Differences in Postmortem Investigation Following Perinatal Death

2021 ◽  
Author(s):  
Matthew A. Nestander ◽  
Kathryn Berryman ◽  
Robert Brady ◽  
James Aden ◽  
Gayle Haischer-Rollo
Keyword(s):  
Fetal Death ◽  
Perinatal Death ◽  
Intrauterine Fetal Death ◽  
Placental Pathology ◽  
Perinatal Deaths ◽  
Neonatal Deaths ◽  
Key Points ◽  
To Receive ◽  
Postmortem Genetic Testing ◽  
Early Neonatal Deaths

Objective The study aimed to describe the postmortem investigation patterns for perinatal deaths and compare the degree of investigation between stillbirths and early neonatal deaths. Study Design We conducted a single-center retrospective review of all perinatal deaths from 2011 to 2017. Perinatal death was defined as intrauterine fetal death at ≥20 weeks' gestation, plus neonatal deaths within the first 7 days of life. Rates of postmortem investigation were compared. Results There were 97 perinatal deaths, with 54 stillbirths (56%) and 43 neonatal deaths (44%). Stillbirths were significantly more likely to receive autopsy (p = 0.013) and postmortem genetic testing (p = 0.0004) when compared with neonatal deaths. Maternal testing was also more likely in stillbirths than neonatal deaths. A total of 32 deaths (33%) had no postmortem evaluation beyond placental pathology. Conclusion Investigation following perinatal death is more likely in stillbirths than neonatal deaths. Methods to improve postmortem investigation following perinatal death are needed, particularly for neonatal deaths. Key Points

scholarly journals KEMATIAN PERINATAL DI BLU RSU PROF. DR. R. D. KANDOU MANADO

2013 ◽  
Vol 1 (1) ◽  
Author(s):  
Mercy Tumundo ◽  
Hermie Tendean ◽  
Eddy Suparman
Keyword(s):  
Mortality Rate ◽  
Perinatal Mortality ◽  
Perinatal Death ◽  
Developed Countries ◽  
Perinatal Deaths ◽  
Neonatal Deaths ◽  
Normal Birth ◽  
Perinatal Mortality Rate ◽  
Still Births ◽  
Early Neonatal Deaths

Abstract: Perinatal death is a big problem especially in a developing country. Some of the hospitals in Indonesia have declared that the number of perinatal death in developing countries is higher than in  developed countries. The purpose of this research is to determine the incidence of the factors that affecting perinatal mortality at Prof. DR. R. D. Kandou General Hospital Manado. This research used retrospective descriptive method through medical records of perinatal deaths patients. There were 164 cases of perinatal deaths found where 109 cases still births and 55 cases were early neonatal deaths in 2011, so the number of perinatal mortality rate was 40.17 per mil. The highest number of perinatal death was from multigravide mother, mother with age  ≥ 35 years old, spontaneous parturition. There were unknown caused of still births cases (77,06%) and sepsis in early neonatal deaths. The normal birth weight is also with most include of perinatal deaths. Keywords: still birth, early neonatal death, perinatal deaths, perinatal mortality rate.     Abstrak: Kematian perinatal merupakan masalah besar khususnya di negara sedang berkembang. Beberapa rumah sakit pendidikan di Indonesia melaporkan angka kematian perinatal yang tinggi dibandingkan dengan laporan angka kematian perinatal di negara – negara maju yang jumlahnya rendah. Tujuan penelitian untuk mengetahui angka kejadian kematian perinatal serta faktor – faktor yang mempengaruhinya. Penelitian ini menggunakan metode deskriptif retrospektif dengan menggunakan data catatan medik pasien. Hasil penelitian yaitu jumlah kematian perinatal pada tahun 2011 sebanyak 164 kasus dengan 109 kasus lahir mati dan 55 kasus kematian neonatal dini sehingga angka kematian perinatal pada tahun 2011 yaitu 40.17 per mil. Kematian perinatal paling banyak pada ibu multigravida, ibu dengan kelompok usia ≥ 35 tahun, menggunakan jenis persalinan spontan. Pada lahir mati 77.06 % penyebab kematiannya tidak diketahui sedangkan sepsis paling banyak menyebabkan kematian neonatal dini. Berat badan lahir normal juga menjadi salah satu faktor terjadinya kematian perinatal. Kata kunci: lahir mati, kematian neonatal dini, kematian perinatal, angka kematian perinatal.

