Perinatal outcomes in Finnish twins: a retrospective study

Abstract Background To establish the changes in perinatal morbidity and mortality in twin pregnancies in Finland, a retrospective register research was conducted. Our extensive data from a 28-year study period provide important information on the outcome of twin pregnancies in Finland that has previously not been reported to this extent. Methods All 23,498 twin pregnancies with 46,996 children born in Finland during 1987–2014 were included in the study. Data were gathered from the Medical Birth Register and the Hospital Discharge Register (Finnish Institute for Health and Welfare, Finland) regarding perinatal mortality (PNM) and morbidity. For statistical analysis, binomial regression analysis and crosstabs were performed. The results are expressed in means, percentages and ranges with comparison to singletons when appropriate. Odds ratios from binomial regression analysis are reported. A p-value <0.05 was considered statistically significant. Results There were 46,363 liveborn and 633 stillborn twins in Finland during 1987–2014. Perinatal mortality decreased markedly, from 45.1 to 6.5 per 1000 for twin A and from 54.1 to 11.9 per 1000 for twin B during the study period. Yet, the PNM difference between twin A and B remained. Early neonatal mortality did not differ between twins, but has decreased in both. Asphyxia, respiratory distress syndrome, need for antibiotics and Neonatal Intensive Care Unit (NICU) stay were markedly more common in twin B. Conclusions In Finland, PNM and early neonatal mortality in twins decreased significantly during 1987–2014 and are nowadays very low. However, twin B still faces more complications. The outline provided may be used to further improve the monitoring and thus perinatal outcome of twins, especially twin B.

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Prospective study to explore changes in quality of care and perinatal outcomes after implementation of perinatal death audit in Uganda

BMJ Open ◽

10.1136/bmjopen-2018-027504 ◽

2020 ◽

Vol 10 (7) ◽

pp. e027504

Author(s):

Victoria Nakibuuka Kirabira ◽

Mamuda Aminu ◽

Juan Emmanuel Dewez ◽

Romano Byaruhanga ◽

Pius Okong ◽

...

Keyword(s):

Mortality Rate ◽

Neonatal Mortality ◽

Perinatal Mortality ◽

Perinatal Death ◽

Perinatal Outcomes ◽

Stillbirth Rate ◽

Neonatal Mortality Rate ◽

Neonatal Deaths ◽

Early Neonatal Mortality ◽

Early Neonatal Mortality Rate

ObjectiveTo assess the effects of perinatal death (PND) audit on perinatal outcomes in a tertiary hospital in Kampala.DesignInterrupted time series (ITS) analysis.SettingNsambya Hospital, Uganda.ParticipantsLive births and stillbirths.InterventionsPND audit.Primary and secondary outcome measuresPrimary outcomes: perinatal mortality rate, stillbirth rate, early neonatal mortality rate. Secondary outcomes: case fatality rates (CFR) for asphyxia, complications of prematurity and neonatal sepsis.Results526 PNDs were audited: 142 (27.0%) fresh stillbirths, 125 (23.8%) macerated stillbirths and 259 (49.2%) early neonatal deaths. The ITS analysis showed a decrease in perinatal death (PND) rates without the introduction of PND audits (incidence risk ratio (IRR) (95% CI) for time=0.94, p<0.001), but an increase in PND (IRR (95% CI)=1.17 (1.0 to –1.34), p=0.0021) following the intervention. However, when overdispersion was included in the model, there were no statistically significant differences in PND with or without the intervention (p=0.06 and p=0.44, respectively). Stillbirth rates exhibited a similar pattern. By contrast, early neonatal death rates showed an overall upward trend without the intervention (IRR (95% CI)=1.09 (1.01 to 1.17), p=0.01), but a decrease following the introduction of the PND audits (IRR (95% CI)=0.35 (0.22 to 0.56), p<0.001), when overdispersion was included. The CFR for prematurity showed a downward trend over time (IRR (95% CI)=0.94 (0.88 to 0.99), p=0.04) but not for the intervention. With regards CFRs for intrapartum-related hypoxia or infection, no statistically significant effect was detected for either time or the intervention.ConclusionThe introduction of PND audit showed no statistically significant effect on perinatal mortality or stillbirth rate, but a significant decrease in early neonatal mortality rate. No effect was detected on CFRs for prematurity, intrapartum-related hypoxia or infections. These findings should encourage more research to assess the effectiveness of PND reviews on perinatal deaths in general, but also on stillbirths and neonatal deaths in particular, in low-resource settings.

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Selective IUGR in dichorionic twins: what can Doppler assessment and growth discordancy say about neonatal outcomes?

