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This study aimed to compare trends and characteristics of assisted reproductive technology (ART) and non-ART perinatal deaths and to evaluate the association of perinatal mortality and method of conception (ART vs. non-ART) among ART and non-ART deliveries in Florida, Massachusetts, and Michigan from 2006 to 2011. Retrospective cohort study using linked ART surveillance and vital records data from Florida, Massachusetts, and Michigan. During 2006 to 2011, a total of 570 ART-conceived perinatal deaths and 25,158 non-ART conceived perinatal deaths were identified from the participating states. Overall, ART perinatal mortality rates were lower than non-ART perinatal mortality rates for both singletons (7.0/1,000 births vs. 10.2/1,000 births) and multiples (22.8/1,000 births vs. 41.2/1,000 births). At28 weeks of gestation, the risk of perinatal death among ART singletons was significantly lower than non-ART singletons (adjusted risk ratio [aRR] = 0.46, 95% confidence interval [CI]: 0.26-0.85). Similar results were observed among multiples at28 weeks of gestation (aRR = 0.64, 95% CI: 0.45-0.89). Our findings suggest that ART use is associated with a decreased risk of perinatal deaths prior to 28 weeks of gestation, which may be explained by earlier detection and management of fetal and maternal conditions among ART-conceived pregnancies. These findings provide valuable information for health care providers, including infertility specialists, obstetricians, and pediatricians when counseling ART users on risk of treatment.· ART use is associated with a decreased risk of perinatal deaths prior to 28 weeks of gestation.. · ART perinatal mortality rates were lower than that for non-ART perinatal mortality.. · This study used linked data to examine associations between use of ART and perinatal deaths..

Post-mortem imaging has a high acceptance rate amongst parents and healthcare professionals as a non-invasive method for investigating perinatal deaths. Previously viewed as a ‘niche’ subspecialty, it is becoming increasingly requested, with general radiologists now more frequently asked to oversee and advise on appropriate imaging protocols. Much of the current literature to date has focussed on diagnostic accuracy and clinical experiences of individual centres and their imaging techniques (e.g. post-mortem CT, MRI, ultrasound and micro-CT), and pragmatic, evidence-based guidance for how to approach such referrals in real-world practice is lacking. In this review, we summarise the latest research and provide an approach and flowchart to aid decision-making for perinatal post-mortem imaging. We highlight key aspects of the maternal and antenatal history that radiologists should consider when protocolling studies (e.g. antenatal imaging findings and history), and emphasise important factors that could impact the diagnostic quality of post-mortem imaging examinations (e.g. post-mortem weight and time interval). Considerations regarding when ancillary post-mortem image-guided biopsy tests are beneficial are also addressed, and we provide key references for imaging protocols for a variety of cross-sectional imaging modalities.

BackgroundCompetent and skilled birth attendants are critical in the reduction of maternal and infant morbidity and mortality at delivery. This study aimed to determine the association between knowledge and self-rated confidence in facility birth attendants affiliated with maternal and neonatal health (MNH) interventions.MethodsA descriptive cross-sectional study was conducted in 24 primary healthcare facilities in Osun state, Nigeria among 128 consenting facility birth attendants who were selected via a multi-stage sampling technique. Each attendant received a semi-structured interviewer-administered questionnaire. The dependent variables included the respondent’s level of knowledge in MNH interventions and their self-rated confidence in MNH skills such as the provision of antenatal care service, normal labour, use of a partograph and the management of obstetric complications and post-partum haemorrhage. Bivariate analysis of factors associated with knowledge and self-rated confidence in MNH skills was performed with statistical significance set at p

Introduction and backgroundLike many health systems in low-income and middle-income countries, the South African health system has failed to decrease both maternal and perinatal mortality significantly, especially in district hospitals. Inappropriately trained healthcare providers and poor clinical leadership are repeatedly linked to healthcare providers’ preventable factors contributing to most maternal and perinatal deaths. Clinical skills of healthcare providers have been largely addressed, while clinical leadership remained neglected. One strategy implemented recently to support clinical leadership is the introduction of District Clinical Specialist Teams (DCSTs). Clinical leadership in the labour ward of district hospitals in KwaZulu-Natal (KZN) is conceptualised as an emergent phenomenon arising from dynamic interactions in the labour ward and the broader health system, converging to attain optimal patient care.AimTo evaluate the enablers and barriers to clinical leadership in the labour ward of district hospitals.MethodIterative data collection and analysis, following the Corbin and Strauss grounded theory approach, was applied. In-depth interviews were carried out with the midwifery members of the DCSTs in KZN. The emergent enablers and barriers to clinical leadership were presented and discussed at a workshop with broader midwifery representation, leading to a final classification of enablers and barriers to clinical leadership.Results and conclusionEnablers and barriers to clinical leadership arise as a result of emergent dynamic interactions within the labour ward and the broader health system, located at policy, organisational, team and individual healthcare provider levels, with the policy context as the overriding factor framing the implementation of clinical leadership.

Background: Syphilis is one of the major causes of adverse outcomes in pregnancy in developing countries. Antenatal screening for syphilis aims primarily at timely detecting & treating pregnant women with congenitally transmissible syphilis, there by preventing perinatal deaths. Objective: To study prevalence of syphilis in antenatal women by screening them with the Rapid Plasma Reagin (RPR) & rapid immunochromatographic (ICT) method. Materials and Methods: A total of 2258 pregnant women attending antenatal care from January to December 2018 were tested for Syphilis by RPR & rapid ICT. Results: Out of 2258 women screened during their antenatal visits, 12 (0.53%) were positive by RPR as well as rapid ICT test method. Conclusion(s): Early detection of syphilis in pregnancy is the best tool for prevention of adverse pregnancy outcomes. Antenatal screening of syphilis with Rapid plasma regain (RPR) and Rapid immunochromatography (ICT) is sensitive, specific, rapid and cost-effective method.

