Barão de Lucena (HBL). Foram incluídas gestantes com diagnóstico de óbito fetal, apresentando idade gestacional a partir da 20ª semana. As características sociodemográficas, causas e tipos de óbito fetal, antecedentes obstétricos e as características do parto foram as variáveis avaliadas. Na avaliação da associação entre as variáveis, empregaram-se os testes χ2 de associação e exato de Fisher, a um nível de significância de 5%. Calculou-se a razão de prevalência como medida de risco e seu intervalo de confiança (IC) a 95%. Realizou-se, ainda, análise de regressão logística, calculando-se o Odds Ratio (OR). RESULTADOS: das 258 gestantes incluídas com óbito fetal, 27,5% (n=71) submeteram-se a cesariana. Após análise multivariada, os fatores que permaneceram significativamente associados à cesariana foram idade materna abaixo de 20 anos (OR=0,23; IC95%=0,06-0,85), antecedentes de uma ou mais cesarianas (OR=7,02; IC95%=2,29-21,55), gestação múltipla (OR=9,06; IC95%=2,01-40,71), uso de misoprostol para indução do parto (OR=0,07; IC95%=0,01-0,32), óbito fetal ocorrido durante o trabalho de parto (OR=4,01; IC95%=1,13-14,24), baixo peso do feto ao nascer (OR=0,33; IC95%=0,11-0,94), presença de síndromes hipertensivas (OR=3,7; IC95%=1,46-9,39) e descolamento prematuro de placenta (OR=13,9; IC95%=4,67-41,69). CONCLUSÃO: os fatores de risco à cesariana em gestantes com óbito fetal no HBL foram cesariana anterior, gestação múltipla, óbito intraparto, síndromes hipertensivas e DPP, enquanto os fatores protetores foram adolescentes, misoprostol e baixo peso do feto ao nascer.PURPOSE: to determine the factors associated with cesarean section in pregnancies with fetal death at a maternity hospital in Recife, Pernambuco, Brazil. METHODS: a cross-sectional study was performed, which analyzed data from the information system about mortality and medical records, from January 2005 to December 2008, of Hospital Barão de Lucena (HBL). We analyzed women with fetal death diagnosis, with gestational age of 20 weeks or more, in terms of sociodemographic characteristics, causes and types of fetal death, obstetrical precedents and birth characteristics. The associations between the variables were analyzed by the χ2 test of association and Fisher exact test, with the level of significance set at 5%. We calculated the prevalence ratio as the measure of risk and the confidence interval (CI) at 95%. Logistic regression analysis was also performed and the Odds Ratio (OR) was calculated. RESULTS: among the 258 pregnant women with fetal death, 27.5% (n=71) underwent cesarean section. After multivariate analysis, the factors that remained significantly associated with cesarean section were maternal age below 20 years (OR=0.23; 95%CI=0.06-0.85), history of one or more cesarean sections (OR=7.02; 95%CI=2.29-21.55), multiple gestation (OR=9.06; 95%CI=2.01-40.71), use of misoprostol for birth induction (OR=0.07; 95%CI=0.01-0.32), fetal death occurring during birth (OR=4.01; 95%CI=1.13-14.24), low birth weight (OR=0.33; 95%CI=0.11-0.94), presence of hypertensive disorders (OR=3.7; 95%CI=1.46-9.39) and abruptio placentae (OR=13.9; 95%CI=4.67-41.69). CONCLUSION: in HBL, the risk factors for cesarean section in pregnancies with fetal death were previous cesarean section, multiple gestation, intrapartum deaths, hypertensive disorders and abruptio placentae. The protective factors were teenage pregnancy, use of misoprostol and low birth weight.

