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Adverse pregnancy outcomes (APOs) affect a large proportion of pregnancies and represent an important cause of morbidity and mortality worldwide. Yet the pathophysiology of APOs is poorly understood, limiting our ability to prevent and treat these conditions. To search for genetic markers of maternal risk for four APOs, we performed multi-ancestry genome-wide association studies (GWAS) for pregnancy loss, gestational length, gestational diabetes, and preeclampsia. We clustered participants by their genetic ancestry and focused our analyses on three sub-cohorts with the largest sample sizes: European, African, and Admixed American. Association tests were carried out separately for each sub-cohort and then meta-analyzed together. Two novel loci were significantly associated with an increased risk of pregnancy loss: a cluster of SNPs located downstream of the TRMU gene (top SNP: rs142795512), and the SNP rs62021480 near RGMA. In the GWAS of gestational length we identified two new variants, rs2550487 and rs58548906 near WFDC1 and AC005052.1, respectively. Lastly, three new loci were significantly associated with gestational diabetes (top SNPs: rs72956265, rs10890563, rs79596863), located on or near ZBTB20, GUCY1A2, and RPL7P20, respectively. Fourteen loci previously correlated with preterm birth, gestational diabetes, and preeclampsia were found to be associated with these outcomes as well.

BACKGROUND: Mother-to-child transmission is the primary cause of HIV cases among children. Antiretroviral therapy (ART) plays a critical role in preventing mother-to-child transmission and reducing HIV progression, morbidity, and mortality among mothers. However, after more than two decades of ART during pregnancy, the comparative effectiveness and safety of ART medications during pregnancy are unclear, and existing evidence is contradictory. This study aimed to assess the effectiveness and safety of different ART regimens among pregnant women living with HIV at preconception or during pregnancy. METHODS: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science. We included randomized trials that enrolled pregnant women living with HIV and randomized them to receive ART for at least four weeks. Pairs of reviewers independently completed screening for eligible studies, extracted data, and assessed the risk of bias using the Cochrane risk of bias tool. Our outcomes of interest included low birth weight, stillbirth, preterm birth, mother-to-child transmission of HIV, neonatal death, and congenital anomalies. Network meta-analysis was performed using a random-effects frequentist model, and the certainty of evidence was evaluated using the GRADE approach. RESULTS: We found 14 eligible randomized trials enrolling 9,561 pregnant women. The median duration of ART uptake ranged from 6.0 to 17.4 weeks. No treatment was statistically better than a placebo in reducing the rate of neonatal mortality, stillbirth, congenital defects, preterm birth, or low birth weight deliveries. Compared to placebo, zidovudine (ZDV)/lamivudine (3TC) and ZDV monotherapy likely reduce mother-to-child transmission (odds ratio (OR): 0.13; 95% CI: 0.05 to 0.31, high-certainty; and OR: 0.50; 95% CI: 0.33 to 0.74, moderate-certainty). Moderate-certainty evidence suggested that ZDV/3TC was associated with decreased odds of stillbirth (OR: 0.47; 95% CI: 0.09 to 2.60). CONCLUSIONS: Our analysis provides high- to moderate-certainty evidence that ZDV/3TC and ZDV are more effective in reducing the odds of mother-to-child transmission, with ZDV/3TC also demonstrating decreased odds of stillbirth. Notably, our findings suggest an elevated odds of stillbirth and preterm birth associated with all other ART regimens.

Household air pollution (HAP) from cooking with solid fuels used during pregnancy has been associated with adverse pregnancy outcomes. The Household Air Pollution Intervention Network (HAPIN) trial was a randomized controlled trial that assessed the impact of a liquefied petroleum gas (LPG) stove and fuel intervention on health in Guatemala, India, Peru, and Rwanda. Here we investigated the effects of the LPG stove and fuel intervention on stillbirth, congenital anomalies and neonatal mortality and characterized exposure-response relationships between personal exposures to fine particulate matter (PM2.5), black carbon (BC) and carbon monoxide (CO) and these outcomes. Pregnant women (18 to

BACKGROUND: Female genital fistula is a traumatic debilitating injury, frequently caused by prolonged obstructed labor, affecting between 500,000-2 million women in lower-resource settings. Vesicovaginal fistula causes urinary incontinence, and other morbidity may occur during fistula development. Women with fistula are stigmatized, limit social and economic engagement, and experience psychiatric morbidity. Improved surgical access has reduced fistula consequences yet post-repair risks impacting quality of life and well-being include fistula repair breakdown or recurrence and ongoing or changing urine leakage or incontinence. Limited evidence on risk factors contributing to adverse outcomes hinders interventions to mitigate adverse events. This study aims to quantify these adverse risks and inform clinical and counseling interventions to optimize womens health and quality of life following fistula repair through: identifying predictors and characteristics of post-repair fistula breakdown and recurrence (Objective 1) and post-repair incontinence (Objective 2), and to identify feasible and acceptable intervention strategies (Objective 3). METHODS: This mixed-methods study incorporates a prospective cohort of women with successful vesicovaginal fistula repair at approximately 12 fistula repair centers in Uganda (Objectives 1-2) followed by qualitative inquiry among key stakeholders (Objective 3). Cohort participants will have a baseline visit at the time of surgery followed by data collection at 2 weeks, 6 weeks, 3 months and quarterly thereafter for 3 years. Primary predictors to be evaluated include patient-related factors, fistula-related factors, fistula repair-related factors, and post-repair behaviors and exposures, collected via structured questionnaire at all data collection points. Clinical exams will be conducted at baseline, 2 weeks post-surgery, and for outcome confirmation at symptom development. Primary outcomes are fistula repair breakdown or fistula recurrence and post-repair incontinence. In-depth interviews will be conducted with cohort participants (n ~ 40) and other key stakeholders (~ 40 including family, peers, community members and clinical/social service providers) to inform feasibility and acceptability of recommendations. DISCUSSION: Participant recruitment is underway. This study is expected to identify key predictors that can directly improve fistula repair and post-repair programs and womens outcomes, optimizing health and quality of life. Furthermore, our study will create a comprehensive longitudinal dataset capable of supporting broad inquiry into post-fistula repair health. Trial Registration ClinicalTrials.gov Identifier: NCT05437939.

Stillbirth can lead to complex and varied psychological outcomes for parents. Many choose to have another pregnancy following a stillbirth; however, little is known about the experience of parenting and bonding with the subsequent baby. Couples, who were the biological parents of a stillborn baby and at least one subsequent live baby aged under five, were recruited and interviewed individually. Data were analysed using interpretative phrenomenological analysis. Twelve individual interviews (of six couples) were conducted and four themes with nine subthemes were developed. Theme 1 " Back to the starting line: pregnancy as a means to an end " captured parents' desire to bring a live baby home with pregnancy being experienced alongside fear, trauma, and grief. Theme 2 " Reality hits " encapsulated the experience of arriving home and feeling overwhelmed by the demands of a new-born baby. Theme 3 " Being a living and loss parent " captured the experience of being a parent to both a living and non-living baby with conflicting emotions. Theme 4 " Protection: ' I need him there next to me, so I know he's alive '" represented the fear some parents felt when parenting their live baby and included parents' strategies to manage this anxiety. This study presents novel insight into the complexities of being a parent to a stillborn baby in tandem with a live baby, with difficulties arising in bonding, and managing emotional distress linked to trauma and grief. Potential implications for care includes a need for increased training for professionals providing postnatal care. [ABSTRACT FROM AUTHOR]