The 5-year public-private partnership boldly addressed maternal mortality in Uganda and Zambia using a systems approach at the district level to avoid delays in women seeking, reaching, and receiving timely, quality services. This supplement provides details on the Saving Mothers, Giving Life partnership and approach, including the model, impact, costs, and sustainability.

Background Globally, 2.6 million stillbirths occur every year. Of these, 98% occur in developing countries. According to the United Nations Children’s Fund, the neonatal mortality rate in Zambia in 2014 was 2.4%. In 2016, the World Health Organization released the International Classification of Diseases - Perinatal Mortality (ICD-PM) as a globally applicable and comparable system for the classification of the causes of perinatal deaths. However, data for developing countries are scarce. The aim of this study was to evaluate the rates and causes of stillbirths and neonatal deaths at a local hospital in Zimba, Zambia to identify opportunities for preventive interventions. Methods All cases of stillbirths and neonatal deaths at Zimba Mission Hospital in Zambia in 2017 were included in this study. Outborn neonates who were transferred to the hospital and later died were also included in the study. Causes of stillbirths and neonatal deaths were analyzed and classified according to ICD-PM. Results In total, 1754 babies were born via 1704 deliveries at the hospital, and 28 neonates were transferred to the hospital after birth. The total number of perinatal deaths was 75 (4.2%), with 7 deaths in the antepartum, 25 deaths in the intrapartum, and 43 deaths in the neonatal period. Most antepartum deaths (n = 5; 71.4%) were classified as fetal deaths of unspecified causes. Intrapartum deaths were due to acute intrapartum events (n = 21; 84.0%) or malformations, deformations, or chromosomal abnormalities (n = 4; 16.0%). Neonatal deaths were related primarily to complications from intrapartum events (n = 19; 44.2%); low birth weight or prematurity (n = 16; 37.2%); or infection (n = 3; 7.0%). Conclusions Perinatal deaths were associated with acute intrapartum events and considered preventable in 40 cases (53.3%). Effective interventions to prevent perinatal deaths are needed.

Mohammad S Alyahya,1 Yousef S Khader2 1Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; 2Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan Objectives: There is a lack of studying vital registration and disease classification systems in low- and middle-income countries. This study aimed to assess health care professionals’ (HCPs’) level of awareness, knowledge, use, and perceived barriers of the International Classification of Diseases, 10th version (ICD-10) as well as their perceptions of the electronic neonatal death registration system. Participants and methods: A mixed method approach including descriptive cross-sectional quantitative and focus groups with HCPs (physicians, nurses, and midwives) was used to collect data from four major selected hospitals in Jordan. A total of 16 focus groups were conducted. Also, a survey, which included three case studies about the ability of nurses and physicians to identify cause of death, was completed using structured face-to-face interviews. Results: Overall, there was congruency between both the quantitative results and the qualitative findings. The majority of nurses and physicians in the four hospitals were not familiar with the ICD-10 coding system and hence reported minimal use of the coding system. Additionally, the majority of HCPs were not aware whether or not their departments used the ICD-10 to record perinatal mortality. These HCPs identified that lack of knowledge, time, staff and support, and an effective and comprehensive electronic system that allows physicians to accurately choose the exact cause of death were their main barriers to the use of the ICD-10 coding system. Conclusion: Our findings emphasize the importance of developing an effective and comprehensive electronic system which allows HCPs to accurately report and register all perinatal deaths. This system needs to account for the direct and indirect causes of death and for contributing factors such as maternal conditions at the time of perinatal death. Training HCPs on how to use the system is vital for the success and accuracy of the data registration process. Keywords: neonatal deaths, stillbirths, neonatal causes of deaths, causes of stillbirths, ICD-PM, perinatal deaths, perinatal death registry, perinatal surveillance system

The perinatal mortality is a public health issue in developing countries. In fact, the perinatal death rate seems the highest in a Malian rural area. The objective of this work was to study the perinatal mortality in a rural area of Mali (Kadiolo). Methodology: It was a cross-sectional descriptive study conducted in Kadiolo over 12 months. The study took place from April 1, 2016 to March 31, 2017. We have included in our study all dead fetuses in gestational age ≥ 28 weeks of amenorrhea (WA) or weight ≥ 500 grams (g) and infants died during the first week of life. Mothers who have experienced a perinatal death were included. Results: During the 12 months of study period, we have recorded a total of 2212 births out of which we have collected 205 perinatal deaths, a perinatal mortality rate of 205/2212 with 93 per 1000. The stillbirth rate was 152/2212 with 69‰ and the early neonatal mortality rate was 53/2212 with 24‰. The sociodemographic characteristic of the patients was: patient who has been evacuated 71.70%, unschooled 77.1%, coming out of the city Kadiolo 76%, young women 65% and patient who did not receive antenatal care 35%. Conclusion: Our study confirms the high rates of perinatal deaths in rural areas. The implementation of a coherent and efficient care strategy should help in reducing the still high rates.

Perinatal mortality is the death of a baby born at 28 weeks of gestation until less than 7 days afterbirth. Perinatal mortality is used to attribute causes of infant death to obstetric events such as stillbirth andinfant mortality in the first week of life. The purpose of this study was to describe the causes, periods, andrisk factors that influence perinatal mortality . The design of this study is the Sequential Explanatory MixedMethods , Research Quantitative designed with analytical methods conducted cross-sectiona l. Sampling wasdone by total sampling. 396 research sample data. The subjects in this study were parents, health workerswho were involved and understood about the causes of perinatal death and the person in charge of recordingand reporting perinatal deaths in health care facilities . 60.6% of the fatalities that occurred were preventabledeaths. Perinatal deaths that often occur are still births and early neonatal. At 2-21% perinatal kamtian, it iscarried out by non-health workers. The risk factors that affect perinatal mortality are pregnancy distance (p= 0.04 ) and comorbidities (p = 0.019).

