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• Hypertensive disorders of pregnancy (HDP) are a major cause of maternal deaths in low- to middle-income countries (LMIC). • Workshops to review critical barriers for preeclampsia diagnosis in La Paz-El Alto, Bolivia increased detection of severe diease but its diagnosis remained underreported due to use of outdated prenatal forms. • Biomarker tests that can be applied at point-of-care, ongoing workforce training and timely adoption of updated prenatal forms can help lessen maternal mortality in LMIC. Hypertensive disorders of pregnancy (HDP) exert a heavy mortality burden in low- to middle-income countries (LMIC). ACOG revised HDP diagnostic guidelines to improve identifying pregnancies at greatest risk but whether they are used in LMIC is unknown. We held a workshop to review ACOG guidelines in La Paz, Bolivia (BO) and then reviewed prenatal, labor and delivery records for all HDP diagnoses and twice as many controls at its three largest delivery sites during the year before and the nine months after a workshop (n = 1376 cases, 2851 controls during the two periods). HDP diagnoses, maternal, and infant characteristics. Bolivian and ACOG criteria identified similar frequencies of gestational hypertension (GH) or eclampsia, but preeclampsia with severe features (sPE) was under- and preeclampsia without severe features (PE) over-reported during both periods. Increases occurred after the workshop in testing for proteinuria and the detection of abnormal laboratory values and severe hypertension in HDP women. Any adverse maternal outcome occurred more frequently after the workshop in women with BO PE or sPE diagnoses who met ACOG sPE criteria. Utilization of ACOG guidelines increased following the workshop and improved identification of PE or sPE pregnancies with adverse maternal outcomes. Continued use of a CLAP perinatal form recognizing HELLP as the only kind of sPE resulted in under-reporting of sPE. NIH TW010797, HD088590, HL138181. [ABSTRACT FROM AUTHOR]

Background and objectives: To ascertain the prevalence of obstructed labour and to research numerous risk variables that affect obstructed labour To research the problems related to pregnancy and birth and, investigate about maternal and perinatal deaths in addition to the numerous variables that contribute to these losses. To Discuss methods for reducing obstructed labour with the available resources. Methods: A prospective study was carried out for a full year, from January 2020 to December 2020, in the Obstetrics and Gynaecology Department at Kurnool Medical College, Kurnool, Andhra Pradesh, India, in which all term pregnant women with obstructed labour who attend labour room emergency referred from outlying health care facilities were included. Results: In the present study, 69% of the cases were 21 to 30 years old, followed by 19% aged 21 and 12% aged 31 and older. Mean height was 142.7+ 4.0 cm. 59.5% of the pregnant women were primigravida, followed by second (16.7%) and third (11.9%) gravidas. 14.7% of cases with a labour duration of 24 hours had PPH and 62.5% of cases with a labour duration >24 hours had PPH. 11.8% of cases with a duration of labour 24 hours and 50% of cases with a duration of labour >24 hours had APGAR of 0, and 50% of cases with a duration of labour 24 hours and 0% of cases with a duration of labour >24 hours had APGAR of 10. Conclusion: Even though obstructed labour is preventable, it still significantly increases mother and infant morbidity in our country. As a result, prevention is better than treatment. Enhancing remote healthcare can reduce incidence. [ABSTRACT FROM AUTHOR]

Background: Neonatal near-miss (NNM) can be considered as an end of a spectrum that includes stillbirths and neonatal deaths. Clinical audits of NNM might reduce perinatal adverse outcomes. The aim of this review is to evaluate the effectiveness of NNM audits for reducing perinatal mortality and morbidity and explore related contextual factors. Methods: PubMed, Embase, Scopus, CINAHL, LILACS and SciELO were searched in February/2023. Randomized and observational studies of NNM clinical audits were included without restrictions on setting, publication date or language. Primary outcomes: perinatal mortality, morbidity and NNM. Secondary outcomes: factors contributing to NNM and measures of quality of care. Study characteristics, methodological quality and outcome were extracted and assessed by two independent reviewers. Narrative synthesis was performed. Results: Of 3081 titles and abstracts screened, 36 articles had full-text review. Two studies identified, rated, and classified contributing care factors and generated recommendations to improve the quality of care. No study reported the primary outcomes for the review (change in perinatal mortality, morbidity and NNM rates resulting from an audit process), thus precluding meta-analysis. Three studies were multidisciplinary NNM audits and were assessed for additional contextual factors. Conclusion: There was little data available to determine the effectiveness of clinical audits of NNM. While trials randomised at patient level to test our research question would be difficult or unethical for both NNM and perinatal death audits, other strategies such as large, well-designed before-and-after studies within services or comparisons between services could contribute evidence. This review supports a Call to Action for NNM audits. Adoption of formal audit methodology, standardised NNM definitions, evaluation of parent's engagement and measurement of the effectiveness of quality improvement cycles for improving outcomes are needed. [ABSTRACT FROM AUTHOR]

Objective: To describe the perinatal mortality rate (PMR) of birth defects and to define the relationship between birth defects (including a broad range of specific defects) and a broad range of factors. Methods: Data were obtained from the Birth Defects Surveillance System in Hunan Province, China, 2010–2020. The prevalence rate (PR) of birth defects is the number of birth defects per 1000 fetuses (births and deaths at 28 weeks of gestation and beyond). PMR is the number of perinatal deaths per 100 fetuses. PR and PMR with 95% confidence intervals (CI) were calculated using the log-binomial method. Chi-square trend tests (χ2trend) were used to determine trends in PR and PMR by year, maternal age, income, education level, parity, and gestational age of termination. Crude odds ratios (ORs) were calculated to examine the association of each maternal characteristic with perinatal deaths attributable to birth defects. Results: Our study included 1,619,376 fetuses, a total of 30,596 birth defects, and 18,212 perinatal deaths (including 16,561 stillbirths and 1651 early neonatal deaths) were identified. The PR of birth defects was 18.89‰ (95%CI: 18.68–19.11), and the total PMR was 1.12%(95%CI: 1.11–1.14). Birth defects accounted for 42.0% (7657 cases) of perinatal deaths, and the PMR of birth defects was 25.03%. From 2010 to 2020, the PMR of birth defects decreased from 37.03% to 2010 to 21.00% in 2020, showing a downward trend (χ2trend = 373.65, P < 0.01). Congenital heart defects caused the most perinatal deaths (2264 cases); the PMR was 23.15%. PMR is highest for encephalocele (86.79%). Birth defects accounted for 45.01% (7454 cases) of stillbirths, and 96.16% (7168 cases) were selective termination of pregnancy. Perinatal deaths attributable to birth defects were more common in rural than urban areas (31.65% vs. 18.60%, OR = 2.03, 95% CI: 1.92–2.14) and in females than males (27.92% vs. 22.68%, OR = 1.32, 95% CI: 1.25–1.39). PMR of birth defects showed downward trends with rising maternal age (χ2trend = 200.86, P < 0.01), income (χ2trend = 54.39, P < 0.01), maternal education level (χ2trend = 405.66, P < 0.01), parity (χ2trend = 85.11, P < 0.01) and gestational age of termination (χ2trend = 15297.28, P < 0.01). Conclusion: In summary, birth defects are an important cause of perinatal deaths. Rural areas, female fetuses, mothers with low maternal age, low income, low education level, low parity, and low gestational age of termination were risk factors for perinatal deaths attributable to birth defects. Future studies should examine the mechanisms. Our study is helpful for intervention programs to reduce the PMR of birth defects. [ABSTRACT FROM AUTHOR]

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Summary: Background: The aim of this study was to detail incidence rates and relative risks for severe adverse perinatal outcomes by birthweight centile categories in a large Australian cohort of late preterm and term infants. Methods: This was a retrospective cohort study of singleton infants (≥34+0 weeks gestation) between 2000 and 2018 in Queensland, Australia. Study outcomes were perinatal mortality, severe neurological morbidity, and other severe morbidity. Categorical outcomes were compared using Chi-squared tests. Continuous outcomes were compared using t-tests. Multinomial logistic regression investigated the effect of birthweight centile on study outcomes. Findings: The final cohort comprised 991,042 infants. Perinatal mortality occurred in 1944 infants (0.19%). The incidence and risk of perinatal mortality increased as birthweight decreased, peaking for infants