Introduction Material and Methods Results Conclusions Although perinatal death rates in the Nordic countries are among the lowest in the world, the risk of perinatal death is unevenly distributed across the Nordic countries, despite similarity in health care systems and pregnancy care. Birth registration practices across countries may explain some of the differences. We investigated differences in national registration of perinatal mortality within the Nordic countries and its impact on perinatal mortality according to gestational age.Each country provided information by answering a questionnaire about registration of perinatal deaths. Furthermore, we collected aggregated count data based on Medical Birth Registries (MBR) from all Nordic countries in 2000 to 2021. Perinatal mortality was defined as stillbirth or neonatal death occurring within first 7 days of life. Data were grouped into six groups by gestational age (GA): extremely preterm (>28 + 0 weeks, subdivided into 22 + 0–23 + 6 and 24 + 0–27 + 6), very preterm (GA 28 + 0–31 + 6), moderate preterm (GA 32 + 0–33 + 6), late preterm (GA 34 + 0–36 + 6), term (GA 37 + 0–40 + 6) and late term or post‐term birth (GA ≥ 41 + 0). Perinatal mortality rate and risk ratio with 95% confidence intervals were calculated per country for each gestational age group. For Denmark, separate analyses included and excluded induced abortions.The study included 6 343 805 live births, 22 727 stillbirths and 8932 liveborn infants who died within the first week of life after GA 22 + 0. Further 25 057 births were included with GA < 22 + 0, unknown GA and as a result of induced abortion. Overall, perinatal mortality rates decreased during year 2000–2021 in all Nordic countries. After exclusion of induced abortions, the perinatal mortality rate was similar in the five Nordic countries. The perinatal mortality rate for extremely preterm born infants was highest in Denmark, whereas the highest rate among infants born late term/post‐term was in Sweden.The perinatal mortality rate in the Nordic countries is still decreasing, especially in the group of extremely preterm born infants. This study supports the need for further standardization of birth registration practices to ensure the validity of international comparisons. [ABSTRACT FROM AUTHOR]

Background: Nearly all stillbirths in Canada occur in hospitals--a setting that can either support or exacerbate what is often a traumatic experience. People with lived experience of stillbirth face psychological challenges, barriers to seeking support, and stigma; therefore, patient engagement is critical to optimizing stillbirth care. Methods: We conducted a quality improvement project through a human-centred design approach to understand the hospital stillbirth experience and co-design a vision for improved stillbirth care at BC Women's Hospital and Health Centre. We engaged 30 bereaved parents in two workshops and used design methods to promote refection and gather insights about their experiences. Results: Four key themes emerged via reflexive thematic analysis, which highlighted bereaved parents' desire for stillbirth-specific care, care that honors the baby and recognizes the parents, provision of accommodating spaces, and sharing of information with care. Conclusions: The hospital setting, designed primarily for live deliveries, can contribute to the suffering of bereaved parents of stillborn babies. [ABSTRACT FROM AUTHOR]

Intraplacental choriocarcinoma (IC) is a gestational trophoblastic neoplasia located within the placenta. Due to its silent presentation, more than half of the cases are diagnosed incidentally. An association with fetomaternal hemorrhage (FMH), stillbirth, and intrauterine growth restriction has been found. The aim of this review is to describe the clinical management of this rare condition stemming from a case report of an incidental diagnosis following an emergency cesarean section, and taking into account the available literature. Emergency interventions and examination of the placenta, even for the smallest IC lesion can ensure timely treatment and improve maternal and fetal outcomes. [ABSTRACT FROM AUTHOR]

Introduction: In the context of adverse in utero environments, the fetal brain might be preserved at the expense of other tissues. This trade‐off, brain sparing, has not been studied in the context of maternal infection. We investigated cases of maternal syphilis in the early 20th century and influenza during the 1918–1920 pandemic, in the Swiss city of Lausanne, a relatively high‐income setting. We tested the brain sparing hypothesis, that head circumference is protected at the expense of birth weight. Methods: A total of 8530 individual birth records from 1911 to 1922 from the University Maternity Hospital of Lausanne were used. We fitted generalized linear and additive linear models to explain how neonatal size varies under disease exposure. Results: Influenza reduced head circumference and birth weight among livebirths similarly, by −0.11 and −0.14 standard deviation (SD) units respectively. Conversely, for syphilis‐exposed infants, head circumference was affected more than birth weight (−0.61 SD vs. −0.46 SD). Stillborn infants exposed to syphilis experienced a much greater reduction in head circumference (−1.92 SD) than liveborn infants. After adjustment for gestational age, these findings persisted in the case of influenza, but the effects of syphilis were reduced. Furthermore, half of syphilis‐exposed infants were born before term, suggesting that lower infant size was partly mediated by shorter gestation. Nevertheless, head circumference among stillbirths exposed to syphilis was still substantially reduced, even after adjustment for gestational age (−1.26 SD). Conclusion: Our findings do not support the brain sparing hypothesis. Moreover, the substantial reduction in head circumference among syphilis‐exposed fetuses might help explain why a quarter of them were stillborn. [ABSTRACT FROM AUTHOR]

AbstractFor any expectant mother, the worst possible outcome of pregnancy is for the baby to die. The experience can lead to various forms of physical and psychosocial morbidity. The purpose of this study was to gain in-depth understanding of the experiences of mothers who suffered stillbirth with a view to improving the clinical management of stillbirth. Semi-structured qualitative interviews were conducted with ten women who had experienced stillbirths within one year prior to the interview. The interviews were recorded and transcribed verbatim. The data were analyzed using Smith’s interpretative phenomenological analysis (IPA) model and ATLAS.ti 8 software. Healthcare professionals identified three main themes: clinical management for stillbirth and bereaved mothers across various roles; public hospitals; and the Jordanian Ministry of Health Policies and Guidelines. The study findings underscore the devastating impact of insensitive and poor-quality care on bereaved mothers, highlighting how it exacerbates their grief and sorrow. These findings emphasize the need for training healthcare providers in perinatal loss and bereavement care, as well as the importance of adopting new policies and guidelines to improve the quality of care provided to bereaved mothers. [ABSTRACT FROM AUTHOR]

Background & Objective: Pregnancy related acute kidney injury (Pr-AKI) is coupled with adverse feto-maternal outcomes. Adverse perinatal outcome comprising of still births, intrauterine growth retardation, neonatal deaths are indicators of severity of underlying obstetrical conditions ending on Pr-AKI. These perinatal outcomes can also serve as potential predictors for long term outcomes of Pr-AKI. Our study aimed to determine frequencies of adverse perinatal outcomes and to evaluate adverse perinatal outcome as predictor for persistent renal injury in patients with pregnancy induced acute renal injury (Pr-AKI). Method: A descriptive case series including 100 women with Pr-AKI, was conducted in a tertiary care hospital of Peshawar from 1st August 2021 to 31st July 2022. Included patients were followed for three months period, from their date of delivery. Adverse perinatal outcome included stillbirths, and early neonatal deaths. Results: The mean age of study sample was 29.20±6.40. The pre dominant etiology for Pr-AKI was primary postpartum hemorrhage, occurring in 52% women. Still births were seen in 48% cases, while early neonatal deaths were seen in 7% cases. Adverse perinatal outcome had statistically significant association with persistent renal failure (p-0.01). Other factors having statistically significant association with persistent renal injury (PRF) were multiparity and cesarean births. (p<0.05) Association of adverse perinatal outcome with persistent renal injury persisted on multivariate logistic regression. a OR 6.14; CI 1.15-32.29, p-0.033. Conclusion: Almost half of the cases with Pr-AKI have still births. Still birth in patients with Pr-AKI is associated with persistent renal injury at 12 weeks follow up period. [ABSTRACT FROM AUTHOR]