Background Stillbirth rates have shown little improvement for two decades in Australia. Perinatal mortality audit is key to prevention, but the literature suggests that implementation is suboptimal. Aim To determine the proportion of perinatal deaths which are associated with contributing factors relating to care in Queensland, Australia. Materials and methods Retrospective audit of perinatal deaths ≥ 34 weeks gestation by the Health Department in Queensland was undertaken. Cases and demographic information were obtained from the Queensland Perinatal Data Collection. A multidisciplinary panel used the Perinatal Society of Australia and New Zealand (PSANZ) perinatal mortality audit guidelines to classify the cause of death and to identify contributing factors. Contributing factors were classified as 'insignificant', 'possible', or 'significant'. Results From 1 January to 31 December 2018, 65 deaths (56 stillbirths and nine neonatal deaths) were eligible and audited. Most deaths were classified as unexplained (51.8% of stillbirths). Contributing factors were identified in 46 (71%) deaths: six insignificant (all stillbirths), 20 possibly related to outcome (17 stillbirths), and 20 significantly (16 stillbirths). Areas for practice improvements mainly related to the care for women with risk factors for stillbirth, especially antenatal care. The PSANZ guidelines were applied and enabled a systematic approach. Conclusions A high proportion of late gestation perinatal deaths are associated with contributing factors relating to care. Improving antenatal care for women with risk factors for stillbirth is a priority. Perinatal mortality audit is a valuable step in stillbirth prevention and the PSANZ guidelines allow a systematic approach to aid implementation and reporting.

ObjectiveWhen a formal review of care takes places after the death of a baby, parents are largely unaware it takes place and are often not meaningfully involved in the review process. Parent engagement in the process is likely to be essential for a successful review and to improve patient safety. This study aimed to evaluate an intervention process of parental engagement in perinatal mortality review (PNMR) and to identify barriers and facilitators to its implementation.DesignMixed-methods study of parents’ engagement in PNMR.SettingSingle tertiary maternity unit in the UK.ParticipantsBereaved parents and healthcare professionals (HCPs).InterventionsParent engagement in the PNMR (intervention) was based on principles derived through national consensus and qualitative research with parents, HCPs and stakeholders in the UK.OutcomesRecruitment rates, bereaved parents and HCPs’ perceptions.ResultsEighty-one per cent of bereaved parents approached (13/16) agreed to participate in the study. Two focus groups with bereaved parents (n=11) and HCP (n=7) were carried out postimplementation to investigate their perceptions of the process.Overarching findings were improved dialogue and continuity of care with parents, and improvements in the PNMR process and patient safety. Bereaved parents agreed that engagement in the PNMR process was invaluable and helped them in their grieving. HCP perceived that parent involvement improved the review process and lessons learnt from the deaths; information to understand the impact of aspects of care on the baby’s death were often only found in the parents’ recollections.ConclusionsParental engagement in the PNMR process is achievable and useful for parents and HCP alike, and critically can improve patient safety and future care for mothers and babies. To learn and prevent perinatal deaths effectively, all hospitals should give parents the option to engage with the review of their baby’s death.

BackgroundMaternal and Perinatal Deaths Review and Surveillance (MPDSR) system when used effectively has the power to bring into reality, a revolutionary victory in the fight against maternal and perinatal mortality from avoidable causes. This study aimed at determining the status of implementation of the system among health facilities in rural settings of Tanzania.MethodThis study was conducted among 38 health facilities from three districts of Morogoro region, Tanzania from April 27, 2020 to May 29, 2020. Quantitative data was collected through document review for MPDSR implementation status. The outcome was determined by using special scoring sheet with a total 30 points. Facilities that scored 10 points or above were considered to have satisfactory status of MPDSR implementation while the facilities that scored below 10 points were considered to have unsatisfactory status of MPDSR implementation. Bivariate logistic regression analyses were used to determine the predictors of implementation status among health facilities.ResultsMajority of health facilities 20(52.6%) had satisfactory MPDSR implementation status. The predictors of MPDSR implementation in a facility were level of health facility [Hospital (AOR = 11.945 at 95% CI = 1.133 – 125.942, P = 0.039)] and ownership of the facility [Public (AOR = 0.133 at 95% CI = 0.019 – 0.920, P = 0.041)].ConclusionMPDSR implementation status among health facility is on average not satisfactory. More efforts are needed to raise the status of MPDSR implementation in the country so that the maximum benefit of MPDSR is obtained.

This population-based study compares U.S. effectiveness with 20 Other Western Countries (OWC) in reducing mortality 1989–1991 and 2013–2015 and, responding to criticisms of Britain’s National Health Service, directly compares U.S. with U.K. child (0–4), adult (55–74), and 24 global mortality categories. World Health Organization Age-Standardized Death Rates (ASDR) data are used to compare American and OWC mortality over the period, juxtaposed against national average percentages of Gross Domestic Product (GDP) Expenditure on Health (%GDPEH) drawn from World Bank data. America’s average %GDPEH was highest at 13.53% and Britain’s the lowest at 7.68%. Every OWC had significantly greater ASDR reductions than America. Current U.S. child and adult mortality rates are 46% and 19% higher than Britain’s. Of 24 global diagnostic mortalities, America had 16 higher rates than Britain, notably for Circulatory Disease (24%), Endocrine Disorders (70%), External Deaths (53%), Genitourinary (44%), Infectious Disease (65%), and Perinatal Deaths (34%). Conversely, U.S. rates were lower than Britain’s for Neoplasms (11%), Respiratory (12%), and Digestive Disorder Deaths (11%). However, had America matched the United Kingdom’s ASDR, there would have been 488,453 fewer U.S. deaths. In view of American %GDPHE and their mortality rates, which were significantly higher than those of the OWC, these results suggests that the U.S. health care system is the least efficient in the Western world.