O interesse pelo tema surgiu a partir de uma pesquisa qualitativa de campo ligada a uma dissertação de mestrado atualmente em desenvolvimento junto ao Programa de Pós-Graduação em Tocoginecologia da Faculdade de Ciências Médicas/Unicamp. Para obtenção dos artigos realizou-se um levantamento bibliográfico junto ao Medline, ao PsycInfo e ao SciELO, utilizando-se as palavras-chave fetal loss, stillbirth, grief, meanings, qualitative eresearch. Também foram considerados capítulos de livros de autores consagrados na área. Os artigos encontrados nas bases de dados, em consonância com os autores consagrados na área, mostram que as experiências de mulheres que sofreram perda fetal evidenciam sentimentos complexos, os quais trazem à tona conflitos relacionados à identidade feminina, ao papel da mulher na sociedade e à morte e seus tabus. O trabalho evidencia também a importância de a equipe de saúde conhecer a dinâmica emocional das mulheres que vivenciaram a experiência de perda.El interés sobre el tema surgió a partir de una investigación cualitativa de campo ligada a la disertación de la maestría (magíster), actualmente en desarrollo, del Programa de Postgrado en Tocoginecología de la Facultad de Ciencias Médicas/ Unicamp. Para la obtención de los artículos ha sido realizada una búsqueda bibliográfica en las bases de datos Medline, PsycInfo y SciELO, utilizándose las siguientes palabras clave: "fetal loss", "stillbirth", "grief", "meanings" y "qualitative research". También han sido considerados capítulos de libros de autores reconocidos. Los artículos encontrados en las bases de datos, añandido a los autores en este área, nos enseñan que las experiencias de las mujeres que han sufrido una pérdida fetal evidencian sentimientos complejos, pues éstos revelan conflictos relacionados a la identidad femenina, al rol de la mujer en la sociedad, a la muerte y sus tabúes. También se destaca la importancia de que el equipo de salud conozca la dinámica emocional de las mujeres que han vivido la experiencia de pérdida.The interest about the subject came from a qualitative field research joined to dissertation of master degree in development together with Pos-Graduation Program in Tocogynecology of the Medical Sciences College of the University of Campinas (UNICAMP). The articles were obtained through a bibliographic survey which was realized in the Medline, PsyInfo and SciELO, using the following keywords: "fetal loss", "stillbirth", "grief", "meanings", "qualitative research". Chapters of book of consecrated authors in this area were also considered. The articles found in the database, in consonance with the consecrated authors in the field, present us that the women experiences who suffered a fetal loss evidence complex feelings, because these feelings bring out conflicts related to feminine identity, woman role in the society, death and its taboo. The importance of the health team to realize the emotional dynamics of women who have lived the loss experience is also evidenced.

Os objetivos do presente estudo foram determinar as características de partos submetidos à intervenção manual e avaliar os efeitos dessa intervenção no desempenho reprodutivo subsequente e na taxa de remoção. Dados de 4121 partos foram separados em grupos Controle (3271 partos) e Intervenção (850 partos). O percentual de partos submetidos à intervenção manual foi de 20,6%. Não houve diferença (P>0,05) na ocorrência de intervenção ao parto de acordo com as classes de tamanho de leitegada (14 leitões). A proporção de intervenção ao parto aumentou (PThe aim of this study was to determine the characteristics of farrowings with manual intervention and to evaluate the effect of this intervention on the subsequent reproductive performance and culling rate. Data of 4121 farrowings were separated in Control (3271 farrowings) and Intervention (850 farrowings) groups. The percentage of farrowings submitted to manual intervention was 20.6%. There was no difference (P>0.05) in the occurrence of intervention according to litter size classes (14 piglets). The proportion of intervention at parturition increased (P