Objective: To establish proof‐of‐concept for the dynamic prediction of adverse pregnancy outcome in women with a history of stillbirth or perinatal death, repeatedly throughout the pregnancy. Methods: A retrospective cohort study of women in a subsequent pregnancy following previous perinatal loss, who received antenatal care at a tertiary hospital between January 2014 and December 2017, was used as the basis for exploratory prognostic model development. Models were developed to repeatedly predict a composite adverse outcome (stillbirth or neonatal death, 5‐min Apgar score < 7, umbilical artery pH ≤ 7.05, admission to the neonatal intensive care unit for longer than 24 h, preterm birth (< 37 completed weeks) or birth weight < 10th centile) using the findings of sequential ultrasound scans for fetal biometry and umbilical and uterine artery Doppler. Results: In total, 506 participants were eligible, of whom 504 were included in the analysis. An adverse pregnancy outcome was experienced by 110 (22%) participants. The ability to predict the composite outcome using repeated head circumference and estimated fetal weight measurements improved as the pregnancy progressed (e.g. area under the receiver‐operating‐characteristics curve improved from 0.59 at 24 weeks' gestation to 0.74 at 36 weeks' gestation), supporting proof‐of‐concept. Predictors to include in dynamic prediction models were identified, including ultrasound measurements of fetal biometry, umbilical and uterine artery Doppler and placental size and shape. Conclusion: The present study supports proof‐of‐concept for dynamic prediction of adverse outcome in pregnancy following prior stillbirth or perinatal death, which could be used to identify risks earlier in pregnancy, while highlighting methodological challenges and requirements for subsequent large‐scale model development studies. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Despite the well-recognized association between pre-existing diabetes mellitus and stillbirth or perinatal mortality, there remain knowledge gaps about the strength of association across different populations. The primary objective of this systematic review and meta-analysis was to quantify the association between pre-existing diabetes and stillbirth or perinatal mortality, and secondarily, to identify risk factors predictive of stillbirth or perinatal mortality among those with preexisting diabetes. DATA SOURCES: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials from inception to April 2022. METHODS OF STUDY SELECTION: Cohort studies and randomized controlled trials in English or French that examined the association between pre-existing diabetes and stillbirth or perinatal mortality (as defined by the original authors) or identified risk factors for stillbirth and perinatal mortality in individuals with pre-existing diabetes were included. Data extraction was performed independently and in duplicate with the use of prespecified inclusion and exclusion criteria. Assessment for heterogeneity and risk of bias was performed. Metaanalyses were completed with a random-effects model. TABULATION, INTEGRATION, AND RESULTS: From 7,777 citations, 91 studies met the inclusion criteria. Preexisting diabetes was associated with higher odds of stillbirth (37 studies; pooled odds ratio [OR] 3.74, 95% CI, 3.17-4.41, I2582.5%) and perinatal mortality (14 studies; pooled OR 3.22, 95% CI, 2.54-4.07, I2582.7%). Individuals with type 1 diabetes had lower odds of stillbirth (pooled OR 0.81, 95% CI, 0.68-0.95, I250%) and perinatal mortality (pooled OR 0.73, 95% CI, 0.61-0.87, I250%) compared with those with type 2 diabetes. Prenatal care and prepregnancy diabetes care were significantly associated with lower odds of stillbirth (OR 0.26, 95% CI, 0.11-0.62, I2587.0%) and perinatal mortality (OR 0.41, 95% CI, 0.29-0.59, I250%). CONCLUSION: Pre-existing diabetes confers a more than threefold increased odds of both stillbirth and perinatal mortality. Maternal type 2 diabetes was associated with a higher risk of stillbirth and perinatal mortality compared with maternal type 1 diabetes. [ABSTRACT FROM AUTHOR]

• We have used a modified e-Delphi study to prioritise risk factors for stillbirth prediction in early pregnancy. • Prioritised maternal characteristics include age, smoking, drug misuse, heritable thrombophilia, hypertension, renal disease, and diabetes. • Prioritised maternal characteristics related to pregnancy history include previous stillbirth, and multiple pregnancy. • Prioritised ultrasound markers for stillbirth prediction are uterine artery Doppler pulsatility index and congenital fetal anomaly. • Placental growth factor is the only prioritised biochemical marker for stillbirth prediction. To identify and prioritise early pregnancy risk factors for stillbirth to inform prognostic factor and model research. We used a modified e-Delphi method and consultation meeting to achieve consensus. Risk factors for early, late and stillbirth at any gestation identified from an umbrella review of risk factors for stillbirth were entered into a two-stage online Delphi survey with an international group of stakeholders made up of healthcare professionals and researchers. The RAND/ University of California at Los Angeles appropriateness method was used to evaluate consensus. Responders voted on a scale of 1–9 for each risk factor in terms of importance for early, late, and stillbirth at any gestation. Consensus for inclusion was reached if the median score was in the top tertile and at least two thirds of panellists had scored the risk factor within the top tertile. Twenty-six risk factors were identified from an umbrella review and presented to stakeholders in round 1 of our e-Delphi survey. Round 1 was completed by 68 stakeholders, 79% (54/68) of whom went on to complete the second round. Seventeen risk factors were discussed at the consensus meeting. From the twenty-six risk factors identified, fifteen of these were prioritised for stillbirth at any gestation, eleven for early stillbirth, and sixteen for late stillbirth, across three domains of maternal characteristics, ultrasound markers and biochemical markers. The prioritised maternal characteristics common to early, late, and stillbirth at any gestation were: maternal age, smoking, drug misuse, history of heritable thrombophilia, hypertension, renal disease, diabetes, previous stillbirth and multiple pregnancy. Maternal BMI, access to healthcare, and socioeconomic status were prioritised for late stillbirth and stillbirth at any gestation. Previous pre-eclampsia and previous small for gestational age baby were prioritised for late stillbirth. Of the ultrasound markers, uterine artery Doppler pulsatility index and congenital fetal anomaly were prioritised for all. One biochemical marker, placental growth factor, was prioritised for stillbirth at any gestation. Our prioritised risk factors for stillbirth can inform formal factor-outcome evaluation of early pregnancy risk factors to influence public health strategies on prevention of such risk factors to prevent stillbirth. [ABSTRACT FROM AUTHOR]

While there is strong evidence that maternal smallpox infection can cause foetal loss, it is not clear whether smallpox infections were a demographically important cause of stillbirths historically. In this paper, we use parish-level data from the Swedish Tabellverket data set for 1780–1839 to test the effect of smallpox on stillbirths quantitatively, analysing periods before and after the introduction of vaccination in 1802. We find that smallpox infection was not a major cause of stillbirths before 1820, because most women contracted smallpox as children and were therefore not susceptible during pregnancy. We do find a small, statistically significant effect of smallpox on stillbirths from 1820 to 1839, when waning immunity from vaccination put a greater share of pregnant women at risk of contracting smallpox. However, the reduced prevalence of smallpox in this period limited its impact on stillbirths. Thus, smallpox was not an important driver of historical stillbirth trends. [ABSTRACT FROM AUTHOR]