BackgroundNeonatal mortality reduction is a global goal, but its factors are seldom studied in most resource-constrained settings. This is the first study conducted to identify the factors affecting perinatal and neonatal deaths in Sao Tome & Principe (STP), the smallest Central Africa country.MethodsInstitution-based prospective cohort study conducted at Hospital Dr. Ayres Menezes. Maternal-neonate dyads enrolled were followed up after the 28th day of life (n = 194) for identification of neonatal death-outcome (n = 22) and alive-outcome groups (n = 172). Data were collected from pregnancy cards, hospital records and face-to-face interviews. After the 28th day of birth, a phone call was made to evaluate the newborn's health status. Crude odds ratios and corresponding 95% confidence intervals were obtained. A p value

Abstract Background Preterm birth is the leading cause of neonatal and under-five mortality worldwide. It is a complex syndrome characterized by numerous etiologic pathways shaped by both maternal and fetal factors. To better understand preterm birth trends, the Global Alliance to Prevent Prematurity and Stillbirth published the preterm birth phenotyping framework in 2012 followed by an application of the model to a global dataset in 2015 by Barros, et al. Our objective was to adapt the preterm birth phenotyping framework to retrospective data from a low-resource, rural setting and then apply the adapted framework to a cohort of women from Migori, Kenya. Methods This was a single centre, observational, retrospective chart review of eligible births from November 2015 – March 2017 at Migori County Referral Hospital. Adaptations were made to accommodate limited diagnostic capabilities and data accuracy concerns. Prevalence of the phenotyping conditions were calculated as well as odds of adverse outcomes. Results Three hundred eighty-seven eligible births were included in our study. The largest phenotype group was none (no phenotype could be identified; 41.1%), followed by extrauterine infection (25.1%), and antepartum stillbirth (16.7%). Extrauterine infections included HIV (75.3%), urinary tract infections (24.7%), malaria (4.1%), syphilis (3.1%), and general infection (3.1%). Severe maternal condition was ranked fourth (15.6%) and included anaemia (69.5%), chronic respiratory distress (22.0%), chronic hypertension prior to pregnancy (5.1%), diabetes (3.4%), epilepsy (3.4%), and sickle cell disease (1.7%). Fetal anaemia cases were the most likely to transfer to the newborn unit (OR 5.1, 95% CI 0.8, 30.9) and fetal anomaly cases were the most likely to result in a pre-discharge mortality (OR 3.9, 95% CI 0.8, 19.2). Conclusions Using routine data sources allowed for a retrospective analysis of an existing dataset, requiring less time and fewer resources than a prospective study and demonstrating a feasible approach to preterm phenotyping for use in low-resource settings to inform local prevention strategies.

Studies that address risks of perinatal mortality among the offspring of people exposed to ionizing radiation in the workplace are significant for developing hygienic standards at production facilities with radiation hazards. The purpose was to analyze perinatal mortality (stillbirths and early neonatal deaths) among the offspring of workers employed by Mayak Production Association (Mayak PA), the first atomic production facility in Russia. A retrospective analysis was performed among 25,007 children born in 1949–1973; parents of 14,580 of these children were exposed to long-term occupational radiation at Mayak PA. The study provides frequency and dynamics of perinatal mortality and comparative analysis of perinatal mortality by sex, year of birth, parental age at childbirth, and dose categories of radiation exposure. Research data were analyzed by methods of non-parametric statistics. We calculated a relative risk (RR) of perinatal mortality among the offspring of exposed and unexposed parents with 95 % CI. The rate of perinatal mortality was generally the same in both groups, 19.9 for 103 in the test group and 17.9 for 103 in the control, p > 0.05. Stillbirths among male offspring were statistically significantly more often observed in the test group due to contribution of the children with only mothers exposed to occupational radiation exposure at Mayak PA prior to conception and offspring exposed in utero. Intrauterine fetal death was observed statistically significantly more often among boys of the test group compared to controls: 2.9 against 0.9 for 103. Rates of stillbirths and perinatal mortality in the main group statistically significantly exceeded the values in the comparison group in 1949–1953: RR = 2.69 (CI: 1.46–4.95) and 2.12 (1.38–3.28) respectively. Significant statistical differences in the perinatal mortality risk were established in certain categories of preconception and intrauterine gamma-exposure. The identified peculiarities of unfavorable outcomes in the perinatal period that were detected among the offspring of Mayak PA workers could be eligible for further epidemiological monitoring. Polyetiology character of perinatal mortality requires further follow up of the cohort of the offspring born to atomic production workers.

Introduction: In developing countries, the incidence of Pregnancy-Related Acute Kidney Injury (PRAKI) has significantly decreased over the past three decades. However, it remains a major contributor to maternal and foetal morbidity and mortality. Aim: This retrospective longitudinal study aims to determine the aetiology, outcomes, and factors associated with maternalfoetal outcomes of PRAKI. Materials and Methods: The study was conducted at a tertiary care Medical College Hospital in Dharwad district, Karnataka, India. It included patients with AKI during pregnancy and the peripartum period, admitted between January 2014 and December 2021. A total of 156 subjects at risk of PRAKI were identified. Data was collected from the Medical Records Department (MRD), and three months of patient follow-up data were also collected. PRAKI diagnosis and staging were done using the Acute Kidney Injury Network (AKIN) criteria. Primary outcomes included the need for dialysis, renal recovery, renal biopsy findings, and development of CKD. Secondary outcomes were maternal and foetal mortality and birth weight. Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 21.0. Results: The mean age of the participants was 26.34±4.67 years. The most common cause of PRAKI was Pregnancy Induced Hypertension (PIH) (75 cases, 48.1%), followed by sepsis (67 cases, 42.90%), and Haemolysis, Elevated Liver enzymes, Low Platelet count (HELLP) syndrome (32 cases, 20.50%). Out of the 156 PRAKI patients, one-fourth (42 cases, 26.92%) required haemodialysis, 126 (93%) achieved complete renal recovery, 12 (7.6%) required renal biopsy, 9 (6.6%) developed chronic kidney disease, and 3 (2.2%) developed end-stage renal disease (ESRD). Maternal mortality was observed in 21 patients (13.46%), and foetal mortality occurred in 47 patients (31%) out of 156 perinatal outcomes. Conclusion: PRAKI was associated with poor maternal and neonatal outcomes. PIH, followed by sepsis, remained the leading cause of PRAKI. Immediate referral of patients to a higher centre and comprehensive antenatal care in peripheral areas can reduce the overall health and economic burden.

Abstract Objective To examine the incidence of adverse perinatal outcomes and the risk of adverse perinatal outcomes for Indian-born mothers compared to other mothers living and giving birth in Australia. Design, setting and participants This retrospective cohort study was designed to investigate all births in Australia in 2012 and those in the Monash Health Birthing Outcomes System (BOS) 2014 to Indian-born mothers in Australia. Data sets were analysed involving descriptive statistics using Statistical Package for Social Sciences (SPSS vs. 23). Results Indian-born mothers in Australia are at increased risk of induced labour, emergency caesarean section, very preterm birth (20–27 weeks), babies with low to very low birth weight, and low Apgar score (0–2) at 5 min, gestational diabetes, hypothyroidism, iron deficiency anaemia and vitamin B12 deficiencies compared to other mothers giving birth in Australia. This is despite a range of protective factors (25–34 years, married, nonsmokers, and a BMI

While cesarean deliveries performed for health indications can save lives, unnecessary cesareans cause unjustifiable health risks for the mother, newborn, and for future pregnancies. Previous recommendations for cesarean delivery rates at a country level in the 10–15% range are currently unrealistic, and the proposed concept that striving to achieve specific rates is not important has resulted in a confusing message reaching healthcare professionals and the public. It is important to have a clear understanding of when cesarean delivery rates are deviating from internationally acceptable ranges, to trigger the implementation of healthcare policies needed to correct this problem. Based on currently existing scientific evidence, we recommend that cesarean delivery rates at a country level should be in the 15–20% range. This advice is based on the demonstration of decreased maternal and neonatal mortalities when national cesarean delivery rates rise to circa 15%, but values exceeding 20% are not associated with further benefits. It is also based on real-world experiences from northern European countries, where cesarean delivery rates in the 15–20% range are associated with some of the best maternal and perinatal quality indicators in the world. With the increase in cesarean delivery rates projected for the coming years, experience in provision of intrapartum care may come under threat in many hospitals, and recovering from this situation is likely to be a major challenge. Professional and scientific societies, together with healthcare authorities and governments need to prioritize actions to reverse the upward trend in cesarean delivery rates observed in many countries, and to strive to achieve values as close as possible to the recommended range. [ABSTRACT FROM AUTHOR]