Journal of Perinatal Medicine ◽

10.1515/jpm-2017-0253 ◽

2018 ◽

Vol 46 (9) ◽

pp. 1028-1034 ◽

Cited By ~ 1

Author(s):

Paola Algeri ◽

Matteo Frigerio ◽

Maria Lamanna ◽

Petya Vitanova Petrova ◽

Sabrina Cozzolino ◽

...

Keyword(s):

Intrauterine Growth Restriction ◽

Neonatal Intensive Care ◽

Neonatal Resuscitation ◽

Perinatal Outcomes ◽

Growth Restriction ◽

Abdominal Circumference ◽

Doppler Study ◽

Umbilical Artery Doppler ◽

Nicu Admission ◽

Twin Pregnancies

Abstract Objective: The aim of the present study was to assess, in a population of dichorionic twin pregnancies with selective growth restriction, the effect of inter-twin differences by use of Doppler velocimetry and fetal growth discordancy on perinatal outcomes. Methods: This was a retrospective study including dichorionic twin pregnancies from January 2008 to December 2015 at the Department of Obstetrics and Gynecology of Fondazione MBBM. Only dichorionic twin pregnancies affected by selective intrauterine growth restriction (IUGR) delivering at ≥24 weeks were included in the study. Results: We found that twin pregnancies with inter-twin estimated fetal weight (EFW) discordance ≥15% were significantly associated with a higher risk of preterm delivery before 32 (P=0.004) and 34 weeks (P=0.04). Similarly, twin pregnancies with inter-twin abdominal circumference (AC) discordance ≥30° centiles were associated with a higher rate of neonatal intensive care unit (NICU) admission (P=0.02), neonatal resuscitation (P=0.02) and adverse neonatal composite outcome (P=0.04). Of interest, when comparing twin pregnancies according to Doppler study, growth restricted twins had a higher rate of composite neonatal outcome and in multivariate analysis, an abnormal Doppler was an independent risk factor for this outcome. Conclusions: Our study associated growth discrepancy with specific pregnancy outcomes, according to defined cut-offs. In addition, we demonstrated that an abnormal umbilical artery Doppler is independently associated with a composite neonatal adverse outcome in growth restricted fetuses.

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Perinatal morbidity and early neonatal mortality in twin pregnancies

Open Journal of Obstetrics and Gynecology ◽

10.4236/ojog.2013.31017 ◽

2013 ◽

Vol 03 (01) ◽

pp. 78-89 ◽

Cited By ~ 9

Author(s):

Corinna Peter ◽

Paul Wenzlaff ◽

Jan Kruempelmann ◽

Gerhard Alzen ◽

Eva Bueltmann ◽

...

Keyword(s):

Neonatal Mortality ◽

Perinatal Morbidity ◽

Early Neonatal Mortality ◽

Twin Pregnancies

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Evaluation of vaginal birth safety in twin pregnancies with the first twin in cephalic presentation

Aegean Journal of Obstetrics and Gynecology ◽

10.46328/aejog.v3i3.93 ◽

2021 ◽

Vol 3 (3) ◽

pp. 59-63

Author(s):

Bekir Kahveci ◽

Mehmet Sukru Budak ◽

Ihsan Baglı ◽

Sedat Akgol

Keyword(s):

Neonatal Mortality ◽

Vaginal Birth ◽

Neonatal Outcomes ◽

Cesarean Birth ◽

Early Neonatal Mortality ◽

Mode Of Birth ◽

Adverse Neonatal Outcomes ◽

Early Neonatal Mortality Rate ◽

Vertex Presentation ◽

Twin Pregnancies

Objective: To evaluate vaginal birth safety by comparing the results of cesarean birth in twin pregnancies with the first twin in vertex presentation. Material and methods: A retrospective cohort study of vertex-presenting twin pregnancies between 32 weeks 0 days and 38 weeks 6 days of gestation was conducted at our hospital from January 2013 to December 2014. The study population was divided according to the mode of birth. The primary outcome was early neonatal mortality, and secondary outcomes related to maternal and perinatal clinical characteristics were analysed between the groups. Results: Of 45,166 births, 1.92% (n = 869) were twin pregnancies. Of the 295 pregnancies meeting the study criteria, 30.16% (n = 89) were in the vaginal birth group, while the remaining 69.84% (n = 206) were in the cesarean birth group. In the vaginal birth group, all the first twins were delivered via vaginal birth, while among the second twins, 82.03% (n = 73) were delivered via vaginal birth, and the remaining 17.97% (n = 16) were delivered via cesarean birth. In the vaginal birth group, the early neonatal mortality rate was 22.4‰ (n = 2), and it was 9.7‰ (n = 2) in the cesarean birth group. All of the deaths occurred in pregnancies under 37 weeks of gestation. Conclusion: The neonatal outcomes between the vaginal birth and cesarean birth groups were similar in term pregnancies with the first in twin vertex presentation, whereas adverse neonatal outcomes were increased in the vaginal birth group in preterm second twin pregnancies.