Purpose: The aim was to evaluate the pregnancy outcomes and identify risk factors for recurrent preeclampsia (PE). Methods: Retrospective analysis of patients discharged with PE between January 1, 2010, and January 1, 2023, from two tertiary referral hospitals. They were classified into recurrent and non-recurrent groups based on the presence of PE in subsequent pregnancies. Results: Among 519 women who had a subsequent pregnancy after a history of PE, 153 developed recurrent PE while 366 did not. The recurrent cases included 81 preterm PE, of which 41 were early-onset PE (EOPE). Recurrent PE correlated significantly with prior EOPE, HELLP syndrome, placental abruption, and stillbirth, as well as with current chronic hypertension (CH) and type 2 diabetes. The recurrent group showed a 5.8-fold higher risk of preterm birth (PTB) compared to the non-recurrent group (50.7% vs. 8.7%). Notably, 58.1% of the PTBs in the non-recurrent group were spontaneous. Logistic regression identified previous EOPE (aOR: 4.22 [95% CI: 2.50–7.13]) and current CH (aOR: 1.86 [95% CI: 1.09–3.18]) as independent contributors for recurrent PE. Furthermore, recurrent preterm PE shared the same risk factors: previous EOPE (aOR: 5.27 [95% CI: 2.82–9.85]) and current CH (aOR: 2.99 [95% CI: 1.57–5.71]). The morbidity of CH in subsequent pregnancy peaked at 31.9% when women with a history of EOPE delivered within three years. Conclusion: Previous EOPE and current CH were sequentially crucial risk factors for the development of PE and preterm PE during the next pregnancy. This may clarify risk stratification in prenatal management for women with a history of PE. [ABSTRACT FROM AUTHOR]

Purpose: Elective induction of labor (IOL) has been increasingly performed since growing data suggesting its safety and potential improved maternal and neonatal outcomes. Recommendations of elective IOL for patients from racial or ethnic minority backgrounds given the data showing increased risk of stillbirth for some populations has been met with criticism. This scoping review aims to determine if there are racial disparities in access to elective IOL and maternal and neonatal outcomes. Methods: A review of the literature on IOL that appeared in English journals was performed using MEDLINE and EMBASE. The search strategy included the combination of key terms "induction of labour" and "race" or "ethnicity" in titles, abstracts, or keywords. Results: A total of 8 studies were identified and included. The articles were heterogenous in the race or ethnicity distinctions they used for analysis. Three out of 4 studies that analyzed the rate of elective IOL by race found that White patients were more likely to receive the intervention. Three out of 4 studies that analyzed outcomes of IOL found no difference, while one study found Black patients benefit most from IOL at 38 weeks compared to other races that had the lowest risk of complications with IOL at 39 weeks. Conclusion: Racial and ethnic disparities exist with White patients being most likely to access this intervention. The majority of data points to similar outcomes, suggesting no increased harm to elective IOL for a particular group. However, the optimal timing of elective IOL given disproportionate stillbirth risk remains to be elucidated. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the reference population size required to obtain substantial prediction accuracy within‐ and across‐lines and the effect of using a multi‐line reference population for genomic predictions of maternal traits in pigs. The data consisted of two nucleus pig populations, one pure‐bred Landrace (L) and one Synthetic (S) Yorkshire/Large White line. All animals were genotyped with up to 30 K animals in each line, and all had records on maternal traits. Prediction accuracy was tested with three different marker data sets: High‐density SNP (HD), whole genome sequence (WGS), and markers derived from WGS based on pig combined annotation dependent depletion‐score (pCADD). Also, two different genomic prediction methods (GBLUP and Bayes GC) were compared for four maternal traits; total number piglets born (TNB), total number of stillborn piglets (STB), Shoulder Lesion Score and Body Condition Score. The main results from this study showed that a reference population of 3 K–6 K animals for within‐line prediction generally was sufficient to achieve high prediction accuracy. However, when the number of animals in the reference population was increased to 30 K, the prediction accuracy significantly increased for the traits TNB and STB. For multi‐line prediction accuracy, the accuracy was most dependent on the number of within‐line animals in the reference data. The S‐line provided a generally higher prediction accuracy compared to the L‐line. Using pCADD scores to reduce the number of markers from WGS data in combination with the GBLUP method generally reduced prediction accuracies relative to GBLUP using HD genotypes. The BayesGC method benefited from a large reference population and was less dependent on the different genotype marker datasets to achieve a high prediction accuracy. [ABSTRACT FROM AUTHOR]

Stillbirth affects 1 in 175 pregnancies in the United States. There are significant racial and ethnic disparities in rates of stillbirth. Rates of stillbirth are highest among non-Hispanic Native Hawaiian or Other Pacific Islander and non-Hispanic Black women, more than twice the rate of non-Hispanic White women. Stillbirth is a public health crisis that warrants attention as it has significant physical, psychosocial, and economic effects on women and their family. Many stillbirths occur due to placental insufficiency, causing a lack of oxygenation of the fetus, which can result in decreased movement. Pregnant patients who experience stillbirth often observe decreased fetal movement days before birth. Daily fetal movement monitoring has the potential to identify pregnancies at risk so providers can intervene. Count the Kicks is a fetal movement monitoring program that provides standardized education and resources for expectant parents. Increased awareness of providers and childbearing families about the importance of fetal movement monitoring, standardized provision of education on fetal movement counting, and what to do if a baby's normal movement patterns change can be helpful in promoting healthy pregnancy outcomes. Fetal movement counting is a patient-centered, low-risk, and low-cost intervention that has the potential to improve outcomes. There is little standardization in the education given to patients by clinicians on how to monitor fetal movements. There is no consensus among experts on a specific fetal movement counting method that works best. Patients need accurate easy to understand information on when to seek care. Count the Kicks provides resources and standardized education on fetal movement counting, promoting shared decision-making and patient empowerment. [ABSTRACT FROM AUTHOR]

Ebstein anomaly (EA) is a rare congenital heart defect characterized by abnormal development of the tricuspid valve (TV) and right ventricular myocardium. This study documents 2 dramatic cases of fetal EA characterized by hydrops and cardiomegaly, leading to intrauterine or early neonatal death. These clinical outcomes were associated with morphological abnormalities including severe tricuspid regurgitation, unguarded TV orifice, pulmonary atresia, and flattened right ventricular myocardium. This study highlights that these adverse anatomical features may result in unfavorable clinical outcomes in fetal EA. While timely identification of such features by prenatal ultrasound is crucial for providing accurate prognostic stratification and guiding treatment decisions, fetopsy may be necessary to discern EA among the spectrum of right-heart anomalies. [ABSTRACT FROM AUTHOR]

Objective: Our objective was to determine the feasibility and interobserver reliability of umbilical cord and placental arteriolar flow assessment in low‐risk pregnancies near term. Methods: This was a prospective pilot study in low‐risk pregnancies at 36 weeks with anterior placentas. We excluded any with an indication for antenatal testing or delivery before 39 weeks. Each participant underwent two ultrasounds by different examiners, which included arterial and venous velocimetry at three cord sites (fetal, free loop, and placental) in addition to maternal and fetal placental arterioles. The interobserver reliability was quantified using the Pearson correlation coefficient with that of standard clinical parameters serving as a benchmark for interpretation. Results: Among 53 participants scanned at 356/7–371/7 weeks, the mean examination duration was 20.5 ± 4.2 minutes. Ascertainment success was high for measures at the free loop, placental cord insertion, and fetal placental arterioles (range 90.6%–99.1%) and was lower at the fetal cord insertion and maternal spiral arterioles (range 47.2%–87.7%). Interobserver reliability estimates for free‐loop systolic/diastolic and pulsatility index ranged from 0.38 to 0.44. Interobserver reliability for experimental parameters varied by measurement site, and all were poor at the fetal insertion and in placental arterioles. Parameters had significant variation across cord sites (range 4.3%–21.7%). Conclusion: In our cohort, flow assessments of the free loop, placental insertion, and placental arterioles are feasible, but interrater reliability varies by measurement type and cord site. Future studies are needed to establish feasibility and reliability in nonanterior placentation and to assess clinical relevance. [ABSTRACT FROM AUTHOR]