Abstract Background International and national New Zealand (NZ) research has identified women of South Asian ethnicity at increased risk of perinatal mortality, in particular stillbirth, with calls for increased perinatal research among this ethnic group. We aimed to analyse differences in pregnancy outcomes and associated risk factors between South Asian, Māori, Pacific and NZ European women in Aotearoa NZ, with a focus on women of South Asian ethnicity, to ultimately understand the distinctive pathways leading to adverse events. Methods Clinical data from perinatal deaths between 2008 and 2017 were provided by the NZ Perinatal and Maternal Mortality Review Committee, while national maternity and neonatal data, and singleton birth records from the same decade, were linked using the Statistics NZ Integrated Data Infrastructure for all births. Pregnancy outcomes and risk factors for stillbirth and neonatal death were compared between ethnicities with adjustment for pre-specified risk factors. Results Women of South Asian ethnicity were at increased risk of stillbirth (aOR 1.51, 95%CI 1.29–1.77), and neonatal death (aOR 1.51, 95%CI 1.17–1.92), compared with NZ European. The highest perinatal related mortality rates among South Asian women were between 20–23 weeks gestation (between 0.8 and 1.3/1,000 ongoing pregnancies; p

Introduction: Perinatal mortality and morbidities constitute a burden on society and healthcare system. One of the major identifiable causes of these conditions in India is Low Birth Weight (LBW) and preterm births. Small for Gestational Age (SGA) infants account for almost 46.9% of LBW infants. They are prone to the morbidities of preterm birth and are the second major contributor to perinatal mortality. Recent studies have reported that higher screening performance for SGA can be achieved through ultrasonographic foetal biometry and Doppler studies during the third trimester. Aim: To stratify foetuses with Estimated Foetal Weight (EFW) below the 40th centile, as determined by obstetric ultrasound, into three categories (low, intermediate, and high-risk), and study the perinatal outcomes in each category. Materials and Methods: The present prospective cohort study was conducted in the Department of Obstetrics and Gynaecology at Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India from November 2020 to April 2022. A total of 280 antenatal women, at a gestational period between 35 to 36+6 weeks with singleton pregnancies, were studied and based on the foetal biometry and Doppler parameters, women were classified into low (Group A), intermediate (Group B) and high risk (Group C) categories. Risk categorisation was based on EFW and Doppler indices. The low-risk group underwent an ultrasound Doppler scan after four weeks, the intermediate-risk group after two weeks, and the high-risk group was scanned weekly. The high-risk group was delivered at 39 weeks of gestation. Perinatal outcomes, neonatal weights, adverse neonatal outcomes {such as Neonatal Intensive Care Unit (NICU) admissions exceeding 48 hours}, stillbirths, and neonatal deaths were recorded. The Area under Curve (AUC) cut-off for EFW percentiles on ultrasonography was calculated as a predictor for SGA foetuses requiring NICU admissions. Concurrent admissions in the NICU of neonates delivered to unregistered pregnant mothers, who were not screened during the antenatal period, were also recorded. The Chi-square test was used to compare categorical data between groups. The receiver operating characteristic curve was used to determine the cut-off for foetal weight to predict NICU admission. A p-value of

IntroductionPericonceptional use of multivitamins containing folic acid prevents external major birth defects, especially neural tube defects. We aimed to explore the effects of maternal folic acid supplementation alone on perinatal mortality with or without external major birth defects plus neural tube defects.MethodsFrom the China-US Collaborative Project for Neural Tube Defects Prevention, we identified 222, 303 singleton pregnancies with detailed information on periconceptional folic acid use, defined as folic acid supplementary before the last menstrual date until to the end of the first trimester. Perinatal mortality included stillbirths after 20 weeks’ gestation and early neonatal deaths within 7 days of delivery.ResultsAmong the fetuses or infants of women who did not take folic acid, the rate of perinatal mortality was 2.99% and 1.62% at least 20 weeks’ gestation in the northern and southern regions. Among the fetuses or infants of the women with periconceptional use of folic acid, the rates were 1.85% and 1.39% in the northern and southern region. The estimated relative risk for perinatal mortality [adjusted risk ratio (RR), 0.72; 95% confidence interval (CI), 0.61- 0.85], stillbirth (adjusted RR, 0.78; 95% CI, 0.64-0.96), early neonatal mortality (adjusted RR, 0.61; 95% CI, 0.45-0.82), and neonatal death (adjusted RR, 0.64; 95% CI, 0.49-0.83) in northern China was significantly decreased in association with periconceptional folic acid supplementation. Compared with northern, there was a lesser effect in southern China.ConclusionPericonceptional intake of 400μg folic acid daily reduces the overall risk perinatal mortality, as well as the risk from external major birth defects and neural tube defects, especially in northern China.

Background: Preterm birth is the leading cause of neonatal and under-five mortality worldwide. It is a complex syndrome characterized by numerous etiologic pathways shaped by both maternal and fetal factors. To better understand preterm birth trends, the Global Alliance to Prevent Prematurity and Stillbirth published the preterm birth phenotyping framework in 2012 followed by an application of the model to a global dataset in 2015 by Barros, et al. Our objective was to adapt the preterm birth phenotyping framework to retrospective data from a low-resource, rural setting and then apply the adapted framework to a cohort of women from Migori, Kenya. Methods: This was a single centre, observational, retrospective chart review of eligible births from November 2015 – March 2017 at Migori County Referral Hospital. Adaptations were made to accommodate limited diagnostic capabilities and data accuracy concerns. Prevalence of the phenotyping conditions were calculated as well as odds of adverse outcomes. Results: Three hundred eighty-seven eligible births were included in our study. The largest phenotype group was none (no phenotype could be identified; 41.1%), followed by extrauterine infection (25.1%), and antepartum stillbirth (16.7%). Extrauterine infections included HIV (75.3%), urinary tract infections (24.7%), malaria (4.1%), syphilis (3.1%), and general infection (3.1%). Severe maternal condition was ranked fourth (15.6%) and included anaemia (69.5%), chronic respiratory distress (22.0%), chronic hypertension prior to pregnancy (5.1%), diabetes (3.4%), epilepsy (3.4%), and sickle cell disease (1.7%). Fetal anaemia cases were the most likely to transfer to the newborn unit (OR 5.1, 95% CI 0.8, 30.9) and fetal anomaly cases were the most likely to result in a pre-discharge mortality (OR 3.9, 95% CI 0.8, 19.2). Conclusions: Using routine data sources allowed for a retrospective analysis of an existing dataset, requiring less time and fewer resources than a prospective study and demonstrating a feasible approach to preterm phenotyping for use in low-resource settings to inform local prevention strategies. Plain English summary: Preterm birth is a complex syndrome, yet it is the leading cause of death in children worldwide. To help unravel the clinical complexities, preterm birth phenotyping is a framework that considers multiple diagnoses in the mother, helping to evaluate trends in causes of preterm birth in a given region. In our study, we adapted this international phenotyping framework to accommodate a rural, low-resource setting where obstetrical and neonatal technologies were limited, but preterm birth rates were high. We evaluated data from the patient records of a large hospital in Migori, Kenya, in the southwestern region of the country. By lowering the threshold of diagnostic criteria, we were able to apply this framework to our dataset and see that maternal infection and maternal chronic illness appear to be a significant driving forces of preterm birth. Given high rates of HIV and malaria in the region, this is not a surprising finding, but one that can inform antenatal care practices, mainly the need to test and treat for common infections (HIV, malaria, as well as urinary and reproductive tract infections), and to increase the frequency of antenatal care interactions per the World Health Organization recommendations. [ABSTRACT FROM AUTHOR]