ObjectivesTo investigate if the implementation of the 2016 WHO Recommendations for a Positive Pregnancy Experience reduced perinatal mortality in a South African province. The recommendations were implemented which included increasing the number of contacts and also the content of the contacts.MethodsRetrospective interrupted time-series analysis was conducted for all women accessing a minimum of one antenatal care contact from April 2014 to September 2019 in Mpumalanga province, South Africa. Retrospective interrupted time-series analysis of province level perinatal mortality and birth data comparing the pre-implementation period (April 2014–March 2017) and post-implementation period (April 2018–September 2019). The main outcome measure was unadjusted prevalence ratio (PR) for perinatal deaths before and after implementation; interrupted time-series analyses for trends in perinatal mortality before and after implementation; stillbirth risk by gestational age; primary cause of deaths (and maternal condition) before and after implementation.ResultsOverall, there was a 5.8% absolute decrease in stillbirths after implementation of the recommendations, however this was not statistically significant (PR 0.95, 95% CI 0.90% to 1.05%; p=0.073). Fresh stillbirths decreased by 16.6% (PR 0.86, 95% CI 0.77% to 0.95%; p=0.003) while macerated stillbirths (p=0.899) and early neonatal deaths remained unchanged (p=0.499). When stratified by weight fresh stillbirths >2500 g decreased by 17.2% (PR 0.81, 95% CI 0.70% to 0.94%; p=0.007) and early neonatal deaths decreased by 12.8% (PR 0.88, 95% CI 0.77% to 0.99%; p=0.041). The interrupted time-series analysis confirmed a trend for decreasing stillbirths at 0.09/1000 births per month (−0.09, 95% CI −1.18 to 0.01; p=0.059), early neonatal deaths (−0.09, 95% CI −0.14 to 0.04; p=ConclusionThe implementation of the 2016 WHO Recommendations for a Positive Pregnancy Experience may be an effective public health strategy to reduce stillbirths in South African provinces.

Premature birth is a large-scale medical issue by being the cause of most of the perinatal deaths and a risk factor for other medical issues affecting the health and life quality of both mother and infant. Early diagnosis of such cases may prove to be very helpful in improving the health quality of society overall. So, in this study, such early diagnostic methodology is proposed by employing the non-invasive technique of uterine electromyography, which is also called electrohysterography (EHG). The raw EHG signals from three recording channels are first filtered using a 4-pole band-pass Butterworth filter of 0.8Hz-4Hz of each channel. Algorithm of Empirical Mode Decomposition (EMD) is applied as a pre-processing approach and for segmentation purposes. Then using nine statistical features, EHG signals are very accurately classified as ones leading to term or preterm labors under the Quadratic Discriminant at 25% holdout validation. The proposed framework is 98.5% accurate for classification of term and preterm deliveries with 98.48% sensitivity and 98.48% specificity. This technique will help obstetricians in their clinical practices by providing an early assessment of pregnancies and for saving the life of infants and improving the infant and maternal health status.

Background: Around 70% of all pregnancies (Including 15% of clinically-recognized ones) are lost due to various fetal or maternal disorders. Chromosomal aneuploidies are among the most common causes of pregnancy loss. Standard chromosome analysis using G-banding technique (Karyotype) is the technique of choice in studying such abnormalities; however, this technique is time-consuming and sensitive, and limited by vulnerabilities such as cell culture failure. The use of molecular cytogenetic techniques, including array-based techniques and Multiplex Ligation-Dependent Probe Amplification (MLPA), has been proposed to overcome the limitations of this method to study the products of conception. This study has been designed to investigate the feasibility of using MLPA technique as a standalone genetic testing, with histopathologic examinations and genetic counseling to detect aneuploidies in products of conception and neonatal deaths. Methods: Forty-two verified fetal and neonatal samples were studies and genetic counseling was scheduled for all parents. Histopathologic examinations were carried out on the products of conception, and appropriate fetal tissues were separated for genetic studies. Following DNA extraction and purification, MLPA was carried out to investigate chromosomal aneuploidies. Results: Nine samples (21.42%) were diagnosed to be affected with aneuploidy. Detected aneuploidies were trisomy 22 (n=3), trisomy 21(n=1), trisomy 18 (n=2), trisomy 16 (n=1), trisomy 13 (n=1), and monosomy of chromosome X (n=1). The MLPA analysis results were conclusive for all of the fetal samples (Success rate: 100%). Conclusion: These results suggest that MLPA, as a standalone genetic testing, is an accurate, rapid, and reliable method in overcoming the limitations of standard cytogenetic techniques in genetic investigation of products of conception.

In a recent randomized clinical trial, Wennerholm and colleagues compared induction of labour at 41 weeks with expectant management and induction at 42 weeks. The trial was stopped early, because six perinatal deaths occurred in the expectant management group, whereas none occurred in the induction group. Our Bayesian reanalysis finds that the SWEPIS data indeed support the hypothesis that induction of labour at 41 weeks of pregnancy is associated with a lower rate of stillbirths. However, the degree of this support is moderate at best, and arguably provides insufficient ground for terminating the study. In general, it seems hazardous to terminate clinical studies on the basis of a single P

Lack of a professional body to address patients’ complaints regarding quality of health care and absence of clear medicolegal guidance hamper maternal death reviews in Ethiopia., Key Messages Performing effective maternal death reviews as part of the maternal death surveillance and response program has been hindered by challenges including poor attendance, defensive attitudes, and blame shifting.Reviews of maternal and perinatal deaths should be based on a “no blame” principle. Emphasis should be on learning lessons and health professionals should feel safe to discuss the circumstances surrounding death.Meaningful reduction in maternal mortality requires a depoliticizing paradigm shift, a professional body to address patients’ worries, and clear medicolegal guidance to encourage providers to identify care deficiencies.