Background: Policymakers use clinical and cost-effectiveness evidence to support decisions about health service commissioning. In England, the National Institute for Health and Care Excellence (NICE) recommend that in cost-effectiveness analyses "effectiveness" is measured as quality-adjusted life years (QALYs), derived from health utility values. The impact of perinatal death (stillbirth/neonatal death) on parents' health utility is currently unknown. This knowledge would improve the robustness of cost-effectiveness evidence for policymakers. Objective: This study aimed to estimate the impact of perinatal death on parents' health utility. Methods: An online survey conducted with mothers and fathers in England who experienced a perinatal death. Participants reported how long ago their baby died and whether they/their partner subsequently became pregnant again. They were asked to rate their health on the EQ-5D-5L instrument (generic health measure). EQ-5D-5L responses were used to calculate health utility values. These were compared with age-matched values for the general population to estimate a utility shortfall (i.e. health loss) associated with perinatal death. Results: There were 256 survey respondents with a median age of 40 years (IQR 26–40). Median time since death was 27 months (IQR 8–71). The mean utility value of the sample was 0.774 (95% CI 0.752–0.796). Utility values in the sample were 13% lower than general population values (p < 0.05). Over 10 years, this equated to a loss of 1.1 QALYs. This reduction in health utility was driven by anxiety and depression. Conclusions: Perinatal death has important and long-lasting health impacts on parents. Mental health support following perinatal bereavement is especially important. [ABSTRACT FROM AUTHOR]

Introduction: The use of dairy x dairy crossbreeding has increased in Sweden. This study aimed to compare crosses between Swedish Red (R), Holstein (H), Jersey (J), and Montbé liarde (M) to purebred R, H, and J for fertility, calving, production, and survival traits. The focus was on F1 crosses between either H or R on the one hand and J or M on the other hand, but three-breed crosses were also studied. Material and methods: There were 2,154,241 observations collected from the official cattle recording database for cows that calved between 2005 and 2020 in 7,390 herds. The dataset was separated into first and second parity and analyzed using a mixed linear model including fixed effects of breed group, herd, and yearseason and a random effect of herd-year. Results and discussion: Fertility traits were improved in the F1 crosses with J or M compared with R or H (i.e., JR and MR vs. R; JH andMH vs. H), especially in the first parity. In parity 2, the difference was often not significant. Crossing R or H with Jersey gave lower calving difficulty than in the pure breeds in the first parity. However, crossing with Montbé liarde rather tended to give slightly more calving difficulties, albeit not significantly so. Generally, there was no significant change in stillbirthswhen crossing purebred R orHwith J or M. Therewas a general tendency for better survival in the F1-crosses, however, only significantly so for Jersey crosses in parity 2 with respect to R or H. F1 between J and H (JH) had a higher 305-day fat yield than H, but lower milk and protein yields. MH had higher fat and protein yields than H and MR had higher 305-d milk and protein yields than R. In conclusion, crossing R or H with either Jersey or Montbé liarde can be expected to improve fertility and probably also survival. Depending on the current situation, one could choose to improve fat yield (crossing with J) or protein yield (crossing with M), however, depending on the breed, there could be a trade-off, e.g., inmilk yield. For other traits, one would not expect any deterioration. [ABSTRACT FROM AUTHOR]

Introduction Material and Methods Results Conclusions It is well known that both women with polycystic ovary syndrome (PCOS) and women with gestational diabetes mellitus (GDM) have increased risks of adverse pregnancy outcomes, but little is known whether the combination of these two conditions exacerbates the risks. We explored risk estimates for adverse pregnancy outcomes in women with either PCOS or GDM and the combination of both PCOS and GDM.Nationwide register‐based historical cohort study in Sweden including women who gave birth to singleton infants during 1997–2015 (N = 281 806). The risks of adverse pregnancy outcomes were estimated for women exposed for PCOS‐only (n = 40 272), GDM‐only (n = 2236), both PCOS and GDM (n = 1036) using multivariable logistic regression analyses. Risks were expressed as odds ratios with 95% confidence intervals (CIs) and adjusted for maternal characteristics, including maternal BMI. Women with neither PCOS nor GDM served as control group. Maternal outcomes were gestational hypertension, preeclampsia, postpartum hemorrhage, and obstetric anal sphincter injury. Neonatal outcomes were preterm birth, stillbirth, shoulder dystocia, born small or large for gestational age, macrosomia, low Apgar score, infant birth trauma, cerebral impact of the infant, neonatal hypoglycemia, meconium aspiration syndrome and respiratory distress.Based on non‐significant PCOS by GDM interaction analyses, we found no evidence that having PCOS adds any extra risk beyond that of having GDM for maternal and neonatal outcomes. For example, the adjusted odds ratio for preeclampsia in women with PCOS‐only were 1.18 (95% CI 1.11–1.26), for GDM‐only 1.77 (95% CI 1.45–2.15), and for women with PCOS and GDM 1.86 (95% CI 1.46–2.36). Corresponding adjusted odds ratio for preterm birth in women with PCOS‐only were 1.34 (95% CI 1.28–1.41), GDM‐only 1.64 (95% CI 1.39–1.93), and for women with PCOS and GDM 2.08 (95% CI 1.67–2.58). Women with PCOS had an increased risk of stillbirth compared with the control group (aOR 1.52, 95% CI 1.29–1.80), whereas no increased risk was noted in women with GDM (aOR 0.58, 95% CI 0.24–1.39).The combination of PCOS and GDM adds no extra risk beyond that of having GDM alone, for a number of maternal and neonatal outcomes. Nevertheless, PCOS is still an unrecognized risk factor in pregnancy, exemplified by the increased risk of stillbirth. [ABSTRACT FROM AUTHOR]

AbstractTrial RegistrationStillbirth and neonatal death are devastating pregnancy outcomes with enduring psychosocial and emotional effects on parents and families. Families need appropriate support, yet access to services is often limited. In a randomized controlled trial, we evaluated the efficacy and acceptability of a self-guided internet-based perinatal grief program, Living with Loss (LWL), to support coping and wellbeing among bereaved parents following perinatal death. Eligible parents, largely mothers, were recruited online and randomized to the intervention arm (n = 48) or a care-as-usual (CAU) control arm (n = 47). The LWL program comprised six internet-based modules completed over 8 weeks. The primary outcome was psychological distress; secondary outcomes were perinatal grief intensity, anxiety, depression, and program satisfaction and acceptability. The LWL program reduced psychological distress at post-program compared with CAU. The program had moderate adherence rates and high program satisfaction. There were no differences in the secondary outcomes, and the effect on psychological distress was not sustained at 3-month follow-up. This study provides preliminary evidence for the utility of an internet-based perinatal grief support program to reduce psychological distress in the shorter term among bereaved parents. Further research is needed to determine how psychological distress can be minimized in the longer term, and whether self-guided internet-based support is effective for bereaved fathers and extended family members. Further research is also needed to investigate the effectiveness of the program in real-world settings.Australian New Zealand Clinical Trials Registry, ACTRN12621000631808, registered prospectively on 27/05/2021; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381231&isReview=true [ABSTRACT FROM AUTHOR]