Background and objectives: UTI is one of the most common bacterial infections in pregnant women. E. coli is the most frequent urinary pathogen isolated from 40-60% of all uncomplicated UTI. Untreated UTI in pregnancy leads to low-birthweight, premature delivery, pre-eclampsia, postpartum endometritis, pyelonephritis etc. Historically, the measurement of virulence has led to measurable outcomes like morbidity and mortality of the host. Therefore, screening for UTI and determining their virulence in pregnancy is important to prevent these complications. The objectives are to isolate E. coli species from the pregnant women suffering from urinary tract infection, to determine the urovirulence factors and to study the antimicrobial susceptibility pattern of the E. coli isolates. Material and methods: Inclusion criteria: Pregnant women suspected of UTI. Exclusion criteria: Cases who are on antibiotic therapy. Virulence tests like Mannose Resistant Haemagglutination test (MRHA), Cell Surface Hydrophobicity (CSH), ⍺ Haemolysin Production, Serum Resistance (SR) test and Gelatinase test (GT) were done on E. coli isolates. AST was performed by Kirby-Bauer’s disk diffusion method. Results: Out of 683 urine samples tested, 405 samples exhibited significant growth. Among 405 isolates, all the 285 E. coli isolates exhibited virulence markers, and 50% of E. coli isolates exhibited more than one virulence marker. Serum resistance is the commonest and Gelatinase production is the least common virulence marker. The overall sensitivity of E. coli is 89.8% to Cefotaxime, 83.8% to Nitrofurantoin, 56.1% to Amoxiclav, 52.2% to Netilmicin, 42.4% to Cotrimoxazole, and 41% to Gentamicin. Conclusion: Virulence markers such as serum resistance, ⍺ - haemolysin production and MRHA contributed to highest virulence. This study reflects the importance of identifying virulence markers, to prevent mortality and morbidity in pregnant women. The highest prevalence of resistance in UTI, calls for stringent policies for rational drug use and infection control measures in hospital practices. [ABSTRACT FROM AUTHOR]

Background: Hypertension complicates 5–10% of pregnancies and is a common cause of perinatal death. The perinatal mortality is estimated to be 3 to 5 times higher in hypertensive women compared to those without hypertension. Methods: A hypertensive mother either with a stillbirth or if baby died within 7 days of life was included as a case. Once a case was recognized, the next two consecutive hypertensive mothers who delivered a live baby, who survived up to 7 days of life, were taken as controls. Fetuses with congenital malformations incompatible with life and multiple pregnancies were excluded from the study. One hundred and twelve women in cases and 224 women in controls were studied. Results: Among 112 cases of perinatal death, 70% had died in utero before labor. Among the 33 fetuses alive, 50% were born still after labor and 50% died within 7 days of birth. We found that early onset hypertension (< 34 weeks) (p-< 0.001 (Chi2-23.819)), gestational age at termination of 28–32 weeks (OR 2.76), value of serum creatinine > 1.1 mg/dl (OR 10.1), abruption (OR 6.2) and birth weight < 1.5 kg was significantly associated with perinatal mortality (p-0.007, OR 5.7). Abnormal Doppler findings was a predictor of perinatal deaths. Conclusion: Severely growth retarded fetuses in association with early onset severe preeclampsia are likely to die in utero and need vigilant monitoring antenatally. Abnormal umbilical artery Dopplers predict perinatal mortality. Caesarean section at the gestational age of ≥ 32 weeks and an estimated fetal weight of ≥ 1.2 kg in our hospital resulted in favorable outcome. [ABSTRACT FROM AUTHOR]

Background: (1) The aim of this article is to describe the physiopathology underlying umbilical cord diseases and their relationship with obstetric and perinatal outcomes. (2) Methods: Multicenter case series of umbilical cord diseases with illustrations from contributing institutions are presented. (3) Results: Clinical presentations of prenatal ultrasound findings, clinical prenatal features and postnatal outcomes are described. (4) Conclusions: Analysis of our series presents and discusses how umbilical cord diseases are associated with a wide variety of obstetric complications leading to a higher risk of poor perinatal outcomes in pregnancies. Knowing the physiopathology, prenatal clinical presentations and outcomes related to umbilical diseases allow for better prenatal counseling and management to potentially avoid severe obstetric and perinatal complications. [ABSTRACT FROM AUTHOR]

Objective: To examine the incidence of adverse perinatal outcomes and the risk of adverse perinatal outcomes for Indian-born mothers compared to other mothers living and giving birth in Australia. Design, setting and participants: This retrospective cohort study was designed to investigate all births in Australia in 2012 and those in the Monash Health Birthing Outcomes System (BOS) 2014 to Indian-born mothers in Australia. Data sets were analysed involving descriptive statistics using Statistical Package for Social Sciences (SPSS vs. 23). Results: Indian-born mothers in Australia are at increased risk of induced labour, emergency caesarean section, very preterm birth (20–27 weeks), babies with low to very low birth weight, and low Apgar score (0–2) at 5 min, gestational diabetes, hypothyroidism, iron deficiency anaemia and vitamin B12 deficiencies compared to other mothers giving birth in Australia. This is despite a range of protective factors (25–34 years, married, nonsmokers, and a BMI < 30) that would normally be expected to reduce the risk of adverse perinatal outcomes for mothers giving birth in a developed country. Conclusion: In the absence of many of the recognized maternal risk factors, Indian-born mothers continue to face increased risk of adverse perinatal outcomes, despite access to high quality maternity care in Australia. Recommendations arising from this study include the need for an intervention study to identify maternal risk factors for Indian-born mothers in mid to late pregnancy that contribute to the risk for very preterm birth and low birth weight. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to evaluate the association of a low cerebroplacental ratio (CPR) with hypoxic ischaemic encephalopathy (HIE), severe neonatal morbidity (SNM) and perinatal mortality (PNM). Methods: This was a retrospective cohort study of late‐preterm and term births at Mater Mothers' Hospital, Brisbane, between 2016 and 2020. Study outcomes were HIE, PNM and SNM (a composite of severe acidosis, Apgar score less than four at 5 min, severe respiratory distress or need for significant cardiopulmonary resuscitation at birth). Univariate and multivariable logistic regressions were used to determine if a low CPR was associated with HIE, SNM or PNM. Results: A total of 51 870 births met the inclusion criteria. Of these, 216 (0.42%) were complicated by HIE, 10 224 (19.7%) had SNM and 251 (0.48%) had PNM. Rates of low CPR (<10th and <5th centile) were significantly higher in the SNM cohort (20.1 and 13.2%, respectively) and PNM cohort (21.1 and 15.1%, respectively) compared to the overall cohort. A low CPR was associated with significantly increased adjusted odds for SNM but not for HIE or PNM. The area under the receiver operating characteristic curve for CPR <10th centile was greatest for SNM (0.768) and lowest for HIE (0.595). Predictive margins of a low CPR for HIE, SNM and PNM were significant only for SNM at late‐preterm gestations. Conclusions: A low CPR is associated with increased odds of SNM in infants born >34 weeks' gestation but not for HIE or PNM. [ABSTRACT FROM AUTHOR]

Background: While a male infant is usually born with a higher birthweight than his female counterpart, he is more at risk of variety of adverse perinatal outcomes. Indeed, throughout life, females exhibit a marked survival advantage compared to males. The aetiology for such pertinent sex disparity remains unclear and is likely multifactorial. Aims: The aim of this study was to investigate obstetric and perinatal outcomes by infant sex from 28 weeks in a contemporary, large Australian birth cohort. Materials and Methods: A 14‐year retrospective cohort study of 130 133 births over 28 weeks gestation from a single tertiary centre. Results: Male infants had overall higher rates of neonatal mortality (0.12% vs 0.06%, P < 0.001) and severe neonatal morbidity (12% vs 9.1%, P < 0.001) (adjusted odds ratio (aOR) 1.41, 95% CI 1.35–1.47). The odds of overall perinatal mortality (stillbirth and neonatal death) were higher for male infants (aOR 1.30, 95% CI 1.08–1.56). The difference in severe neonatal morbidity when stratified by gestational age at birth only remained significant from >35 weeks gestation. Regardless of infant sex, rates of neonatal mortality and morbidity were lowest at 39 weeks gestation. Rates of preterm birth and operative birth were also higher for male infants. Conclusions: Our study demonstrates significant disparities in clinical outcomes by infant sex with males at a disadvantage to female infants. [ABSTRACT FROM AUTHOR]