Avaliaram-se os parâmetros e as tendências genéticas de características reprodutivas de suínos da raça Large White. Utilizaram-se dados de número de leitões nascidos (NLN), número de leitões aos 21 dias (NLD), peso médio da leitegada ao nascimento (PMNasc), peso médio de leitegada ao desmame ajustado para 21 dias (PMD), ganho médio diário (GMD) e número de natimortos (NatMort) de uma amostra constituída de 12.840 leitegadas, registradas de 1989 a 2003, nos arquivos da Associação Brasileira de Criadores de Suínos - ABCS referentes ao estado do Rio Grande do Sul. As estimativas genéticas foram obtidas pelo Método REML utilizando-se um modelo que incluiu os efeitos genéticos diretos, maternos e comuns de leitegada, os efeitos fixos de grupo contemporâneo (granja, ano de nascimento dos leitões e estação do ano) e as co-variáveis número de partos da mãe, idade da mãe ao primeiro e idade da mãe ao último parto. Avaliaram-se ainda as tendências genéticas diretas e maternas por meio da regressão dos valores genéticos direto e materno sobre o ano de nascimento da mãe. A ANOVA para as tendências genéticas apresentou efeitos genéticos direto e materno para todas as características, exceto NLN, que não apresentou efeito materno. As tendências genéticas aditivas diretas e maternas, respectivamente, foram positivas para as características NLN (0,0019/0,0002 leitões/ano), NLD (0,0019/0,0005 leitões/ano); negativas para efeito aditivo direto; positivas para efeito materno em GMD (-0,0292/0,0162 g/ano), PMNasc (-6E-05/+4E-05 g/ano) e PMD (-0,0013/+0,0006 g/ano); e negativas para ambos os efeitos em NatMort (-0,0014/-0,0005 leitões/ano).Data from 12.840 litters, recorded from 1989 to 2003, were used to evaluate genetic parameters and genetic trends of reproductive traits in Large White pigs. Data were provided by the Swine Breeders Brazilian Association - ABCS and included records on litter size at birth (NLN), litter size at 21 days (NLD), average litter weight at birth (PMNasc), litter weight at weaning adjusted to 21 days (PMD), average daily weight gain (GMD) and number of stillbirth (NatMort). Variance components were estimated by REML using a model that included the contemporary group (herd-year-season of farrowing) and the covariates number of farrowings, age of the sow at the first and at the last farrowings as fixed effects; and the direct genetic, maternal, common litter and residual random effects. Direct genetic and maternal genetic trends were estimated by regression of breeding values on birth year of the dam. Genetic trends for direct and maternal genetic effects were significant for all traits, except for the maternal genetic effect for NLN. Estimates of direct and maternal genetic gains were, respectively, 0.0019 and 0.0002 piglets/year for NLN, 0.0019 and 0.0005 piglets/year for NLD, -0.0292 and 0.0162 g/year for GMD, -6E-05 and 4E-05 g/year for PMNasc, -0.0013 and 0.0006 g/year for PMD and -0.0014 and -0.0005 piglets/year for NatMort.

Infecções por protozoários têm distribuição mundial e podem causar aborto, nascimentos prematuros e ou morte fetal em diversas espécies animais. Em julho de 2004, oito ovinos Corriedale apresentaram problemas reprodutivos caracterizados por aborto e natimortalidade no terço final da gestação. Dessas oito perdas, um natimorto macho foi enviado ao Setor de Patologia Veterinária para necropsia. Alterações macroscópicas não foram observadas durante a necropsia. Lesões histológicas foram observadas principalmente no cérebro e coração e se caracterizaram por encefalite não-supurativa multifocal acentuada associada à presença de protozoários no interior de células endoteliais e vasos sanguíneos e miocardite não-supurativa focal leve. Alguns desses organismos apresentaram formato de roseta. O teste de imunoistoquímica anti-Toxoplasma gondii foi negativo, mas houve reação cruzada com anticorpo anti-Neospora caninum. O exame de imunofluorescência direta para Leptospira sp. foi negativo. A bacteriologia aeróbica e micro-aeróbica não revelou crescimento significativo. Esses achados foram compatíveis com o diagnóstico de Sarcocystis sp.Protozoal infection has worldwide distribution and may cause abortion, premature parturition or fetal death in almost all domestic animals. In July 2004, eight Corriedale sheep showed abortion and stillbirth in the third trimester of gestation. Of these reproductive losses, one stillborn male was submitted to the Laboratory of Veterinary Pathology for necropsy investigation. The direct immunofluorescence test for Leptospira sp. was negative. No significant bacteria was isolated from lung and liver by aerobic and microaerobic cultures. Macroscopic lesions were not found in any fetal tissue. The histological lesions were observed mainly in the brain and heart and consisted primarily of severe multifocal nonsupurative encephalitis and nonsuppurative myocarditis. Schizonts of a protozoan parasite consistent with Sarcocystis sp. were found in the endothelial cells and vascular endothelium in several organs. Many schizonts with merozoites arranged in a rosette-like pattern were observed in brain and kidney tissues. In sections stained with periodic acid-Schiff (PAS), the limiting membrane of some schizonts appeared to be weakly PAS-positive. Merozoites and nuclei were PAS-negative. Protozoa did not react immunohistochemically to the antibody anti-Toxoplasma gondii; however, cross-reactivity was observed with Neospora caninum antibody. These findings were consistent with the diagnosis of Sarcocystis sp.