scholarly journals Epidemiological investigation of perinatal deaths in Recife-Pernambuco: a quality assessment

2018 ◽  
Vol 71 (5) ◽  
pp. 2519-2526 ◽  
Author(s):  
Isabela de Lucena Heráclio ◽  
Maysa Almeida da Silva ◽  
Mirella Bezerra Rodrigues Vilela ◽  
Conceição Maria de Oliveira ◽  
Paulo Germano de Frias ◽  
...  
Keyword(s):  
Prenatal Care ◽  
Perinatal Death ◽  
Family Characteristics ◽  
Perinatal Deaths ◽  
Neonatal Deaths ◽  
Information Block ◽  
Care Family ◽  
Components Method ◽  
Death Investigation ◽  
Median Rate

ABSTRACT Objective: to evaluate the completeness of perinatal death investigation sheets, stratified by age components. Method: descriptive study carried out in Recife, PE, in 2014. Among 308 perinatal deaths, 46 were excluded from this study due to association with congenital malformations, and 7 due to missing investigation sheets. Analysis included 255 deaths (160 fetal deaths, and 95 preterm neonatal deaths). The degree of completeness of 98 variables was calculated. They were aggregated into six blocks: identification, prenatal care, birth care, family characteristics, occurrence of death and conclusions and recommendations. Results: the median rate of completeness for perinatal death investigation sheets was 85.7% (82.8% for records of fetal deaths and 89.5% for records of preterm neonatal deaths). The best-filled information block was “identification” (96.1%), as well as its components: fetal (94.7%) and preterm neonatal (97.9%). The worst was “prenatal care” (69.8%), along with its components: fetal (73.8%) and preterm neonatal (67.4%). Conclusion: investigation sheets had good completeness; there were differences between variables and components of perinatal death.

The Contribution of an Infectious Workup in Understanding Stillbirth

2019 ◽  
Author(s):  
Yuval Fouks ◽  
Ariel Many ◽  
Yael Shulman ◽  
Stella Bak ◽  
Shiri Shinar
Keyword(s):  
Medical Records ◽  
Fetal Death ◽  
Acute Infection ◽  
Intrauterine Fetal Death ◽  
Placental Pathology ◽  
Fetal Autopsy ◽  
Fetal Infection ◽  
Included Review ◽  
The Mean ◽  
Infectious Etiology

Abstract Objective This study was aimed to assess the utility of diagnostic tests of maternal and fetal infection in the evaluation of stillbirth. Study Design A single-center retrospective study from January 2011 to December 2016 of all women presenting to the hospital with intrauterine fetal death at or after 20 weeks of gestation. Standard evaluation included review of medical records, clinical and laboratory inflammatory workup, maternal serologies, fetal autopsy, placental pathology, and fetal and placental cultures. A suspected infectious etiology was defined as meeting at least two diagnostic criteria, and only after exclusion of any other identifiable stillbirth cause. Results During the 7-year study period, 228 cases of stillbirth were diagnosed at our center. An infectious etiology was the suspected cause of stillbirth in 35 cases (15.3%). The mean gestational age of infection-related stillbirth was 28 1/7 (range: 22–37) weeks, while for a noninfectious etiology, it was 34 0/7 (range: 25–38) weeks (p = 0.005). Placental histological findings diagnostic of overt chorioamnionitis and funisitis were observed in 31 (88.5%) cases. In 16 (45.7%) cases the placental and fetal cultures were positive for the same pathogen. Serology of acute infection was positive in three (8.5%) of the cases. Conclusion Maternal and fetal infectious workup is valuable in the investigation of stillbirth, particularly before 30 weeks of gestation and should be considered a part of standard evaluation.

Study of obstetric factors in perinatal morbidity and mortality at a tertiary centre

2017 ◽  
Vol 7 (1) ◽  
pp. 198
Author(s):  
Sanjaykumar G. Tambe ◽  
Yogesh A. Thawal ◽  
Tania Anand ◽  
Dipak Suresh Kolate
Keyword(s):  
Perinatal Mortality ◽  
Health Care Providers ◽  
Perinatal Death ◽  
Golden Rule ◽  
Vital Statistics ◽  
Safe Motherhood ◽  
Care Providers ◽  
Perinatal Deaths ◽  
Neonatal Deaths ◽  
Tertiary Center