Objectives: In Karnataka state, perinatal mortality rate is almost equal to infant mortality rate. This preliminary study was conducted in two districts of Karnataka to study potential problems to start of perinatal death audit. Methods: Hospitals providing maternal and child health care services, which met study inclusion criteria, in Dakshina Kannada and Koppal Districts were included. Following variables were studied: (i) Documentation and reporting systems in these hospitals; (ii) Role of health care personnel in documentation and reporting (iii) Existing system of audit, if any. Results: Totally 94 hospitals met our criteria with Dakshina Kannda District having 63 (67.02%) and the rest in Koppal District. Documentation and reporting was poor in Koppal District and inadequate in Dakshina Kannada district. Health care personnel were apprehensive about perinatal death audit. Conclusion: Problems identified need to be addressed before starting perinatal death audit.

Background. A preliminary review of perinatal mortality surveillance data (January - August 2017) suggested an under-reporting of perinatal deaths in Gwanda District, Matabeleland South. Objective. To evaluate the effectiveness of the perinatal mortality surveillance system in Gwanda District, Matabeleland South, Zimbabwe. Methods. This descriptive cross-sectional study interviewed 50 healthcare workers employed in the district using pretested intervieweradministered questionnaires. The sample was drawn from 16 randomly selected healthcare facilities. Records for perinatal mortality cases were reviewed and data were analysed. Results. Only 32% of healthcare workers knew the case definition of perinatal death. Approximately two-thirds of participants (68%) knew who should complete notification forms and ~half (52%) of the respondents cited fear of blame as the reason for a low perinatal death report rate in the district. Although 50% of participants reporting having participated in perinatal death reviews and 78% reporting using the data for planning community health programmes, there was no recorded evidence in support. Perinatal mortality case notification forms were not in stock at 13 of the 16 sampled healthcare facilities. Conclusion. Poor knowledge of the perinatal mortality surveillance system was found among participants. The low reporting rate suggests that the system does not function effectively in the district. Healthcare workers feared blame, which suggests management intervention is required to create a trusted reporting environment.

Background Stillbirths and neonatal deaths have long been imperfectly classified and recorded worldwide. In Hong Kong, the current code system is deficient (>90% cases with unknown causes) in providing the diagnoses of perinatal mortality cases. Objective The objective of this study was to apply the International Classification of Diseases for Perinatal Mortality (ICD-PM) system to existing perinatal death data. Further, the aim was to assess whether there was any change in the classifications of perinatal deaths compared with the existing classification system and identify any areas in which future interventions can be made. Methods We applied the ICD-PM (with International Statistical Classification of Diseases and Related Health Problems, 10th Revision) code system to existing perinatal death data in Kwong Wah Hospital, Hong Kong, to improve diagnostic classification. The study included stillbirths (after 24 weeks gestation) and neonatal deaths (from birth to 28 days). The retrospective data (5 years) from May 1, 2012, to April 30, 2017, were recoded by the principal investigator (HML) applying the ICD-PM, then validated by an overseas expert (EA) after she reviewed the detailed case summaries. The prospective application of ICD-PM from May 1, 2017, to April 30, 2019, was performed during the monthly multidisciplinary perinatal meetings and then also validated by EA for agreement. Results We analyzed the data of 34,920 deliveries, and 119 cases were included for analysis (92 stillbirths and 27 neonatal deaths). The overall agreement with EA of our codes using the ICD-PM was 93.2% (111/119); 92% (78/85) for the 5 years of retrospective codes and 97% (33/34) for the 2 years of prospective codes (P=.44). After the application of the ICD-PM, the overall proportion of unknown causes of perinatal mortality dropped from 34.5% (41/119) to 10.1% (12/119) of cases (P Conclusions Using the ICD-PM would lead to a better classification of perinatal deaths, reduce the proportion of unknown diagnoses, and clearly link the maternal conditions with these perinatal deaths.

Evaluate the impact of third trimester ultrasound in identifying ,small for gestational age (SGA) growth restricted (FGR) and appropriately grown fetuses (AGA).Analyse their outcomes ,ascertain the main causes of perinatal death and lastly compare ultrasound intervention to standard antenatal care . Design Prospective observational study Setting Secondary care, government hospital Population Antenatal women Methods Based on estimated fetal weight by scan , patients were categorized into FGR 3 and 10 centile. Perinatal outcomes and deaths were analysed by category. Health Ministry data was extracted for standard care outcomes and compared to study group. Main Outcomes Perinatal deaths and causes,composite neonatal morbidity ,severe adverse outcomes Results Number of births in study and standard care was 1817 and 15,427 respectively. Detection rate by ultrasound for FGR/SGA fetuses was 28.5%.This contained 44.8% (13/29) of all perinatal deaths. Neonatal deaths, composite neonatal morbidity, serious adverse perinatal outcomes were significantly more in FGR compared to AGA. Standard care group had twice as many stillbirths RR 2.32(1.3-4.1)and early neonatal deaths (RR2.5 (1.18-5.34) . Majority of perinatal deaths (17/29; 58.6%) in study group were the direct result of failure to recognize antepartum/ intrapartum risk factors, leading to delayed delivery. In addition (3/12 ; 25%), women reported late after decreased fetal movements and ( 3/12 25%)were post dated. Ill-equipped nursery contributed to neonatal mortality in (10/17 ; 58.8%) cases. Conclusion Perinatal outcomes will not improve by ultrasound identification of small fetuses unless concomitantly, obstetric protocols and patient awareness programmes are not improved.

Background: Research indicated the prevalence of perinatal deaths of infants immediately or up to a week after birth and includes fresh and macerated stillbirths and neonatal deaths. Worldwide, there is a decline in perinatal deaths. However, in South Africa, it is not the case. Often the quality of maternity care is considered as the most important contributing factor for these deaths. However, maternal and neonatal factors can also contribute. Aim: The aim of the study was to determine the maternal and neonatal factors associated with perinatal deaths in a single selected district hospital within the Free State Province of South Africa. Setting: The maternity unit of the largest district hospital in the specific district in the Free State Province of South Africa. Method: A clinical audit design was used. Units of analysis comprised the Perinatal Problem Identification Programme (PPIP) database of neonates born during 2015, and their mothers. A random sample of 384 alive neonates and an all-inclusive sample of 43 deceased neonates were taken from a total of 2319. Descriptive statistics were reported and Cohen’s effect sizes, d , were calculated to identify practically significant differences between the neonates in the alive and the deceased group, respectively. Results: Cohen’s effect sizes and logistical regression analyses indicate that the Apgar score recorded 10 min after birth, gestational age, birth weight of neonate and the parity of the mother were the most practically significant factors influencing a neonate’s chances of survival. Conclusion: Quality maternity care is not the only cause of perinatal mortality rates; maternal and neonatal factors are also contributors.