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Maternal complications in twin pregnancies in Finland during 1987–2014: a retrospective study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-019-2498-x ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 4

Author(s):

Annu-Riikka S. Rissanen ◽

Riina M. Jernman ◽

Mika Gissler ◽

Irmeli Nupponen ◽

Mika E. Nuutila

Keyword(s):

Retrospective Study ◽

Postpartum Haemorrhage ◽

Study Data ◽

Risk Category ◽

Maternal Complications ◽

Pregnancy And Childbirth ◽

National Medical ◽

Medical Birth Register ◽

Twin Pregnancies ◽

Cholestasis Of Pregnancy

Abstract Background To investigate the trends and changes in the incidence and overall outcome of twin pregnancies in Finland, a retrospective study was conducted with emphasis on maternal complications, covering a 28-year study period. Methods All 23,498 twin pregnancies with 46,363 live born and 633 stillborn children in Finland during 1987–2014 were included in the study. Data were collected from the national Medical Birth Register and the Care Register on Hospital Care (Finnish Institute for Health and Welfare, Finland) regarding the parturients’ characteristics and incidences of several pregnancy and childbirth complications. The incidences of twin pregnancies and maternal complications during pregnancy and childbirth are the main outcome measures of the study. The results are expressed in percentages, means, medians, ranges and standard deviations (SD), when appropriate. Results Twins comprised 1.4% of all births in Finland in 1987–2014. Parturients’ mean age has remained stable, but the share of over 35 year-old parturients is increasing. The incidences of pre-eclampsia, intrahepatic cholestasis of pregnancy, gestational diabetes and postpartum haemorrhage have risen during the study period. Almost half (44.9%) of twins were born preterm, almost half via Caesarean section (47.1%), and 27.7% of twin labours were induced. Conclusions Several pregnancy complications increased during the study period. Advanced maternal age among twin parturients has risen, enhancing the risks for developing complications in a pregnancy already of a high-risk category, and predisposing to preterm delivery. National and international guidelines are necessary to improve the overall outcome of twin pregnancies.

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The result of 10 years of experience in monitoring indicators of infant and perinatal mortality in Khabarovsk Krai

GYNECOLOGY ◽

10.26442/20795696.2020.5.200142 ◽

2020 ◽

Vol 22 (5) ◽

pp. 12-16

Author(s):

Tatyana Yu. Pestrikova

Keyword(s):

Neonatal Mortality ◽

Perinatal Mortality ◽

Care Service ◽

Obstetric Care ◽

Federal District ◽

Mortality Rates ◽

Infant Mortality Rate ◽

Khabarovsk Krai ◽

Early Neonatal Mortality ◽

Far Eastern

Aim.To evaluate the effectiveness of the obstetric care service in Khabarovsk Krai, based on a comparison of the dynamics of infant and perinatal mortality rates for the period 20092018. Materials and methods.A comparative analysis of official statistics of the Ministry of Health of Khabarovsk Krai and other territories of the Far Eastern Federal District was carried out using the Rosstat database for the period 20092018, taking into account the indicators of infant, perinatal mortality, and preterm birth. The trend of the dynamics was determined in the process of graphical analysis of the chart and by modeling trends. The results of the studies were subjected to methods of statistical processing of information. Results.The results revealed in our study indicate that over the 10-year interval, the infant and perinatal mortality rates in Khabarovsk Krai decreased by 2 times, the rate of decrease was higher than similar processes in the Far Eastern Federal District and the Russian Federation. A graphical representation of infant and perinatal mortality rates underlines the instability of these values in Khabarovsk Krai. Тhe decrease in infant and perinatal mortality in Khabarovsk Krai is mainly due to a decrease in early neonatal mortality. The ratio of stillbirth to early neonatal mortality indicates an excess of stillbirth by 7.88 and 6.95 times in 20172018. The relatively high stillbirth rate in Khabarovsk Krai indicates the instability of the results in providing assistance to pregnant women and women in childbirth. Conclusion.The infant mortality rate is the main quality indicator recommended by WHO for assessing the level of care. This indicator must be considered in conjunction with the indicator of perinatal mortality, especially its constituent components of stillbirth and early neonatal mortality, namely the ratio of stillbirth to early neonatal mortality. The deformation of this proportion towards a multiple increase in stillbirth, against the background of a progressive decrease in early neonatal mortality, indicates the presence of an inadequate assessment of the organization of medical care in the obstetric care service.