Background: Safe motherhood and child survival have always been a concern for the policymakers but perinatal mortality, especially stillbirths, have not received due attention. There are 5.9 million perinatal deaths worldwide, almost all of which occur in developing countries. Stillbirths account for over half of all perinatal deaths. This study was aimed to determine perinatal mortality rate and related obstetrics risk factors. Perinatal mortality is only a tip of the iceberg, morbidity being much higher. Vital statistics obtained through this study may serve an important source of information to guide the public health policy makers and health care providers in future.Methods: Present observational study was undertaken in a tertiary center to look into various maternal factors and possible cause of perinatal death. All perinatal deaths including stillbirths (SBs) and early neonatal deaths (ENNDs) within 0-7 days of birth after 28 weeks of gestation were analysed. The data was collected through a pre-designed proforma.Results: Perinatal mortality is 66.27/1000 births in our centre, where 37% were intrauterine deaths, 34% were neonatal deaths and 29% were still births. Preterm, pregnancy induced hypertension; abruptio placentae remain the most important factors for perinatal loss.Conclusions: One of the reasons for high perinatal mortality in tertiary centres is because of poor antenatal care at peripheral centres and late referrals. Early detection of obstetric complications and aggressive treatment is one of golden rule to reduce perinatal loss.

scholarly journals Placental pathology in intrauterine fetal death

2020 ◽  
Vol 11 (SPL4) ◽  
pp. 2376-2380
Author(s):  
Nanda J. Patil ◽  
Jyoti S. Tele ◽  
Rohit S. Kadam ◽  
Pawar S. J ◽  
Sujata M. Kumbar
Keyword(s):  
Fetal Death ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Mirror Image ◽  
Intrauterine Fetal Death ◽  
Care Hospital ◽  
Placental Pathology ◽  
Cross Sectional ◽  
Present Cross Sectional Study ◽  
To Come

Placenta is the most accessible and readily evaluable specimen which is mirror image of pregnancy. The objective here is to study the histomorphological changes in placenta in cases of intrauterine fetal deaths and to study correlation of placental findings with causes of fetal death which is significant to understand. The present cross sectional study was carried out in Department of Pathology of a tertiary care hospital from June 2015 to May 2017. Study of Placental Pathology in Intrauterine Fetal Death cases comprised of 99 placentas. The present study was undertaken to study the placental pathology in cases of intrauterine fetal death. IUFD was found to be more common in primigravida 50/99 (50.50%) mothers. Placental study gives useful morphological information regarding the abnormality of pregnancy. Gross and microscopic examination of the placenta plays an important role in identifying the underlying causes of fetal death and helps prevent further recurrence by making appropriate interventions during the next pregnancy. Study of placental pathology gives clues to events occurring throughout gestation and can potentially help to answer, questions concerning pregnancy management and risk assessment of future pregnancies. It will help the researchers who are doing the research in the field of placental pathology in the days to come.

Perinatal Deaths in Twin Pregnancy: A 22-Year Review

1988 ◽  
Vol 37 (1) ◽  
pp. 47-54 ◽  
Author(s):  
R.H. Lumme ◽  
S.V. Saarikoski
Keyword(s):  
Perinatal Mortality ◽  
Twin Pregnancy ◽  
Distress Syndrome ◽  
Preterm Births ◽  
Central Hospital ◽  
Perinatal Deaths ◽  
Neonatal Deaths ◽  
Obstetric Management ◽  
Twin Pregnancies ◽  
Early Neonatal Deaths

AbstractChanges in the management of 1120 twin pregnancies delivered in Tampere University Central Hospital during the years 1964-1985 were studied, together with changes in the pattern of perinatal deaths. Perinatal mortality decreased from 7.4% in 1964-68 to 3.5% in 1981-85. There were no significant changes in stillbirths. The decrease of perinatal mortality resulted from a reduction in early neonatal deaths, mainly those due to respiratory distress syndrome. Changes in obstetric management include earlier diagnosis by ultrasound, intrapartum monitoring, and an increase in cesarean section rate from 4% to 32%. There is still a need for a reduction in the number of very early preterm births, and for more effective intrauterine supervision of twin pregnancies.