This study takes the body (of mother and child), the technoscientific hospital landscape and professional ritual as the locus of an endeavour to understand the embodied experience of perinatal death, in order to better comprehend how alternate understandings and ontologies of motherhood, personhood and bereavement emerge during care enactments. Grounded in a descriptive and ethnographic approach the research analyses data from the entries of 22 members of a pregnancy loss support forum and 10 narrative style interviews. The research traces embodied experience from pregnancy, through diagnosis to the spatialised experience of the hospital, including the birth, postmortem contact and disposal of the corpse. Bounded by the sudden destruction of ontological security many of these women experience an existential crisis that results in a destructed stigmatised self. The research explores how overly medicalised obstetric care enacts understandings of perinatal death and bereavement that further problematizes postmortem relationships, creating toxic identities and embodied selves. Conversely, woman-centred midwifery that takes relational and social understandings as a basis for care can create the material conditions of possibility for a restoration of confidence in carnal self and a reconstruction of social bonds and order. Assembled through practice, discourse and policy, these bodies are individually, socially and politically enacted, but they are also multiple, mutable and enfolded assemblages of nature and culture. The research proposes that healthcare practice would benefit by considering natural stillbirths, just as contemporary obstetrics advocates natural childbirth.

Foram realizadas observações em quatro granjas de suinocultura industrial nas 24 horas do dia, registrando-se o número de fetos mumificados, de natimortos, de nascidos vivos e total segundo as observações feitas por funcionários da granja (FUN) e por pesquisadores (AO). Foram também registrados resultados de um número semelhante de anotações das mesmas características no período imediatamente anterior à pesquisa, obtidas dos relatórios das granjas. Verificaram-se diferenças entre as avaliações dos FUN e dos AO quanto aos registros dos mumificados e total de nascidos em todas as granjas (PObservational studies were carried out in four industrial swine farms. The observations were performed on a 24 hours basis and mummified fetuses, stillborn and born alive piglets were recorded by observers (OB) and by employees (EM). In all farms, it was also obtained a retrospective data previous to the observational study period, comprising the same number of farrowings. Differences among mummified fetuses and total born piglets recorded by OB and EM in all farms (P

This study investigates if writing may be used as a therapeutic resource for mothers bereaved by stillbirth. Three blogs written by mothers were analyzed, based on Bolwby's theory (attachment and loss). Our findings confirm that writing has a therapeutic effect, since it helps processing both the traumatic experience and the socially invisible loss, in addition of being the most important means to preserve the memory of the lost baby. [ABSTRACT FROM AUTHOR]

A morte fetal não é uma entidade rara e, em países em desenvolvimento, suas causas mais prevalentes continuam sendo passíveis de controle e/ou tratamento. O objetivo deste estudo foi investigar causas de morte fetal em uma população brasileira. Foi um estudo descritivo realizado no Hospital Maternidade Leonor Mendes de Barros, em São Paulo. Foram estudadas 122 gestantes com diagnóstico de óbito fetal e idade gestacional de vinte semanas ou mais. Os procedimentos estatísticos utilizados foram média e desvio-padrão. As principais causas de morte identificadas foram hipertensão arterial e infecções e em um quarto dos casos a causa não foi determinada. Concluiu-se que uma proporção importante de óbitos era prevenível e que houve taxa significativa de causas não-identificadas. Os resultados deste estudo poderão ser úteis para orientação de programas de prevenção primária, principalmente quanto à assistência pré-natal.Fetal death may not be considered an unusual event and, in developing countries, the most prevalent causes could be possibly controlled and/or treated. The purpose of the present study was to investigate causes of fetal death in a Brazilian population. This is a descriptive study performed at the Hospital Maternidade Leonor Mendes de Barros in São Paulo. The study subjects were 122 pregnant women with diagnosis of fetal death and gestation age of 20 or more weeks. The statistical procedures used were means and standard deviation. The main causes of the fetal death were hypertensive disorders and infections and, for a quarter of the cases, they were not identified at all. It is concluded that an important percentage of fetal deaths would have been prevented and that there was a significant number of unidentified causes. Results of the present study might be useful to orientate a primary prevention health program, specially concerning antenatal care.