Introduction: In developing countries, the incidence of Pregnancy-Related Acute Kidney Injury (PRAKI) has significantly decreased over the past three decades. However, it remains a major contributor to maternal and foetal morbidity and mortality. Aim: This retrospective longitudinal study aims to determine the aetiology, outcomes, and factors associated with maternalfoetal outcomes of PRAKI. Materials and Methods: The study was conducted at a tertiary care Medical College Hospital in Dharwad district, Karnataka, India. It included patients with AKI during pregnancy and the peripartum period, admitted between January 2014 and December 2021. A total of 156 subjects at risk of PRAKI were identified. Data was collected from the Medical Records Department (MRD), and three months of patient follow-up data were also collected. PRAKI diagnosis and staging were done using the Acute Kidney Injury Network (AKIN) criteria. Primary outcomes included the need for dialysis, renal recovery, renal biopsy findings, and development of CKD. Secondary outcomes were maternal and foetal mortality and birth weight. Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 21.0. Results: The mean age of the participants was 26.34±4.67 years. The most common cause of PRAKI was Pregnancy Induced Hypertension (PIH) (75 cases, 48.1%), followed by sepsis (67 cases, 42.90%), and Haemolysis, Elevated Liver enzymes, Low Platelet count (HELLP) syndrome (32 cases, 20.50%). Out of the 156 PRAKI patients, one-fourth (42 cases, 26.92%) required haemodialysis, 126 (93%) achieved complete renal recovery, 12 (7.6%) required renal biopsy, 9 (6.6%) developed chronic kidney disease, and 3 (2.2%) developed end-stage renal disease (ESRD). Maternal mortality was observed in 21 patients (13.46%), and foetal mortality occurred in 47 patients (31%) out of 156 perinatal outcomes. Conclusion: PRAKI was associated with poor maternal and neonatal outcomes. PIH, followed by sepsis, remained the leading cause of PRAKI. Immediate referral of patients to a higher centre and comprehensive antenatal care in peripheral areas can reduce the overall health and economic burden. [ABSTRACT FROM AUTHOR]

Stillbirth describes the delivery of a baby with no signs of life in relation to thresholds of either gestational age or birthweight. In the UK, a stillbirth is legally defined as the delivery of a baby at or after 24 weeks' gestation or 500 g where gestation is unknown. A history of previous stillbirth remains one of the strongest risk factors for subsequent stillbirth and other adverse outcomes in a subsequent pregnancy. According to World Health Organization (WHO), there are nearly 2 million stillbirths globally every year. There is a drive to reduce the rate of stillbirths by 50% in England by 2025 and a global target of 12 or fewer stillbirths per 1000 total births in every country by 2030. The significant psychological burden placed on parents following a stillbirth and the associated increased risk of complications in subsequent pregnancies need appropriate management. This article covers the investigation and management of stillbirth reflecting current UK practice. [ABSTRACT FROM AUTHOR]

BackgroundSome scholars posit that attempts to avert stillbirth among extremely preterm gestations may result in a live birth but an early neonatal death. The literature, however, reports no empirical test of this potential form of left truncation. We examine whether annual cohorts delivered at extremely preterm gestational ages show an inverse correlation between their incidence of stillbirth and early neonatal death.MethodsWe retrieved live birth and infant death information from the California Linked Birth and Infant Death Cohort Files for years 1989 to 2015. We defined the extremely preterm period as delivery from 22 to

Background. Despite the decrease in fetoinfantile losses, the levels of perinatal mortality and stillbirth remain quite high. One of the medical criteria for viability is the anthropometric indicators of the child, therefore, their relevant medical and statistical assessment may allow us to establish potential opportunities for reducing the loss of viable children at perinatal period.Objective. The aim of the study is to assess anthropometric data of children died at perinatal period.Methods. We have analyzed 277 cases of children deaths at ante- and intranatal periods and 197 cases of newborns deaths during first 7 days of life. Assessment of anthropometric data of children died at perinatal period was presented via the method of sigmal deviations and the centile method.Results. Anthropometric data of premature infants died at perinatal period in 90–94% of cases corresponded to the physical development for children of this gestational age. Anthropometric data of full-term children died during the first 168 hours of life, in 70.0% of cases, corresponded to 3–6 corridors of physical development (P10–P90), in 20.0% of cases — 7–8 corridors. 58.3% of full-term children died at perinatal period have harmonious development which significantly exceeds the proportion of children with sharply disharmonious development (19.5%) and with disharmonious development (22.2%). 79.0% of all neonatal deaths occur in the first 72 hours of life (for the early neonatal period), while losses on the first day account for 54.0% of all deaths in children during the first week.Conclusion. This study has shown that the anthropometric data of children died at perinatal period significantly corresponded to the standard indicators established for children of this gestation age.

Abstract Background Perinatal mortality (newborn deaths in the first week of life and stillbirths) continues to be a significant global health threat, particularly in resource-constrained settings. Low-tech, innovative solutions that close the quality-of-care gap may contribute to progress toward the Sustainable Development Goals for health by 2030. From 2012 to 2018, the Saving Mothers, Giving Life Initiative (SMGL) implemented the Birth weight and Age-at-Death Boxes for Intervention and Evaluation System (BABIES) matrix in Western Uganda. The BABIES matrix provides a simple, standardized way to track perinatal health outcomes to inform evidence-based quality improvement strategies. Methods In November 2017, a facility-based qualitative evaluation was conducted using in-depth interviews with 29 health workers in 16 health facilities implementing BABIES in Uganda. Data were analyzed using directed content analysis across five domains: 1) perceived ease of use, 2) how the matrix was used, 3) changes in behavior or standard operating procedures after introduction, 4) perceived value of the matrix, and 5) program sustainability. Results Values in the matrix were easy to calculate, but training was required to ensure correct data placement and interpretation. Displaying the matrix on a highly visible board in the maternity ward fostered a sense of accountability for health outcomes. BABIES matrix reports were compiled, reviewed, and responded to monthly by interprofessional teams, prompting collaboration across units to fill data gaps and support perinatal death reviews. Respondents reported improved staff communication and performance appraisal, community engagement, and ability to track and link clinical outcomes with actions. Midwives felt empowered to participate in the problem-solving process. Respondents were motivated to continue using BABIES, although sustainability concerns were raised due to funding and staff shortages. Conclusions District-level health systems can use data compiled from the BABIES matrix to inform policy and guide implementation of community-centered health practices to improve perinatal heath. Future work may consider using the Conceptual Framework on Use of the BABIES Matrix for Perinatal Health as a model to operationalize concepts and test the impact of the tool over time.

ObjectiveResearch suggests that sociopolitical stressors connected with the 2016 presidential election were associated with increases in preterm birth among Latina women. This study determined whether periviable births (

Background In a recent multicenter study of perinatal outcome in fetuses with Ebstein anomaly or tricuspid valve dysplasia, we found that one third of live-born patients died before hospital discharge. We sought to further describe postnatal management strategies and to define risk factors for neonatal mortality and circulatory outcome at discharge. Methods and Results This 23-center, retrospective study from 2005 to 2011 included 243 fetuses with Ebstein anomaly or tricuspid valve dysplasia. Among live-born patients, clinical and echocardiographic factors were evaluated for association with neonatal mortality and palliated versus biventricular circulation at discharge. Of 176 live-born patients, 7 received comfort care, 11 died

BACKGROUND: Birth weight has a significant impact on perinatal mortality. Therefore, the estimation of fetal weight greatly influences the policies necessary for care during and after delivery. We aimed to investigate Johnson’s rule in estimating fetal weight. MATERIALS AND METHOD: This study was a single-group longitudinal study that was conducted in 6 months from October 2021 to April 2022 on 150 pregnant women in Isfahan-Iran. The sampling method was accessible. Inclusion criteria include being term, singleton, without abnormality, intact membranes, cephalic presentation, and exclusion criteria include diagnosed polyhydramnios or oligohydramnios and mother’s abdominal or pelvic known masses. After completing the informed consent, fetal weight was estimated by Johnson’s rule and was compared with the birth weight. Descriptive and analytical statistics (mean-standard deviation (SD), number-percentage, t-paired, and Spearman’s correlation coefficient) were used to achieve the objectives of the study. The receiver operating characteristic (ROC) curve was also used to determine the sensitivity, specificity, and positive and negative predictive value of Johnson’s law. RESULT: The mean (SD) birth weight was 3032.88 ± 481.11 g and the mean (SD) estimated fetal weight (EFW) by the clinical method was 3152.15 ± 391.95 g. There was a significant difference between the averages (P < 0.001). The percentage error of EFW showed a significant negative correlation (r = -0.286; P < 0.05) with gestational age (GA) and a significant positive correlation (r = 0.263; P < 0.05) with the fetal head station. The sensitivity and specificity of EFW with Johnson’s rule, in normal fetal birth weight, were higher than in low birth weight fetal. The accuracy of EFW with ± 10% of the actual weight was higher in average for gestational age (AGA) (84.3%) and high-for-gestational-age (LGA) (70%) than in low-for-gestational-age (SGA) (4%). The EFW mean percentage error in SGA was higher than in the other two weight groups. This method, especially for AGA and LGA fetuses, can be a suitable alternative to other weight estimation methods. CONCLUSION: Clinical estimation of weight via Johnson’s rule due to availability and no cost can be a suitable method for managing childbirth based on fetal weight.