Anaemia in pregnancy is a global problem of significance in all settings. The most common cause is iron deficiency. Large numbers of women are affected, ranging up to 25–30% antenatally and 20–40% postnatally. It is associated with serious adverse outcomes for both the mother and her baby. The risk of low birth weight, preterm birth, postpartum haemorrhage, stillbirth, and neonatal death are all increased in the presence of anaemia. For the infants of affected pregnancies, complications may include neurocognitive impairment. Making an accurate diagnosis during pregnancy has its challenges, which include the choice of thresholds of haemoglobin below which a diagnosis of anaemia in each trimester of pregnancy can be made and, aligned with this question, which are the most appropriate biomarkers to use to define iron deficiency. Treatment with oral iron supplements increases the haemoglobin concentration and corrects iron deficiency. But high numbers of women fail to respond, probably due to poor adherence to medication, resulting from side effects. This has resulted in an increased use of more expensive intravenous iron. Doubts remain about the optimal regimen to of oral iron for use (daily, alternate days, or some other frequency) and the cost-effectiveness of intravenous iron. There is interest in strategies for prevention but these have yet to be proven clinically safe and effective. [ABSTRACT FROM AUTHOR]

Objective Intrahepatic cholestasis of pregnancy is associated with adverse pregnancy outcomes including intrauterine fetal demise, spontaneous preterm labor, and meconium-stained amniotic fluid. Studies have yet to determine if patients with a history of pregnancy complicated by cholestasis had an association with more severe adverse outcomes in a subsequent pregnancy complicated by cholestasis. Study Design Retrospective cohort study of multiparous, singleton, nonanomalous live gestations complicated by cholestasis at Elmhurst Hospital Center from 2005 to 2019. We compared rates of adverse outcomes in multiparous pregnancies complicated by cholestasis with versus without prior cholestasis. Our primary outcome was rates of spontaneous preterm labor. Our secondary outcomes included rates of iatrogenic preterm birth, meconium-stained amniotic fluid, cesarean delivery for nonreassuring fetal heart tracing. Chi-square and multivariate regression tests were used to determine the strength of association. In all analyses, a p -value less than 0.05 and 95% confidence interval not crossing 1.00 indicated statistical significance. Mount Sinai Icahn School of Medicine Institutional Review Board approval was obtained for this project. Results Of the 795 multiparous pregnancies complicated by cholestasis, 618 (77.7%) had no prior history of cholestasis and 177 (23.3%) had prior history of cholestasis. Multiparous pregnancies with history of cholestasis had higher rates of prior preterm birth, earlier gestational age at diagnosis and delivery, and were more likely to receive ursodeoxycholic acid therapy. Pregnancies with history of cholestasis were not associated with spontaneous preterm labor in subsequent pregnancies with cholestasis, but history of cholestasis was associated with iatrogenic preterm birth and neonatal intensive care unit (NICU) admission. After adjusting for confounders, the association with iatrogenic preterm birth and NICU admission were no longer statistically significant. There was no significant association between history of cholestasis and other adverse obstetric outcomes. Conclusion Findings suggests that history of prior cholestasis is not associated with worsening outcomes in subsequent pregnancies complicated by cholestasis. Key Points Prior cholestasis may not alter risk in subsequent pregnancies. Unclear relationship between cholestasis and hepatobiliary disease. Studies needed to develop cholestasis screening protocol. [ABSTRACT FROM AUTHOR]

Background: A high number of stillborn piglets has a negative impact on production and animal welfare. It is an important contributor to piglet mortality around farrowing and continues to rise with the increase of prolificacy. The objective of this study was to build a predictive model of the stillborn rate. Results: This study was performed on two farrow-to-finish farms and one farrow-to-wean farm located in Brittany, France. At each farm, the number of total born (TB), born alive (BA), stillborn piglets (S), the same data at the previous farrowing (TBn− 1, BAn− 1 and Sn− 1), backfat thickness just before farrowing and at previous weaning and parity rank were recorded in our dataset of 3686 farrowings. Bayesian networks were used as an integrated modelling approach to investigate risk factors associated with stillbirth using BayesiaLab® software. Our results suggest the validity of a hybrid model to predict the percentage of stillborn piglets. Three significant risk factors were identified by the model: parity rank (percentage of total mutual information: MI = 64%), Sn− 1 (MI = 25%) and TBn− 1 (MI = 11%). Additionally, backfat thickness just before farrowing was also identified for sows of parity five or more (MI = 0.4%). In practice, under optimal conditions (i.e., low parity rank, less than 8% of stillborn piglets, and a prolificacy lower than 14 piglets at the previous farrowing), our model predicted a stillborn rate almost halved, from 6.5% (mean risk of our dataset) to 3.5% for a sow at the next farrowing. In contrast, in older sows with a backfat thickness less than 15 mm, more than 15% of stillborn and a prolificacy greater than 18 piglets at the previous farrowing, the risk is multiplied by 2.5 from 6.5 to 15.7%. Conclusion: Our results highlight the impact of parity, previous prolificacy and stillborn rate on the probability of stillborn. Moreover, the importance of backfat thickness, especially in old sows, must be considered. This information can help farmers classify and manage sows according to their risk of giving birth to stillborn piglets. [ABSTRACT FROM AUTHOR]

Introduction: The use of dairy x dairy crossbreeding has increased in Sweden. This study aimed to compare crosses between Swedish Red (R), Holstein (H), Jersey (J), and Montbéliarde (M) to purebred R, H, and J for fertility, calving, production, and survival traits. The focus was on F1 crosses between either H or R on the one hand and J or M on the other hand, but three-breed crosses were also studied. Material and methods: There were 2,154,241 observations collected from the official cattle recording database for cows that calved between 2005 and 2020 in 7,390 herds. The dataset was separated into first and second parity and analyzed using a mixed linear model including fixed effects of breed group, herd, and year-season and a random effect of herd-year. Results and discussion: Fertility traits were improved in the F1 crosses with J or M compared with R or H (i.e., JR and MR vs. R; JH and MH vs. H), especially in the first parity. In parity 2, the difference was often not significant. Crossing R or H with Jersey gave lower calving difficulty than in the pure breeds in the first parity. However, crossing with Montbé liarde rather tended to give slightly more calving difficulties, albeit not significantly so. Generally, there was no significant change in stillbirths when crossing purebred R or H with J or M. There was a general tendency for better survival in the F1-crosses, however, only significantly so for Jersey crosses in parity 2 with respect to R or H. F1 between J and H (JH) had a higher 305-day fat yield than H, but lower milk and protein yields. MH had higher fat and protein yields than H and MR had higher 305-d milk and protein yields than R. In conclusion, crossing R or H with either Jersey or Montbeéliarde can be expected to improve fertility and probably also survival. Depending on the current situation, one could choose to improve fat yield (crossing with J) or protein yield (crossing with M), however, depending on the breed, there could be a trade-off, e.g., in milk yield. For other traits, one would not expect any deterioration. [ABSTRACT FROM AUTHOR]

The objective was to review the existing literature reporting on spontaneous abortion (SA) and intrauterine fetal demise (IUFD) associated with cytomegalovirus (CMV) infection. A review using standardized terminology such as 'intrauterine fetal death', 'congenital cytomegalovirus' and 'CMV' was performed using PubMed and Embase (Medline) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Twenty-one studies met inclusion criteria. CMV was identified as a potential or likely factor in a median of 7.1% of SA or IUFD in study cohorts. Of the studies, 11 used fetal remains, 18 used placenta, 6 used serum, and 1 used post-mortem dried blood spot as specimens for testing for CMV. Features commonly observed were fetal thrombotic vasculopathy, hydrops fetalis and chronic villitis. CMV is frequently noted in studies evaluating viral etiologies of SA or IUFD. Large population-based studies are needed to estimate the incidence of CMV-associated SA or IUFD. CMV and congenital CMV should be included on the differential diagnosis in all cases of SA or IUFD of unknown etiology. [ABSTRACT FROM AUTHOR]