In view of social and lifestyle changes, the incidence of advanced maternal age pregnancy, i.e. in women over 35 years, has markedly increased in recent decades. Such surge contributed to higher rates of obstetric and fetal complications. A critical review of the literature was conducted with the objective of assessing the available evidence on the frequency of the main pregnancy complications in advanced maternal age as well as possible explanations and controversies about the matter. A detailed search of medical literature was performed including the databases: Medline (via PubMed), SciELO and LILACS. Gestational and perinatal outcomes assessed were: gestational age at delivery, low birth weight (LBW < 2.5 kg), Apgar score < 7 at 1 and 5 minutes, increase in the incidence of cesarean sections and stillbirth. The results retrieved were: gestational age (< 37 weeks = 3.4 to 51.4%; > 42 weeks = 0.4 to 6.9%), stillbirth (0 to 3.2%), LBW (0 to 26.8%), Apgar score < 7 (1st min = 5.6 to 22.9; 5th min = 0.9 to 5%), cesarean section (31.9 to 72.4%). The relative impact of maternal ageing and chronic diseases on pregnancy outcomes requires further research. Health professionals must be alert to the peculiarities of advanced maternal age pregnancy in order to timely identify potential complications. A specialized multiprofessional team should be available to warrant specific needs regarding exams and admission. Thus, advanced maternal age pregnancy can be more safely managed, reducing the rate of complications and maternal and perinatal adverse outcomes. [ABSTRACT FROM AUTHOR]

Objective: to verify perinatal mortality and its associated components in an investigation about the history of gestations/deliveries. Methods: the study was carried out at six maternity hospitals in the State of São Paulo that were interested in participating in the research. The population was composed of 7,058 women, of whom 6,530 gave birth; the number of conceptuses was 6,602: 56 stillbirths and 6,546 live births, of which 28 died in the first week of life. Variables related to the mother, the pregnancy, the delivery and the conceptus were studied. Results: the perinatal mortality coefficient was 12.7 per 1,000 births; 66.7% of the conceptuses were stillbirths and 33.3% were live births who died aged less than 7 days at the same hospital where they were born. Approximately 27% of the conceptuses were children of adolescent mothers and 44% of the mothers were primigravidae. Prenatal assistance was attended by 92% of the women; type of pregnancy showed 67.8% of preterm gestations with similar proportions for each one of the components. The coefficient for twin gestations was more than four times higher than the coefficient for mothers of singleton gestations. Regarding type of delivery, Cesarean sections corresponded to 31.1% of the total, and it is important to notice that there was a non-negligible amount of surgical deliveries in mothers whose product was a stillbirth. The coefficient according to sex was higher for males (1.8: 1), and as for birth weight, the highest proportion occurred among those who weighed less than 2,500g (67.9%). Conclusions: there was a relationship of the proportion of neonatal deaths in the first hours of life and the proportion of fetal deaths to the quality of the care offered in the women's pregnancy-puerperal cycle. [ABSTRACT FROM AUTHOR]

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The aim of this study was to determine the characteristics of farrowings with manual intervention and to evaluate the effect of this intervention on the subsequent reproductive performance and culling rate. Data of 4121 farrowings were separated in Control (3271 farrowings) and Intervention (850 farrowings) groups. The percentage of farrowings submitted to manual intervention was 20.6%. There was no difference (P>0.05) in the occurrence of intervention according to litter size classes (<11, 11-14 and >14 piglets). The proportion of intervention at parturition increased (P<0.05) during summer and in higher parity order (PO) females. In farrowings with intervention there were longer farrowing duration in PO 1 females (P<0.05) and greater number of stillborn piglets and higher frequency of farrowings with at least one stillborn (P<0.05) in PO 1, PO 3-5 and PO 6-10 females. In the Intervention group, greater weaning to estrus interval (WEI), lower farrowing rate and lower subsequent total born piglets (P<0.05) were observed in PO 1 and 2, PO 3-5 and PO 6-10, respectively. Removal rate before first insemination post weaning, by both reproductive and non reproductive reasons, was greater (P<0.05) in Intervention group. Manual intervention at parturition is more frequent during summer and among older females. Manual obstetric intervention compromise the WEI, the farrowing rate or the subsequent litter size. [ABSTRACT FROM AUTHOR]