Aim This study aimed to calculate the perinatal mortality rate in Kirakira Hospital, a remote provincial hospital in Solomon Islands, over a 3-year period, from 2014 to 2016. Methods A retrospective audit of the labour ward admission books for the years 2014-2016 was conducted. Patient files of all perinatal deaths and caesarean sections were accessed and reviewed. Stillbirths and early neonatal deaths were classified, and results were compared with the national health statistics of Australia (2014). Results Between 2014 and 2016, there were 1311 births and 40 perinatal deaths (mortality rate of 31 per 1000). This is approximately three times the Australian rate of 9.6 deaths per 1000. Of these deaths, 28 were stillbirths, and 12 were neonatal deaths. Detailed information was available for 88% (35/40) of the perinatal deaths. Only 15 caesarean sections (1.1% of deliveries) were performed, compared to a rate of 32.1% of caesarean sections in Australia (2014). Conclusions Kirakira continues to have a very high perinatal mortality rate that has not changed over the last 6 years. The rate is double that reported for Solomon Islands in current World Health Organization data. This discrepancy is likely due to an absence of clinical data outside of the National Referral Hospital in Honiara. This paper identifies clinical indicators that could be targeted to help lower the perinatal mortality rate in this remote and impoverished community.

Background: Perinatal mortality rate indicates quality of care provided during pregnancy and delivery to the mother and to the neonate in its early neonatal period. The objective of this study was to determine the frequency and causes of perinatal mortality in a tertiary care hospital in Peshawar, Pakistan. Materials & Methods: This cross-sectional study was conducted at Department of Gynaecology & Obstetrics, Khyber Teaching Hospital, Peshawar, Pakistan from 1st January 2016 to 31st December 2016. The inclusion criteria was all singleton gestation with gestational age of at least 24 weeks presenting with perinatal mortality. Data was collected for the following variables; age groups (up to 20 years, 21-30 years, 31-40 years and > 40 years), booking status (yes/ no), period of gestation (24-31+6, 32-36+6, 37-39+6 and > 40 weeks), Foetal weight ( 3.5 kg) and cause of perinatal mortality. Results: Out of 4508 deliveries there were 288 perinatal deaths, including 228 stillbirths and 60 neonatal deaths, so perinatal mortality rate was 63.8/1000 births. 90.28% women were unbooked. Most common cause was hypertensive disorders of pregnancy (27.78%) followed by antepartum haemorrhage (25.71%) and then mechanical causes (13.88%). Congenital anomalies comprised 11.8% cases, neonatal problems 10.07% and maternal medical disorders for 4.16% cases. Cause of 4.16% cases remained unexplained. Conclusion: Appropriate strategies like control of identifiable causes, proper antenatal and postnatal care, healthy delivery practices and availability of emergency neonatal care facilities can bring down perinatal mortality rates.

Preterm birth (delivery prior to 37 completed weeks of gestation) is the leading cause of perinatal deaths worldwide. Preterm infants are born when their hearts are structurally and functionally immature; as a result, maladaptive cardiac remodelling occurs in the neonatal period which may lead to cardiac dysfunction later in life. Hypotension is a common co-morbidity of preterm birth in the neonatal period; however, hypertension often manifests in adulthood. Adults born preterm exhibit altered heart growth, which may in part be linked to their elevation in blood pressure. Clinical interventions used to facilitate lung function in preterm infants, including antenatal glucocorticoids and mechanical ventilation, may also impact cardiac growth early in life, with lifelong implications for cardiac structure and function.

Babies born to women who live in the most deprived areas of the UK are twice as likely to be stillborn and are at a 73% excess risk of neonatal death when compared with babies born in the most affluent areas, and the poverty gap is widening, a surveillance report has found.1 The report produced by MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK) looked at perinatal deaths (including late fetal losses, stillbirths, and neonatal deaths) from gestational age of 22 weeks among babies born in the UK between 1 January and 31 December 2019. The results showed that perinatal deaths are declining overall. Between 2013 and 2019 numbers of stillbirths across the UK fell by more than 20%, representing around 610 fewer stillbirths in 2019, and neonatal mortality by 12%, representing around 160 fewer neonatal deaths in 2019. However, stillbirth rates among babies of black ethnicity were more than …

Accurate and consistent classification of causes and associated conditions for perinatal deaths is essential to inform strategies to reduce the five million which occur globally each year. With the majority of deaths occurring in low- and middle-income countries (LMICs), their needs must be prioritised. The aim of this paper is to review the classification of perinatal death, the contemporary classification systems including the World Health Organization's International Classification of Diseases Perinatal Mortality (ICD-PM), and next steps. During the period from 2009 to 2014, a total of 81 new or modified classification systems were identified with the majority developed in high-income countries (HICs). Structure, definitions and rules and therefore data on causes vary widely and implementation is suboptimal. Whereas system testing is limited, none appears ideal. Several systems result in a high proportion of unexplained stillbirths, prompting HICs to use more detailed systems that require data unavailable in low-income countries. Some systems appear to perform well across these different settings. ICD-PM addresses some shortcomings of ICD-10 for perinatal deaths, but important limitations remain, especially for stillbirths. A global approach to classification is needed and seems feasible. The new. ICD-PM system is an important step forward and improvements will be enhanced by wide-scale use and evaluation. Implementation requires national-level support and dedicated resources. Future research should focus on implementation strategies and evaluation methods, defining placental pathologies, and ways to engage parents in the process. (C) 2017 Elsevier Ltd. All rights reserved.