Background Congenital anomalies are most common worst outcome as still birth and neonatal mortality during pregnancy. One of the major mental trauma to the mother and family members. It is also a heart felt trauma to doctor also while informing the patient and their relatives. The aim of the study is to determine the congenital anomalies baby born in this relief society hospital in Raniganj. Methods The present retrograde study done in this relief society hospital in Raniganj in a period of January 2015 to June 2024. All the babies delivered in this hospital were included. The new born babies were examined by the obstetrician and the pediatrician properly for any kind of congenital anomalies. Detailed history from mother were also taken, specially for previous birth of any congenital malformation baby. Results During the study period around 8219 babies were born of which 93babies were born with congenital anomalies. The age group of the mother are 18-36 years. The prevalence rate is 1.13%. The system involved predominantly was the musculoskeletal system(40.86%) followed by the central nervous system (23.65%) and the gastrointestinal system(13.97%). The most common anomalies were talipes in the musculoskeletal group and meningomyelocele in CNS. Conclusions Health education and programme based awareness is the key of success for the preventable anomalies. Prepregnancy counselling is good option. Folic acid supplementation is also good for them who are planning for pregnancy. [ABSTRACT FROM AUTHOR]

Objective: To assess stillbirth mortality by Robson ten‐group classification and the usefulness of this approach for understanding trends. Design: Cross‐sectional study. Setting: Prospectively collected perinatal e‐registry data from 16 hospitals in Benin, Malawi, Tanzania and Uganda. Population: All women aged 13–49 years who gave birth to a live or stillborn baby weighting >1000 g between July 2021 and December 2022. Methods: We compared stillbirth risk by Robson ten‐group classification, and across countries, and calculated proportional contributions to mortality. Main outcome measures: Stillbirth mortality, defined as antepartum and intrapartum stillbirths. Results: We included 80 663 babies born to 78 085 women; 3107 were stillborn. Stillbirth mortality by country were: 7.3% (Benin), 1.9% (Malawi), 1.6% (Tanzania) and 4.9% (Uganda). The largest contributor to stillbirths was Robson group 10 (preterm birth, 28.2%) followed by Robson group 3 (multipara with cephalic term singleton in spontaneous labour, 25.0%). The risk of dying was highest in births complicated by malpresentations, such as nullipara breech (11.0%), multipara breech (16.7%) and transverse/oblique lie (17.9%). Conclusions: Our findings indicate that group 10 (preterm birth) and group 3 (multipara with cephalic term singleton in spontaneous labour) each contribute to a quarter of stillbirth mortality. High mortality risk was observed in births complicated by malpresentation, such as transverse lie or breech. The high mortality share of group 3 is unexpected, demanding case‐by‐case investigation. The high mortality rate observed for Robson groups 6–10 hints for a need to intensify actions to improve labour management, and the categorisation may support the regular review of labour progress. [ABSTRACT FROM AUTHOR]

Racial/ethnic disparities in the association between short-term (eg, days, weeks), ambient fine particulate matter (PM2.5) and temperature exposures and stillbirth in the United States have been understudied. A time-stratified, case-crossover design using a distributed lag nonlinear model (0- to 6-day lag) was used to estimate stillbirth odds due to short-term increases in average daily PM2.5 and temperature exposures among 118 632 Medicaid recipients from 2000 to 2014. Disparities by maternal race/ethnicity (Black, White, Hispanic, Asian, American Indian) and zip code–level socioeconomic status (SES) were assessed. In the temperature-adjusted model, a 10 μg m−3 increase in PM2.5 concentration was marginally associated with increased stillbirth odds at lag 1 (0.68%; 95% CI, −0.04% to 1.40%) and lag 2 (0.52%; 95% CI, −0.03 to 1.06) but not lag 0-6 (2.80%; 95% CI, −0.81 to 6.45). An association between daily PM2.5 concentrations and stillbirth odds was found among Black individuals at the cumulative lag (0-6 days: 9.26% 95% CI, 3.12%-15.77%) but not among other races or ethnicities. A stronger association between PM2.5 concentrations and stillbirth odds existed among Black individuals living in zip codes with the lowest median household income (lag 0-6: 14.13%; 95% CI, 4.64%-25.79%). Short-term temperature increases were not associated with stillbirth risk among any race/ethnicity. Black Medicaid enrollees, and especially those living in lower SES areas, may be more vulnerable to stillbirth due to short-term increases in PM2.5 exposure. This article is part of a Special Collection on Environmental Epidemiology. [ABSTRACT FROM AUTHOR]

Customized birthweight centiles have improved the detection of small for gestational age (SGA) and large for gestational age (LGA) babies compared to existing population standards. This study used perinatal registry data to derive coefficients for developing customized growth charts for Qatar. The PEARL registry data on women delivering in Qatar (2017–2018) was used to develop a multivariable linear regression model predicting optimal birthweight. Physiological variables included gestational age, maternal height, weight, ethnicity, parity, and sex of the baby. Pathological variables such as hypertension, preexisting and gestational diabetes and smoking were calculated and excluded to derive the optimal weight at term. The regression model found a term optimal birthweight of 3,235 g for a Qatari nationality mother with median height (159 cm), booking weight (72 kg), parity (1) and gestation at birth (276 days) at the end of an uncomplicated pregnancy. Constitutional coefficients significantly affecting birthweight were gestational age, height, weight, and parity. The main pathological factors were preexisting diabetes (increase by +175.7 g) and smoking (decrease by −190.9 g). The SGA and LGA rates in the entire cohort after applying the population-specific customized centiles were 11.1 and 12.2 %, respectively (contrasting with the Hadlock standard: SGA-26.3 % and LGA-1.8 %, and Fenton standard: SGA-12.9 % and LGA-4.0 %). Constitutional and pathological variations in fetal growth and birthweight apply in the maternity population in Qatar and have been quantified to allow the generation of customised charts for better identification of pregnancies with abnormal growth. Currently in-use population standards may misdiagnose many SGA and LGA babies. [ABSTRACT FROM AUTHOR]

Introduction: The present study was conducted with the aim of evaluating the accuracy of International Classification of Disease Perinatal Mortality (ICD-PM) codes assigned on death certificates before and after an expert panel review. Method: The present study was a mixed methods observational study conducted at Umm al-Benin Hospital, the sole specialized obstetrics and gynecology center affiliated with Mashhad University of Medical Sciences. The study comprised three distinct stages: (1) Collecting primary ICD-PM codes assigned to perinatal death certificates, along with other relevant information, from October 2021 to March 2022; (2) Examining the circumstances of each perinatal death case and re-identifying the causes of death through a consensus process involving a panel of experts comprising pediatricians, obstetrics and gynecology specialists, and nursing and midwifery experts; presenting the new ICD-PM code; (3) Comparing the ICD-PM codes assigned to perinatal death certificates before and after the expert panel's evaluation. Result: During the study period, a total of seven specialized panels were conducted to examine perinatal deaths. Out of the 71 cases, 41 were carefully reviewed by experts. These cases included 32 stillbirths and nine neonatal deaths. The examination process followed specific inclusion and exclusion criteria. The findings revealed that there were no significant changes in the causes of neonatal deaths. However, it was notable that 80% of the previously unknown causes of stillbirths were successfully identified. Notably, the occurrence of stillbirths increased by 78% due to maternal causes and conditions. Conclusion: Convening panels of experts to discuss the causes of perinatal deaths can effectively reduce the percentage of unknown causes, as classified by ICD-PM. This approach also guarantees the availability of essential data for implementing effective interventions to decrease preventable perinatal deaths. [ABSTRACT FROM AUTHOR]