Objective: to understand professional care for maternal grief in the puerperium of stillbirth., Methods: a clinical-qualitative study with all the women who had stillbirths living in Maringá (Brazil) and participating in the Center d'Études et de Recherche in Family Intervention at the University of Quebec in Outaouais in Gatineau (Canada). Semi-structured interviews were carried out and the relevant aspects were categorized into themes., Results: the identified categories were: Assistance received in the puerperium with a focus on grief: hospital and outpatient environment, and Professional support in coping with maternal grief after fetal loss: with contact and memories, without contact and without memories and impossibilities of contact with the baby., Final: considerations: the need for a multidisciplinary support and monitoring network for women who experienced fetal loss was evident. From this study, a routine of care for grief can be implemented in Brazil based on experiences in Canada.

Objectives: Understand the experiences of health professionals in obstetric care in relation to the situation of intrauterine fetal death., Method: Study of a qualitative approach, in which 11 health professionals participated. Data were collected through semi-open interviews and submitted to thematic content analysis., Results: The professionals' difficulty in dealing with the topic and its invisibility during the training proved to be challenging. The lack of ambience and the forms of organization of attention reflected in the care for women and families who are undergoing intrauterine fetal death. The lack of strategies and spaces for sharing among professionals was directly related to the suffering and feeling of helplessness in the cases., Final Considerations: There is a need to develop strategies for changes in the model and organization of the service in the face of situations of fetal death, promoting spaces that are welcoming producers.

This article analyzes the way the Porto-based journal Jornal do Médico reported on the thalidomide disaster. The pages of the publication are researched from the beginning of 1960 to the end of 1962 with the aim of identifying and discussing two interconnected questions: the delay in publishing news on the harmful effects of the drug, which was sold in the country under the brand name Softenon®, and the discursive construction of a lack of accountability on the part of physicians for the phenomenon of medication iatrogenesis.

Abstract This article explores women’s reproductive health in early twentieth-century Rio de Janeiro, showing that elevated and sustained stillbirth and maternal mortality rates marked women’s reproductive years. Syphilis and obstetric complications during childbirth were the main causes of stillbirths, while puerperal fever led maternal death rates. Utilizing traditional sources such as medical dissertations and lesser-used sources including criminal investigations, this article argues that despite official efforts to medicalize childbirth and increase access to clinical healthcare, no real improvements were made to women’s reproductive health in the first half of the twentieth century. This, of course, did not make pregnancy and childbirth any easier for the women who embodied these statistics in their reproductive lives.

OBJECTIVE: To describe the capacity of Peru's Perinatal Information System (Sistema Informático Perinatal, SIP) to provide estimates for monitoring the proportion of stillbirths and other adverse birth outcomes attributable to maternal syphilis. METHODS: A descriptive study was conducted to assess the quality and completeness of SIP data from six Peruvian public hospitals that used the SIP continuously from 2000 - 2010 and had maternal syphilis prevalence of at least 0.5% during that period. In-depth interviews were conducted with Peruvian stakeholders about their experiences using the SIP. RESULTS: Information was found on 123 575 births from 2000 - 2010 and syphilis test results were available for 99 840 births. Among those 99 840 births, there were 1 075 maternal syphilis infections (1.1%) and 619 stillbirths (0.62%). Among women with syphilis infection in pregnancy, 1.7% had a stillbirth, compared to 0.6% of women without syphilis infection. Much of the information needed to estimate the proportion of stillbirths attributable to maternal syphilis was available in the SIP, with the exception of syphilis treatment information, which was not collected. However, SIP data collection is complex and time-consuming for clinicians. Data were unlinked across hospitals and not routinely used or quality-checked. Despite these limitations, the SIP data examined were complete and valid; in 98% of records, information on whether or not the infant was stillborn was the same in both the SIP and clinical charts. Nearly 89% of women had the same syphilis test result in clinical charts and the SIP. CONCLUSIONS: The large number of syphilis infections reported in Peru's SIP and the ability to link maternal characteristics to newborn outcomes make the system potentially useful for monitoring the proportion of stillbirths attributable to congenital syphilis in Peru. To ensure good data quality and sustainability of Peru's SIP, data collection should be simplified and information should be continually quality-checked and used for the benefit of participating facilities.