Background. Maternal death is a tragic event. Of maternal deaths worldwide, 99% occur in low- and middle-income countries. Perinatal outcome is related to maternal wellbeing. Maternal death has a negative impact on fetal and neonatal outcome in the short and long term. Objectives. To determine the perinatal outcomes of pregnancies that ended in a maternal death at Chris Hani Baragwanath Academic Hospital (CHBAH), Johannesburg, South Africa, over a 5-year period, to describe the causes of maternal death, and to determine the stillbirth rate (SBR) and early neonatal death (ENND) rate in this population. Methods. This was a retrospective cross-sectional study of maternal deaths in women with a viable pregnancy from January 2014 to June 2019 at CHBAH. All maternal deaths with gestation >26 weeks or fetal weight >500 g were included in the study. Information on demographics, booking status, antenatal care, pregnancy outcome, and fetal and neonatal outcome was extracted from maternal and neonatal files. Results. Of a total of 183 maternal deaths during the study period, 147 were included in the study. The institutional maternal mortality ratio was 135 deaths per 100 000 live births. Hypertension was the main direct cause of death (36.5%; n=27/74), followed by pregnancy related sepsis (27.4%; n=21/74) and obstetric haemorrhage (20.6%; n=15/74). Non-pregnancy-related infections, of which 91.4% were HIV and HIV-related complications, comprised 47.9% (n=35/73) of indirect causes of death, followed by medical and surgical disorders. Of a total of 151 babies, including two sets of twins and one set of triplets, 137 were delivered and 14 were undelivered at the time of maternal death. Ninety-one babies (61.9%) were born alive and 51 (34.6%) were stillbirths. Of the 91 liveborn infants, 6 (6.5%) had an ENND. Of the 51 stillbirths, 14 (27.5%) were undelivered and 11 (21.6%) were delivered by perimortem caesarean section. The SBR was 347 per 1 000 maternal deaths and the ENND rate 66 per 1 000 live births. The perinatal mortality rate (PMR) was 388 per 1 000 maternal deaths, which is 12 times higher than the PMR per 1 000 live births for the general population. Conclusion. Women who experience maternal death have babies with very poor perinatal outcomes, with a very high SBR, ENND rate and PMR. The health of the mother has a direct and significant effect on fetal and neonatal outcomes.

Introduction: Perinatal mortality encompasses stillbirths and early neonatal deaths. A perinatal death surveillance and response cycle has been recommended by the World Health Organization for use in the review of perinatal deaths. The main components of the cycle include identifying and reporting perinatal deaths, and reviewing the deaths, including potentially modifiable factors, in order to measure and improve quality of care provided to women and infants. There is no consensus on the best way to design, implement and conduct perinatal death reviews. This systematic review aims to identify standardised tools that are used to review perinatal deaths. Objectives: The primary aim of this protocol is to describe methodology for a systematic search of the literature to identify standardised tools that are used to review perinatal deaths in upper-middle to high-income countries. Review tools may include standardised checklists, forms, frameworks or other structured documents used to review perinatal deaths. Review tools will be appraised to see if they incorporate the identification of modifiable factors in perinatal deaths and establish recommendations for improvements to quality of care provided. Methods: A systematic review of the literature will be performed to identify peer-reviewed publications and grey literature describing the use of perinatal mortality review tools without date restrictions. The eligibility of review tools for inclusion will be based on inclusion and exclusion criteria applied to the SPIDER framework. Data will be extracted based on the structure and content of included review tools, and the tools will be appraised using the Appraisal of Guidelines Research and Evaluation Health Systems (AGREE-HS) instrument. Conclusion: This systematic review protocol for identifying and appraising standardised perinatal mortality review tools may help to establish the optimal way to structure a standardised review process for perinatal mortality in middle- to high-income countries. PROSPERO registration: CRD42022326877

Background: International and national New Zealand (NZ) research has identified women of South Asian ethnicity at increased risk of perinatal mortality, in particular stillbirth, with calls for increased perinatal research among this ethnic group. We aimed to analyse differences in pregnancy outcomes and associated risk factors between South Asian, Māori, Pacific and NZ European women in Aotearoa NZ, with a focus on women of South Asian ethnicity, to ultimately understand the distinctive pathways leading to adverse events. Methods: Clinical data from perinatal deaths between 2008 and 2017 were provided by the NZ Perinatal and Maternal Mortality Review Committee, while national maternity and neonatal data, and singleton birth records from the same decade, were linked using the Statistics NZ Integrated Data Infrastructure for all births. Pregnancy outcomes and risk factors for stillbirth and neonatal death were compared between ethnicities with adjustment for pre-specified risk factors. Results: Women of South Asian ethnicity were at increased risk of stillbirth (aOR 1.51, 95%CI 1.29–1.77), and neonatal death (aOR 1.51, 95%CI 1.17–1.92), compared with NZ European. The highest perinatal related mortality rates among South Asian women were between 20–23 weeks gestation (between 0.8 and 1.3/1,000 ongoing pregnancies; p < 0.01 compared with NZ European) and at term, although differences by ethnicity at term were not apparent until ≥ 41 weeks (p < 0.01). No major differences in commonly described risk factors for stillbirth and neonatal death were observed between ethnicities. Among perinatal deaths, South Asian women were overrepresented in a range of metabolic-related disorders, such as gestational diabetes, pre-existing thyroid disease, or maternal red blood cell disorders (all p < 0.05 compared with NZ European). Conclusions: Consistent with previous reports, women of South Asian ethnicity in Aotearoa NZ were at increased risk of stillbirth and neonatal death compared with NZ European women, although only at extremely preterm (< 24 weeks) and post-term (≥ 41 weeks) gestations. While there were no major differences in established risk factors for stillbirth and neonatal death by ethnicity, metabolic-related factors were more common among South Asian women, which may contribute to adverse pregnancy outcomes in this ethnic group. [ABSTRACT FROM AUTHOR]

Introduction: In 1989, the St Vincent declaration aimed to approximate pregnancy outcomes of diabetes to that of healthy pregnancies. We aimed to compare frequency and trends of outcomes of pregnancies affected by type 1 diabetes and controls in 1996-2018. Methods: We used anonymized records of a mandatory nation-wide registry of all deliveries between gestational weeks 24 and 42 in Hungary. We included all singleton births (4,091 type 1 diabetes, 1,879,183 controls) between 1996 and 2018. We compared frequency and trends of pregnancy outcomes between type 1 diabetes and control pregnancies using hierarchical Poisson regression. Results: The frequency of stillbirth, perinatal mortality, large for gestational age, caesarean section, admission to neonatal intensive care unit (NICU), and low Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score was 2-4 times higher in type 1 diabetes compared to controls, while the risk of congenital malformations was increased by 51% and SGA was decreased by 42% (all p<0.05). These observations remained significant after adjustment for confounders except for low APGAR scores. We found decreasing rate ratios comparing cases and controls over time for caesarean sections, low APGAR scores (p<0.05), and for NICU admissions (p=0.052) in adjusted models. The difference between cases and controls became non-significant after 2009. No linear trends were observed for the other outcomes. Conclusions: Although we found that the rates of SGA, NICU care, and low APGAR score improved in pregnancies complicated by type 1 diabetes, the target of the St Vincent Declaration was only achieved for the occurrence of low APGAR scores. [ABSTRACT FROM AUTHOR]

Objective: to identify health inequalities associated with perinatal mortality during the Ten-Year Public Health Plan 2012-2021 in the 42 municipalities of the Department of Cauca, Colombia. Methods: ecological study that addressed the period 2012 - 2021 based on data from secondary sources from the National Administrative Department of Statistics. The study population was women between 12 and 49 years of age residing in Cauca. Rank inequalities and regression models were calculated according to the Slope Inequality Index, the Relative Inequality Index and the Concentration Index. Results: 42 municipalities reported 3 110 perinatal deaths. The mean age of the affected women was 25,3 years with a predominance of the 20-24 years age group. The Pacific region reported the highest mortality rate. Ethnicity, illiteracy and the Multidimensional Poverty Index were statistically associated with mortality. There was greater inequality in perinatal mortality in municipalities with worse socioeconomic status. Conclusions: despite the operationalization of the Ten-Year Public Health Plan, perinatal mortality in Cauca continues to be a challenge in the health/disease process. There is disparity in perinatal mortality in relation to socioeconomic level, and although a decrease in inequality has been observed over the years, significant gaps still persist. The findings underscore the need to monitor and account for health inequalities in the design, implementation and evaluation of public policies to prevent perinatal mortality. [ABSTRACT FROM AUTHOR]