Objectives: Twin pregnancies are at higher risk of stillbirth compared to singletons. Fetal growth restriction (FGR) is a major cause of perinatal mortality, but its impact on twins vs singletons remains unclear. The primary objective of this study was to investigate the association of FGR and small‐for‐gestational age (SGA) with stillbirth in twin compared with singleton pregnancies. A secondary objective was to assess these associations stratified by gestational age at delivery. Furthermore, we aimed to compare the associations of FGR and SGA with stillbirth in twin pregnancies using twin‐specific vs singleton birth‐weight charts, stratified by chorionicity. Methods: This was a retrospective cross‐sectional study of pregnancies receiving obstetric care and giving birth between 1999 and 2022 at St George's Hospital, London, UK. The exclusion criteria included triplet and higher‐order pregnancies, those resulting in miscarriage or live birth at ≤ 23 + 6 weeks, termination of pregnancy and missing data regarding birth weight or gestational age at birth. Birth‐weight data were collected and FGR and SGA were defined as birth weight <5th and <10th centiles, respectively. While standard logistic regression was used for singleton pregnancies, the association of FGR and SGA with stillbirth in twin pregnancies was investigated using mixed‐effects logistic regression models. For twin pregnancies, intercepts were allowed to vary for twin pairs to account for intertwin dependency. Analyses were stratified by gestational age at delivery and chorionicity. Statistical significance was set at P ≤ 0.001. Results: The study included 95 342 singleton and 3576 twin pregnancies. There were 494 (0.52%) stillbirths in singleton and 41 (1.15%) stillbirths in twin pregnancies (17 dichorionic and 24 monochorionic). SGA and FGR were associated significantly with stillbirth in singleton pregnancies across all gestational ages at delivery: the odds ratios (ORs) for SGA and FGR were 2.36 ((95% CI, 1.78–3.13), P < 0.001) and 2.67 ((95% CI, 2.02–3.55), P < 0.001), respectively, for delivery before 32 weeks; 2.70 ((95% CI, 1.71–4.31), P < 0.001) and 2.82 ((95% CI, 1.78–4.47), P < 0.001), respectively, for delivery between 32 and 36 weeks; and 3.85 ((95% CI, 2.83–5.21), P < 0.001) and 4.43 ((95% CI, 3.16–6.12), P < 0.001), respectively, for delivery after 36 weeks. In twin pregnancies, when stratified by gestational age at delivery, both SGA and FGR determined by twin‐specific birth‐weight charts were associated with increased odds of stillbirth for those delivered before 32 weeks (SGA: OR, 3.87 (95% CI, 1.56–9.50), P = 0.003 and FGR: OR, 5.26 (95% CI, 2.11–13.01), P = 0.001), those delivered between 32 and 36 weeks (SGA: OR, 6.67 (95% CI, 2.11–20.41), P = 0.001 and FGR: OR, 9.54 (95% CI, 3.01–29.40), P < 0.001) and those delivered beyond 36 weeks (SGA: OR, 12.68 (95% CI, 2.47–58.15), P = 0.001 and FGR: OR, 23.84 (95% CI, 4.62–110.25), P < 0.001). However, the association of stillbirth with SGA and FGR in twin pregnancies was non‐significant when diagnosis was based on singleton charts (before 32 weeks: SGA, P = 0.014 and FGR, P = 0.005; 32–36 weeks: SGA, P = 0.036 and FGR, P = 0.008; after 36 weeks: SGA, P = 0.080 and FGR, P = 0.063). Conclusion: Our study demonstrates that SGA and, especially, FGR are associated significantly with an increased risk of stillbirth across all gestational ages in singleton pregnancies, and in twin pregnancies when twin‐specific birth‐weight charts are used. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. Linked article: There is a comment on this article by Nicolaides et al. Click here to view the Correspondence. [ABSTRACT FROM AUTHOR]

This study aims to investigate whether trial of labor after cesarean delivery (TOLAC) in women with antepartum fetal death, is associated with an elevated risk of maternal morbidity. A retrospective multicenter. TOLAC of singleton pregnancies following a single low-segment incision were included. Maternal adverse outcomes were compared between women with antepartum fetal death and women with a viable fetus. Controls were matched with cases in a 1:4 ratio based on their previous vaginal births and induction of labor rates. Univariate analysis was followed by multiple logistic regression modeling. During the study period, 181 women experienced antepartum fetal death and were matched with 724 women with viable fetuses. Univariate analysis revealed that women with antepartum fetal death had significantly lower rates of TOLAC failure (4.4% vs. 25.1%, p < 0.01), but similar rates of composite adverse maternal outcomes (6.1% vs. 8.0%, p = 0.38) and uterine rupture (0.6% vs. 0.3%, p = 0.56). Multivariable analyses controlling for confounders showed that an antepartum fetal death vs. live birth isn't associated with the composite adverse maternal outcomes (aOR 0.96, 95% CI 0.21–4.44, p = 0.95). TOLAC in women with antepartum fetal death is not associated with an increased risk of adverse maternal outcomes while showing high rates of successful vaginal birth after cesarean (VBAC). [ABSTRACT FROM AUTHOR]

Background Objectives Methods Results Conclusions To minimise the risk of perinatal mortality, clinicians and expectant mothers must understand the risks and benefits associated with continuing the pregnancy.Report the gestation‐specific risk of perinatal mortality at term.Population‐based cohort study using linked health data to identify all singleton births at gestations 37–41 weeks, in Western Australia (WA) from 2009 to 2019. Lifetable analysis was used to combine the risk of each type of perinatal mortality and calculate the cumulative risk of perinatal mortality, termed the perinatal risk index (PRI). Rates of antepartum and intrapartum stillbirth and neonatal death, as well as the PRI, were examined for each gestational week at term by non‐Aboriginal and Aboriginal ethnicity. For non‐Aboriginal women, rates were also examined by time‐period (pre‐ vs. post‐WA Preterm Birth Prevention Initiative (the Initiative) rollout), primiparity, and obstetric risk.There were 332,084 singleton term births, including 60 perinatal deaths to Aboriginal mothers (3.2 deaths per 1000 births to Aboriginal mothers) and 399 perinatal deaths to non‐Aboriginal mothers (1.3 deaths per 1000 births to non‐Aboriginal mothers). For non‐Aboriginal women, the PRI was at its lowest (PRI 0.80, 95% CI 0.61, 1.00) at 39 weeks gestation. For Aboriginal women, it was at its lowest at 38 weeks (PRI 2.43, 95% CI 0.48, 4.39) with similar risk at 39 weeks (PRI 2.68, 95% CI 1.22, 4.14). The PRI increased steadily after 39 weeks gestation. The risk of perinatal mortality was higher among Aboriginal women. The gestation‐specific perinatal mortality rates were similar by the time‐period, primiparity and obstetric risk.The gestational ages at term associated with the lowest risk of perinatal mortality reinforce that the recommendation not to deliver before 39 weeks without medical indication is applicable to both Aboriginal and non‐Aboriginal women giving birth in WA. There was no increase in the perinatal mortality rate associated with the introduction of the Initiative. [ABSTRACT FROM AUTHOR]