Introduction An estimated 2.6 million stillbirths occur worldwide each year. A standardized classification system setting out possible cause of death and contributing factors is useful to help obtain comparative data across different settings. We undertook a systematic review of stillbirth classification systems to highlight their strengths and weaknesses for practitioners and policymakers. Material and methods We conducted a systematic search and review of the literature to identify the classification systems used to aggregate information for stillbirth and perinatal deaths. Narrative synthesis was used to compare the range and depth of information required to apply the systems, and the different categories provided for cause of and factors contributing to stillbirth. Results A total of 118 documents were screened; 31 classification systems were included, of which six were designed specifically for stillbirth, 14 for perinatal death, three systems included neonatal deaths and two included infant deaths. Most (27/31) were developed in and first tested using data obtained from high‐income settings. All systems required information from clinical records. One‐third of the classification systems (11/31) included information obtained from histology or autopsy. The percentage where cause of death remained unknown ranged from 0.39% using the Nordic‐Baltic classification to 46.4% using the Keeling system. Conclusion Over time, classification systems have become more complex. The success of application is dependent on the availability of detailed clinical information and laboratory investigations. Systems that adopt a layered approach allow for classification of cause of death to a broad as well as to a more detailed level.

Hatirnaz, Safak/0000-0001-8859-0639; Ozer, Alev/0000-0002-0934-0226 WOS: 000400814700017 PubMed: 28258586 Objective: To determine the efficiency of pre-implantation genetic screening (PGS) among women scheduled to undergo intracytoplasmic sperm injection who had experienced recurrent in vitro fertilization (IVF) failure. Methods: The present retrospective cohort study reviewed the medical records of consecutive women who had experienced recurrent IVF failure and had presented at a private IVF facility in Trabzon Province, Turkey, to undergo intracytoplasmic sperm injection between May 1, 2012, and December 31, 2014. Patient data and perinatal outcomes were compared between patients who underwent PGS and those who did not. Results: There were 88 patients included in the study; 43 patients had undergone PGS and 45 had declined to do so. No differences were detected in the clinical pregnancy rate (P=0.846), spontaneous abortion rate (P=0.416), number of perinatal deaths (P=0.162), or the number of live deliveries (P=0.188) between the groups of patients. The pregnancies included in the study resulted in 25 neonates being delivered; 24 had normal karyotypes, and one neonate from the control group had a karyotype of 46, XX, 9ph. Among the 19 embryos that were not transferred, the most frequently encountered chromosomal anomalies were diploidy, monosomy X, and 2N/N/4N mosaicism, detected in 7 (37%), 2 (11%), and 2 (11%) embryos, respectively. Conclusion: PGS had no effect on perinatal outcomes among women experiencing recurrent IVF failure.

Aim A cohort study was performed to clarify the influence of risk factors on perinatal events (obstetric complications and/or perinatal deaths). Methods This cohort study reviewed 395 785 births from 2011 to 2013. Women with singleton pregnancies delivered after 22 weeks of gestation were included. The OR were determined on multivariate analysis. The perinatal event score (PES) for risk factors, which is the product of the OR of risk factors for obstetric complications, OR of risk factors for perinatal death, and OR of obstetric complications for perinatal death, was introduced to clarify the impact of each risk combination. Results There were 20 risk factors such as maternal age and medical complications relating to the 11 obstetric complications, including pregnancy-induced hypertension and preterm labor. As a result, 77 combinations of risk factors and obstetric complications were found to be significant. Six obstetric complications such as preterm labor and cervical insufficiency were found to be related to perinatal death. Two factors were found to be directly related to perinatal death: age >40 years old (OR, 1.24; 95%CI: 1.11–1.39) and essential hypertension (OR, 1.56; 95%CI: 1.19–2.05). As a result, PES ranged from 1.07 (primipara for premature rupture of membrane) to 40.1 (essential hypertension for placental abruption), and high PES (≥8) was identified in 21 combinations of risk factors and obstetric complications. Conclusion This newly created score for perinatal events, PES, can be used as an indicator of the impact of risk factors on perinatal events.

Today pre-eclampsia remains one of the most urgent problems in obstetrics. This condition is associated with a high incidence of maternal and perinatal deaths, which ranges from 12.1 to 23.2%. This pathological condition occurs in 7-23% of pregnancies and it does not tend to decrease. In this review article, we present and analyze the current concepts on the etiology and pathogenesis of pre-eclampsia. The issues concerning functional disorders of the hepatobiliary system in pregnant women are also discussed.