Objective 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. Study Design Retrospective cohort study using linked ART surveillance and vital records data from Florida, Massachusetts, and Michigan. Results 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). At <28 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 at <28 weeks of gestation (aRR = 0.64, 95% CI: 0.45–0.89). Conclusion 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. Key Points 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. [ABSTRACT FROM AUTHOR]

Women of South Asian ethnicity are overrepresented in adverse pregnancy outcome across high-income countries, including those related to placental dysfunction. It has been hypothesised that placental aging occurs at earlier gestation in South Asian pregnancies. We aimed to identify differences in placental pathology among perinatal deaths ≥28 weeks gestation, between South Asian, Māori and New Zealand (NZ) European women in Aotearoa NZ, with a focus on women of South Asian ethnicity. Placental pathology reports and clinical data from perinatal deaths between 2008 and 2017 were provided by the NZ Perinatal and Maternal Mortality Review Committee, blinded, and analysed by an experienced perinatal pathologist using the Amsterdam Placental Workshop Group Consensus Statement criteria. 790 of 1161 placental pathology reports, 346 preterm (28+0 to 36+6 weeks) and 444 term (≥37+0 weeks) deaths, met the inclusion criteria. Among preterm deaths, South Asian women had higher rates of maternal vascular malperfusion compared with Māori (aOR 4.16, 95%CI 1.55–11.15) and NZ European (aOR 2.60, 95%CI 1.10–6.16). Among term deaths, South Asian women had higher rates of abnormal villous morphology compared with Māori (aOR 2.19, 95%CI 1.04–4.62) and NZ European (aOR 2.12, 95%CI 1.14–3.94), mostly due to increased rates of chorangiosis (36.7%, compared to 23.3% and 21.7%, respectively). Differences in placental pathology by ethnicity were observed among preterm and term perinatal deaths. While we suspect differing underlying causal pathways, these deaths may be associated with maternal diabetic and red blood cell disorders among South Asian women, leading to a hypoxic state in-utero. • Placental pathology by ethnicity differs among preterm and term perinatal deaths. • South Asian women with preterm deaths have more maternal vascular malperfusion. • Term South Asian deaths show more abnormal villous maturation and chorangiosis. • Diabetic and anaemic disorders may contribute to South Asian placental pathology. [ABSTRACT FROM AUTHOR]

Introduction: The aim was to determine risk factors among mothers and outcomes for their children born at the limit of viability in 2009–2019, before and after the introduction of extended interventionist guidelines. Methods: A retrospective cohort study of births at 22 + 0–23 + 6 gestational weeks in a Swedish Region in 2009–2015 (n = 119), as compared to 2016–2019 (n = 86) after the introduction of new national interventionist guidelines. Infant mortality, morbidity, and cognitive functions at 2 years corrected age according to the Bayley-III Screening Test were monitored. Results: Maternal risk factors for extreme preterm birth were identified. The intrauterine fetal death rates were comparable. Among births at 22 weeks, the neonatal mortality tended to decrease (96 vs. 76% of live births (p = 0.05)), and the 2-year survival tended to increase (4 vs. 24% (p = 0.05)). Among births at 23 weeks, the neonatal mortality decreased (56 vs. 27% of live births (p = 0.01)), and the 2-year survival increased (42 vs. 64% (p = 0.03)). Somatic morbidity and cognitive disability at 2 years corrected age were unchanged. Conclusion: We identified maternal risk factors that emphasize the need for standardized follow-up and counseling for women at increased risk of preterm birth at the limit of viability. The increased infant survival concomitant with unchanged morbidity and cognitive disability highlight the importance of ethical considerations regarding interventionist approaches at threatening preterm birth before 24 weeks. [ABSTRACT FROM AUTHOR]

To date, there are no comprehensive analyses of the official data on home births in Portugal that consider other determinants beyond place of birth, such as the conditions in which births occur or the mothers' social profiles. The aims of this article were: (1) to describe the characteristics of childbirth in Portugal according to the place of birth, and (2) to analyse the association between home birth assistance and perinatal, neonatal, and infant mortality rates. We performed a descriptive, correlational analysis of the official datasets of live births in Portugal (census-based) produced by the National Institute of Statistics. In 2020, home births had more similarities with hospital births than to births occurring in any "other place". Furthermore, considering the 1995–2020 timeframe, home births with specialised assistance were negatively correlated with perinatal, neonatal, and infant mortality, and home births with non-specialised professional assistance or those that were unassisted showed a positive correlation with these mortality rates. Home births are heterogenous, and merely referencing the place of birth does not provide enough information. Although it recommended further investigation, this analysis pointed to the need to assure a specific, systematic evaluation of the quality of care in home births that allows for the consistent assessment and improvement of its safety. [ABSTRACT FROM AUTHOR]

Introduction: Stillbirths account for a major proportion of perinatal deaths. In many cases of stillbirth, the cause remains unexplained. The ReCoDe system (classification of stillbirths by relevant condition at death) is a frequently used classification system that has helped us to improve the understanding of the causes of stillbirths. Aim: To identify factors associated with stillbirths and to classify the causes of stillbirths using the ReCoDe system. Materials and Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynaecology, Government Medical College and Rajindra Hospital, Patiala, Punjab, India, from February 2020 to January 2021. All the mothers with a history of antepartum and intrapartum foetal mortality with the diagnosis of intrauterine foetal death after 20 weeks of gestation were included in the study. A detailed history of the mother was taken and an examination of the mother, stillborn babies, placenta, and umbilical cord was done. ReCoDe system was used to classify the causes of stillbirth. For statistical analysis mean and percentages were used. Results: There were 287 women with intrauterine foetal death admitted during the study period. Maternal age ranged from 18-40 years, majority (n=157, 54.7%) women belonged to the age group of 24-29 years. The stillbirth rate was 78.95 per 1000 live births. The cause of stillbirth could be explained in 235 (81.89%) cases by using the ReCoDe system. Hypertensive disorders in 91 (31.71%) were the most common cause followed by foetal growth restriction in 46 (16.02%). Conclusion: ReCoDe system was useful in classifying the causes of stillbirths in the resource-limited settings. [ABSTRACT FROM AUTHOR]

Background: Cervical insufficiency, the dilation of the cervix in the absence of contractions or labor, can cause second-trimester pregnancy loss or preterm birth. Cervical cerclage is a common treatment for cervical insufficiency and has 3 indications for placement: history, physical examination, and ultrasound. The purpose of this study was to compare pregnancy and birth outcomes for physical examination– and ultrasound-indicated cerclage. Methods: We conducted a retrospective observational descriptive review of second-trimester obstetric patients with transcervical cerclage performed by residents at a single tertiary care medical center from January 1, 2006, to January 1, 2020. We present data on all patients and compare outcomes between the 2 study groups: patients who received physical examination–indicated cerclage vs those who received ultrasound-indicated cerclage. Results: Cervical cerclage was placed on 43 patients at a mean gestational age of 20.4 ± 2.4 weeks (range, 14 to 25 weeks) and with a mean cervical length of 1.53 ± 0.5 cm (range, 0.4 to 2.5 cm). With a latency period of 11.8 ± 5.7 weeks, mean gestational age at delivery was 32.1 ± 6.2 weeks. Fetal/neonatal survival rates were comparable: 80% (16/20) for the physical examination group compared to 82.6% (19/23) for the ultrasound group. No differences were found between groups for gestational age at delivery— 31.5 ± 6.8 in the physical examination group vs 32.6 ± 5.8 in the ultrasound group (P=0.581)—or for preterm birth <37 weeks— 65.0% (13/20) in the physical examination group vs 65.2% (15/23) in the ultrasound group (P=1.000). Rates of maternal morbidity and neonatal intensive care unit morbidity were similar between the groups. No cases of immediate operative complications or maternal deaths occurred. Conclusion: Pregnancy outcomes for physical examination– and ultrasound-indicated cerclage placed by residents at a tertiary academic medical center were similar. Fetal/neonatal survival and preterm birth rates were favorable for physical examination– indicated cerclage when compared to other published studies. [ABSTRACT FROM AUTHOR]