scholarly journals Anemia during Pregnancy: Most Preventable yet most Prevalent

2011 ◽  
Vol 3 (2) ◽  
pp. 75-77 ◽  
Author(s):  
Sulabha Joshi ◽  
Sunita Ghike ◽  
Anuja Bhalerao ◽  
Anjali Kawthalkar
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Antenatal Care ◽  
Perinatal Outcome ◽  
Fetal Death ◽  
Perinatal Death ◽  
Perinatal Outcomes ◽  
Fetal Outcome ◽  
Intrauterine Fetal Death ◽  
Apgar Scores

ABSTRACT Objective To study the relationship between maternal hemoglobin and maternal and perinatal outcomes in a cohort of 1200 women, and to highlight the importance of antenatal care to improve maternal health, maternal and fetal outcome. Method All singleton pregnancies delivering at NKPSIMS, from January 2009 to December 2009 that fulfilled the required criteria were included. Results Out of 1200 women, 787 were anemic (67.2%) < 11 gm of Hb and 413 were nonanemic. Perinatal outcome included preterm delivery, birth weight, intrauterine growth restriction, perinatal death, low Apgar scores and intrauterine fetal death. Risk of preterm and low birth weight among anemic women was 4.2 times and 1.8 times more than nonanemic women. The neonates of anemic women had 1.8 times more risk of low Apgar scores at 1 minute. Among anemic women there was 2.4 times greater risk of intrauterine fetal death than nonanemic women. The women with anemia had 2.5 times higher incidence of PPH than nonanemic women. Puerperal complications were 2.5 times more in anemic women than nonanemic women. Conclusions Regular patient education by imparting proper knowledge regarding iron-rich foods, food fortification, implementation of anemia prophylaxis program from adolescence, regular antenatal care from 1st trimester has a vital role in assessing and managing maternal anemia timely, and it directly affects the perinatal outcome. The patients with anemia have higher risk of having low birth weight, preterm birth and Intrauterine fetal death (Rawalmeds 2007,32:102:101:104).

scholarly journals Improving Diagnostic Classification of Stillbirths and Neonatal Deaths Using ICD-PM (International Classification of Diseases for Perinatal Mortality) Codes: Validation Study (Preprint)

2020 ◽  
Author(s):  
Hiu Mei Luk ◽  
Emma Allanson ◽  
Wai-Kit Ming ◽  
Wing Cheong Leung
Keyword(s):  
Perinatal Mortality ◽  
Perinatal Death ◽  
International Classification Of Diseases ◽  
Diagnostic Classification ◽  
Code System ◽  
Perinatal Deaths ◽  
Neonatal Deaths ◽  
Classification Of Diseases ◽  
Death Data

BACKGROUND Stillbirths and neonatal deaths have long been imperfectly classified and recorded worldwide. In Hong Kong, the current code system is deficient (&gt;90% cases with unknown causes) in providing the diagnoses of perinatal mortality cases. OBJECTIVE The objective of this study was to apply the International Classification of Diseases for Perinatal Mortality (ICD-PM) system to existing perinatal death data. Further, the aim was to assess whether there was any change in the classifications of perinatal deaths compared with the existing classification system and identify any areas in which future interventions can be made. METHODS We applied the ICD-PM (with International Statistical Classification of Diseases and Related Health Problems, 10th Revision) code system to existing perinatal death data in Kwong Wah Hospital, Hong Kong, to improve diagnostic classification. The study included stillbirths (after 24 weeks gestation) and neonatal deaths (from birth to 28 days). The retrospective data (5 years) from May 1, 2012, to April 30, 2017, were recoded by the principal investigator (HML) applying the ICD-PM, then validated by an overseas expert (EA) after she reviewed the detailed case summaries. The prospective application of ICD-PM from May 1, 2017, to April 30, 2019, was performed during the monthly multidisciplinary perinatal meetings and then also validated by EA for agreement. RESULTS We analyzed the data of 34,920 deliveries, and 119 cases were included for analysis (92 stillbirths and 27 neonatal deaths). The overall agreement with EA of our codes using the ICD-PM was 93.2% (111/119); 92% (78/85) for the 5 years of retrospective codes and 97% (33/34) for the 2 years of prospective codes (<i>P</i>=.44). After the application of the ICD-PM, the overall proportion of unknown causes of perinatal mortality dropped from 34.5% (41/119) to 10.1% (12/119) of cases (<i>P</i>&lt;.001). CONCLUSIONS Using the ICD-PM would lead to a better classification of perinatal deaths, reduce the proportion of unknown diagnoses, and clearly link the maternal conditions with these perinatal deaths.