RESUMEN Objetivo: describir la mortalidad perinatal del departamento de Antioquia según la Clasificación Internacional de Enfermedades CIE-MP de la Organización Mundial de la Salud (OMS) y evaluar la factibilidad de aplicar el sistema de clasificación a partir los registros vitales oficiales. Materiales y métodos: estudio descriptivo de las causas de muerte perinatal según el momento del fallecimiento con respecto al parto y las condiciones maternas asociadas. La fuente primaria fue la base de datos oficial de estadísticas vitales entre los años 2013 y 2016. Se midieron: la edad materna, la edad gestacional, el peso al momento del parto, el área de residencia, el tipo de parto, las causas de muerte (directas, asociadas) y otros estados patológicos. Se hace análisis descriptivo, se presenta el número absoluto y el porcentaje de las causas distribuidas según el momento de ocurrencia de la muerte con respecto al parto y el peso al nacer. Resultados: de 3901 muertes perinatales ocurridas en fetos con 22 semanas o más, o mínimo 500 g de peso y hasta los 28 días de vida, 1404 (36,0 %) se presentaron antes del parto, 378 (9,7 %) en el intraparto, 1760 (45,1 %) en el periodo neonatal y 359 (9,2 %) casos no contaban con información del momento del fallecimiento con relación al parto. Las principales causas de muerte de los recién nacidos de 1000 o más g fueron las malformaciones congénitas, las deformidades y las anormalidades cromosómicas (30,2 %); la hipoxia anteparto e intraparto (29,3 %) y la infección (12,3 %). En el 69,5 % no se identificaron causas maternas asociadas, y en las identificadas, la más frecuente fue la complicación de placenta, cordón y membranas (16,8 %). Conclusión: el CIE-MP es un sistema de clasificación aplicable globalmente a partir de los registros vitales, que permitió caracterizar la mortalidad perinatal del departamento. ABSTRACT Objective: To describe perinatal mortality in the Department of Antioquia based on the WHO International Classification of Diseases (ICD-PM) and determine the feasibility of applying this classification system to the official records on vital statistics. Materials and Methods: Descriptive study of the causes of perinatal death according to the time of death in relation to the time of delivery and associated maternal conditions. The primary source was the official database of vital statistics for the period between 2013 and 2016. The variables measured were maternal age, gestational age and weight at the time of birth, area of residence, type of delivery, and causes of death, including direct and associated causes, and other pathological conditions. A descriptive analysis is performed, causes are presented in terms of absolute numbers and percentages, and distributed according to the timing of death in relation to childbirth and birthweight. Results: Of 3901 perinatal deaths occurring in fetuses 22 weeks or more of gestational age or a minimum weight of 500 g, and up to 28 days of life, 1404 (36.0%) occurred before delivery, 378 (9.7%) during the intrapartum period, 1760 (45.1%) during the neonatal period, and 359 (9.2%) cases had no information regarding the time of death in relation to the time of delivery. The main causes of death of the neonates weighing 1000 g or more were congenital malformations, deformities and chromosomal abnormalities (30.2%), antepartum and intrapartum hypoxia (29.3%), and infection (12.3%). In 69.5% of cases, no associated maternal causes were identified and in those in which there were related causes, the most frequent was placenta, cord and membrane complications (16.8%). Conclusion: The ICD-PM is a system globally applicable to records of vital statistics, enabling the characterization of perinatal mortality in the Department.

Objective: Electronic fetal monitoring (EFM) using cardiotocograph (CTG) is commonly used both to assess fetal wellbeing in late antepartum and for intervention during intrapartum period. We validated the performance of indigenously developed mobile cardiotocograph (CTG) device with wireless probes compared to standard CTG device. Materials and methods: We sequentially used mobile and standard CTG devices in 495 pregnant women in labour and 359 pregnant women with gestation > 32 weeks. The CTG interpreted by two independent obstetricians in a blinded manner were compared to estimate the agreement by kappa (k) statistic. Results: High level of agreements between mobile and standard CTG devices for both intrapartum (87.9%; kappa 0.61) and antepartum monitoring (91.2%; kappa 0.60) were observed. Most of the pregnant women (80% in intrapartum and 70% in antepartum groups) and all nurses and obstetricians preferred the mobile CTG device over standard CTG device. Conclusion: The mobile CTG device can reliably be used for both intrapartum and antepartum monitoring instead of the standard CTG devices. The smaller size, portability and ability to transmit the recordings for second opinion make it suitable for use by midwives for appropriate triaging and referral. Wider availability of CTG and interpretation support at the peripheral facilities would assist identifying at-risk pregnancies and foetuses for timely referral and appropriate action to reduce perinatal deaths, stillbirths and birth asphyxi.

Background: The primary purpose of cardiotocography is to detect early signs of intrapartum hypoxia and improve foetal outcomes. Intrapartum hypoxia remains the major cause of perinatal deaths during monitored labours. This is attributed to the midwives’ lack of knowledge and skills in the foetal implementation and interpretation of cardiotocographs. Objectives: This study aimed to establish midwives’ knowledge and interpretive skills of cardiotocography. Method: The study employed a quantitative research approach with an explorative, descriptive, cross-sectional design. A total of 226 purposively selected participants were asked to complete a self-administered, structured questionnaire, of which 125 responded by completing the questionnaire. The study was conducted in labour wards in KwaZulu-Natal public hospitals in 2014. Data analysis was performed by means of descriptive and inferential statistics using analysis of variance. Results: The findings revealed that the midwives in KwaZulu-Natal public hospitals were found to be clinically lacking in knowledge of cardiotocography. Conclusion: The limited cardiotocographic knowledge of the midwives in KwaZulu-Natal public hospitals was possibly because of a lack of in-service training, as more than half of the participants (70%) indicated a need for this.

Objective This study investigates the trend of perinatal mortality rates in Fukushima Prefecture and four neighboring prefectures (Miyagi, Gunma, Tochigi, and Ibaraki) after the disaster at the Fukushima Daiichi nuclear power plant in March 2011. Material and methods Japanese monthly perinatal mortality data on a prefecture level are available on a website of the Japanese government. A combined regression of perinatal mortality rates from the study region and the rest of Japan (the control region) is conducted. The regression model allows for an asymptotic lower limit and a level change of perinatal mortality rates in 2012-2017 in the study region relative to the predicted trend. Results In 2012-2017, perinatal mortality in the study region shows a significant 10.6% increase relative to the trend in preceding years (p = 0.006). The excess mortality translates to 195 (95% CI: 28, 462) excess perinatal deaths. The increase is three times greater in Fukushima Prefecture than in the four neighboring prefectures and the difference in excess rates is statistically significant (p = 0.010). Periodic peaks of perinatal mortality are found in 2012-2017 with maxima around April. Conclusion We find an increase in perinatal mortality in Fukushima and four neighboring prefectures after the Fukushima nuclear accident. The results agree with similar observations in Germany and Ukraine after the Chernobyl disaster. Due to its ecological design, the study cannot prove a causal link between radiation exposure and perinatal mortality. Continued observation of the trend of perinatal mortality in contaminated regions of Japan is recommended.