Background Maternal priming with the Bacille Calmette-Guérin (BCG) vaccine has been associated with reduced offspring mortality rates. We investigated this association in a cohort of frail neonates. Methods We performed an observational study within a randomized BCG trial conducted at the neonatal intensive care unit (NICU) in Guinea-Bissau from 2015 to 2017. At NICU admission and after informed consent, the maternal scar status was evaluated by visual inspection before neonates were randomized 1:1 to receive BCG + oral polio vaccine immediately or at hospital discharge. Stratified by maternal scar status, we assessed overall in-hospital and postdischarge mortality rates through 42 days of age in Cox proportional hazards models providing adjusted mortality rate ratios (aMRRs). Results Overall, 62% of mothers (903 of 1451) had a BCG vaccine scar. During NICU admission, the mortality risk was 1.7% (15 of 903) for neonates born to mothers with a scar versus 3.3% (18 of 548) for those born to mothers with no scar; the aMRR for maternal scar versus no scar was 0.53 (95% CI,.26–1.05), 0.39 (95% CI,.13–1.05) for unvaccinated and 0.70 (95% CI,.26–1.87) for vaccinated neonates. Conclusions This small study indicates that maternal BCG vaccine might be associated with reduced all-cause NICU mortality rate. If confirmed elsewhere, this finding would have substantial ramifications for global health. [ABSTRACT FROM AUTHOR]

Women of South Asian ethnicity are overrepresented in adverse pregnancy outcomes across high-income countries, including placental dysfunction and antepartum haemorrhage. As the burden of mortality is highest for extremely preterm infants, we aimed to identify any differences in placental pathology among perinatal deaths from 20+0 to 27+6 weeks gestation between South Asian, Māori and New Zealand (NZ) European women in Aotearoa NZ, with a focus on women of South Asian ethnicity. Placental pathology reports and clinical data from perinatal deaths between 2008 and 2017 were provided by the NZ Perinatal and Maternal Mortality Review Committee, blinded and analysed by an experienced perinatal pathologist using the Amsterdam Placental Workshop Group Consensus Statement criteria. South Asian ethnicity was classified as Indian, Fijian Indian, South African Indian, Sri Lankan, Pakistani and Bangladeshi. 886 of 1571 placental pathology reports met the inclusion criteria. Women of South Asian ethnicity were significantly more likely to show features of histologic chorioamnionitis (aOR 1.87, 95%CI 1.19–2.94) and chorionic vasculitis (aOR 1.92, 95%CI 1.13–3.29), than NZ European and Māori women respectively. 13 of 15 (87%) of South Asian mothers with a diabetic disorder were identified with chorioamnionitis, compared to 1 in 5 (20%) of Māori and 5 in 12 (41%) of NZ European women. Cord hyper-coiling was also more common among South Asian pregnancies, compared to NZ European (aOR 1.98, 95%CI 1.10–3.56). Differences in placental pathology by ethnicity were observed among extremely preterm perinatal deaths. Underlying metabolic disorders and an associated pro-inflammatory environment may play an important role in the causal pathway leading to these deaths in women of South Asian ethnicity. • Placental pathology differs by ethnicity among extreme preterm perinatal deaths. • South-Asian women have more chorioamnionitis with perinatal deaths <28 weeks. • Chorionic vasculitis is more common in South-Asian perinatal deaths <28 weeks. • Pro-inflammatory conditions may contribute to South-Asian placental pathology. [ABSTRACT FROM AUTHOR]

Background: Perinatal mortality multi-disciplinary team meetings (PM-MDTMs) offer a forum for multi-disciplinary discussion of poor perinatal outcomes. They ensure a thorough understanding of individual cases and present an important learning opportunity for healthcare professionals (HCPs). Attendance at PM-MDTMs in this tertiary maternity hospital has been low. Aims: We aimed to identify barriers which may be targeted to improve attendance and engagement. Methods: An anonymous questionnaire was developed, and all HCPs invited to participate. Demographic data on respondents was collected, as was knowledge of PM-MDTMs, their purpose and relevance to clinical practice, and barriers to attendance at meetings. A total of 78 responses were obtained and analysed. Results: Self-reported understanding of the purpose and format PM-MDTMs was high (84.6% (66/78) and 65.4% (51/78), respectively), while only 50% (39/78) of respondents provided an accurate description of either. Only 50% (39/78) reported having attended a meeting in the hospital, of whom 61.5% (24/39) described the correct meeting. Of these, 37.5% (9/24) reported attending regularly and 70.8% (17/24) found the meeting relevant to their clinical practice. Of the 33.33% (26/78) who reported attending a PM-MDTM in another hospital, 73.1% (19/26) accurately described the meeting, 63.1% (12/19) of these attended regularly, and 100% (19/19) found it relevant. Three main qualitative themes emerged as barriers to attendance and were areas for suggested improvements: workload and staffing levels, meeting logistics, and lack of communication and education regarding PM-MDTMs. Conclusions: Communication regarding PM-MDTMs and their learning opportunities needs to improve. Lack of engagement is likely compounded by high workloads and staffing levels, but these issues should be surmountable. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Goal 3 of sustainable development aims to ensure healthy lives and promote well-being for all people of all ages. One of the components for achieving this objective is the improvement of maternal and child health, with the perinatal mortality (PM) rate serving as an indicator. This study aimed to know the probable cause of perinatal death at a medical center of tertiary care to reduce the incidence of perinatal death and enhance the quality of care. OBJECTIVE: The objective of this study was to study the incidence and associated risk factors of PM in a selected tertiary care hospital. MATERIALS AND METHODS: A prospective case series study was conducted from August 2019 to September 2021 among all pregnant mothers who delivered in selected tertiary care hospitals of Belagavi city among 3508 participants. RESULTS: In the present study, results revealed that 29 per 1000 births and 7.12 per 1000 live births of END. The incidence of PM was 36.48 per 1000 births in the present study. There was a positive correlation between maternal weight in kg versus the birth weight of the baby (R = 0.091, P < 0.001). Results inferred that maternal anemia, antepartum hemorrhage, hypertensive disorders, thyroid disorders, amniotic fluid infections, and placental insufficiency were identified as primary causes of stillbirth. CONCLUSION: There is a region-wise wide variation in the rate of PM. There was an inverse relationship between birth weight and stillbirth, neonatal death, and perinatal death rate. Low birth weight babies contributed more than three times to stillbirths, early neonatal deaths, and perinatal deaths as compared to babies with normal birth weight. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Obstructed labor is the leading cause of hospitalization. It is a preventable obstetric complication. However, it is a major cause of maternal and perinatal morbidity and mortality. The main objective of the study was to find feto-maternal outcome in obstructed labor at tertiary care hospital UCMS-TH, Bhairahawa. MATERIAL AND METHODS: Eighty seven women admitted with features of obstructed labor at our hospital were studied. By clinical examination, diagnosis of cephalopelvic disproportion, malpresentation, malposition, obstruction in birth canal, overdistended bladder, hematuria, rupture uterus and supermoulding of fetal head was detected. Demographic profile of patients, mode of delivery, time interval between referral and admission, intervention done, intrapartum and postpartum complications, maternal and fetal outcome were evaluated. RESULTS: There were 87 cases of obstructed labor among 1655 total deliveries. Most common cause for obstructed labor was cephalopelvic disproportion (34.4%) followed by malpresentation (19.5%) and non progress of labor (17.2%). Majority of the patients were primigravida (43.6%) followed by multiparous (35.6%) and grand multipara (20.6%). Most of cases were unbooked and referral from primary health centers (80.4%). PPH (41.2%), extension of uterine incision (17.4%), followed by sepsis, pyrexia and uterine rupture were common complications. Perinatal morbidity due to obstructed labour requiring NICU admission was (33.9%) and perinatal mortality was (21.7%) mainly due to meconium aspiration, respiratory distress and septicemia. CONCLUSION: Cephalopelvic disproportion and primigravida were the commonest cause of obstructed labour and associated with PPH, extension of uterine incision, uterine rupture, sepsis and neonatal ICU admission and even neonatal death. [ABSTRACT FROM AUTHOR]