scholarly journals Improving Diagnostic Classification of Stillbirths and Neonatal Deaths Using ICD-PM (International Classification of Diseases for Perinatal Mortality) Codes: Validation Study

10.2196/20071 ◽  
2020 ◽  
Vol 8 (8) ◽  
pp. e20071
Author(s):  
Hiu Mei Luk ◽  
Emma Allanson ◽  
Wai-Kit Ming ◽  
Wing Cheong Leung
Keyword(s):  
Perinatal Mortality ◽  
Perinatal Death ◽  
International Classification Of Diseases ◽  
Diagnostic Classification ◽  
Code System ◽  
Perinatal Deaths ◽  
Neonatal Deaths ◽  
Classification Of Diseases ◽  
Death Data

Background Stillbirths and neonatal deaths have long been imperfectly classified and recorded worldwide. In Hong Kong, the current code system is deficient (>90% cases with unknown causes) in providing the diagnoses of perinatal mortality cases. Objective The objective of this study was to apply the International Classification of Diseases for Perinatal Mortality (ICD-PM) system to existing perinatal death data. Further, the aim was to assess whether there was any change in the classifications of perinatal deaths compared with the existing classification system and identify any areas in which future interventions can be made. Methods We applied the ICD-PM (with International Statistical Classification of Diseases and Related Health Problems, 10th Revision) code system to existing perinatal death data in Kwong Wah Hospital, Hong Kong, to improve diagnostic classification. The study included stillbirths (after 24 weeks gestation) and neonatal deaths (from birth to 28 days). The retrospective data (5 years) from May 1, 2012, to April 30, 2017, were recoded by the principal investigator (HML) applying the ICD-PM, then validated by an overseas expert (EA) after she reviewed the detailed case summaries. The prospective application of ICD-PM from May 1, 2017, to April 30, 2019, was performed during the monthly multidisciplinary perinatal meetings and then also validated by EA for agreement. Results We analyzed the data of 34,920 deliveries, and 119 cases were included for analysis (92 stillbirths and 27 neonatal deaths). The overall agreement with EA of our codes using the ICD-PM was 93.2% (111/119); 92% (78/85) for the 5 years of retrospective codes and 97% (33/34) for the 2 years of prospective codes (P=.44). After the application of the ICD-PM, the overall proportion of unknown causes of perinatal mortality dropped from 34.5% (41/119) to 10.1% (12/119) of cases (P<.001). Conclusions Using the ICD-PM would lead to a better classification of perinatal deaths, reduce the proportion of unknown diagnoses, and clearly link the maternal conditions with these perinatal deaths.

scholarly journals Causes of death among full term stillbirths and early neonatal deaths in the Region of Southern Denmark

2018 ◽  
Vol 46 (2) ◽  
pp. 197-202 ◽  
Author(s):  
Millie Nguyen Basu ◽  
Iben Birgit Gade Johnsen ◽  
Sonja Wehberg ◽  
Rikke Guldberg Sørensen ◽  
Torben Barington ◽  
...  
Keyword(s):  
Causes Of Death ◽  
Fetal Death ◽  
Full Term ◽  
Classification Systems ◽  
Normal Body Mass Index ◽  
Term Infants ◽  
Neonatal Deaths ◽  
Associated Conditions ◽  
Stillborn Infant ◽  
Early Neonatal Deaths

AbstractObjective:We examined the causes of death amongst full term stillbirths and early neonatal deaths.Methods:Our cohort includes women in the Region of Southern Denmark, who gave birth at full term to a stillborn infant or a neonate who died within the first 7 days from 2010 through 2014. Demographic, biometric and clinical variables were analyzed to assess the causes of death using two classification systems: causes of death and associated conditions (CODAC) and a Danish system based on initial causes of fetal death (INCODE).Results:A total of 95 maternal-infant cases were included. Using the CODAC and INCODE classification systems, we found that the causes of death were unknown in 59/95 (62.1%). The second most common cause of death in CODAC was congenital anomalies in 10/95 (10.5%), similar to INCODE with fetal, genetic, structural and karyotypic anomalies in 11/95 (11.6%). The majority of the mothers were healthy, primiparous, non-smokers, aged 20–34 years and with a normal body mass index (BMI).Conclusion:Based on an unselected cohort from an entire region in Denmark, the cause of stillbirth and early neonatal deaths among full term infants remained unknown for the vast majority.

Sign in / Sign up

Export Citation Format

Share Document