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Neonatal Mortality and Its Associated Factors among Neonates Admitted to Wollega University Referral Hospital Neonatal Intensive Care Unit, East Wollega, Ethiopia

Global Pediatric Health ◽

10.1177/2333794x211030157 ◽

2021 ◽

Vol 8 ◽

pp. 2333794X2110301

Author(s):

Tesfaye Abera ◽

Lami Bayisa ◽

Teshome Bekele ◽

Mulugeta Dessalegn ◽

Diriba Mulisa ◽

...

Keyword(s):

Intensive Care Unit ◽

Logistic Regression ◽

Regression Analysis ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Mortality ◽

Logistic Regression Analysis ◽

Neonatal Intensive Care ◽

Multiple Logistic Regression Analysis ◽

Birth Asphyxia

Ethiopia has a high neonatal mortality rate in spite of dearth of study. Therefore we aimed to assess magnitude and associated factors of neonatal mortality among neonates admitted to neonatal intensive care units of Wollega University Referral Hospital. Accordingly, a facility based cross-sectional study was conducted on 289 by reviewing medical records of neonates admitted to neonatal intensive care unit. The collected data were entered in to Epi data version 3.1 and Stata version 14 used for analysis. Variables with P-value < 0.25 at with 95% confidence interval in binary logistic regression analysis were taken to the multiple logistic regression analysis. Finally, variables with Likewise, variable with P-value < 0.05 at 95% confidence interval in multiple logistic regression analysis were considered as statistically significant. Among 289 neonates admitted to neonatal intensive care unit, 53 (18.34 %) were died. Majority 42(79.25%) of those deaths occurred at ≤ 7 days of birth. Preterm [AOR 4.15, 95% CI (1.67-10.33)], neonates faced birth asphyxia [AOR 3.26, 95% CI (1.33-7.98)], neonates who developed sepsis [AOR 2.29 95% CI (1.01-5.20)] and neonates encountered with jaundice [(AOR 11.08, 95% CI (1.03-119.59)] were more at risk to die. In general, the magnitude of neonatal mortality among neonates admitted to neonatal intensive care unit was high. Gestational age (maturity of new born), birth asphyxia, neonatal sepsis and neonatal jaundice were predictors of neonatal mortality. Neonates admitted to neonatal intensive care unit with sepsis, jaundice, and birth asphyxia demand special attention to reduce neonatal mortality.

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Decline in Perinatal Mortality in the United States, 2017–2019

10.15620/cdc:112643 ◽

2022 ◽

Author(s):

Claudia Valenzuela ◽

Elizabeth Gregory ◽

Joyce Martin

Keyword(s):

United States ◽

Neonatal Mortality ◽

Perinatal Mortality ◽

The United States ◽

Mortality Trends ◽

Early Neonatal Mortality ◽

Hispanic Origin ◽

Mother’S Age

This report presents trends in perinatal mortality, as well as its components, late fetal and early neonatal mortality, for 2017 through 2019. Also shown are perinatal mortality trends by mother’s age, race and Hispanic origin, and state for 2017–2019.

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Risk Factors for Stillbirth and Early Neonatal Mortality: A Case-Control Study in Tertiary Hospitals in Addis Ababa, Ethiopia

10.21203/rs.3.rs-37249/v2 ◽

2020 ◽

Author(s):

Eskinder Kebede Weldetensaye ◽

Melani Kekulawala

Keyword(s):

Risk Factors ◽

Neonatal Mortality ◽

Perinatal Mortality ◽

Maternal Education ◽

Case Control Study ◽

Case Control ◽

Categorical Variables ◽

Early Neonatal Mortality ◽

Tertiary Hospitals ◽

Control Study

Abstract Background: Ethiopia is a Sub-Saharan country that has made significant improvements in maternal mortality and under-five mortality over the past 15 years. However, perinatal mortality continues to be a major obstacle. The nation continues to have one of the highest rates of perinatal mortality in the entire world with current estimates at 33 deaths per 1000 live births.Methods: This case-control study was conducted between October 2016 and May 2017 at Tikur Anbessa Hospital (TAH) and Gandhi Memorial Hospital (GMH). All women who had a stillbirth or early neonatal mortality during this period willing to participate were included as cases. A systematic random sample of women delivering at the hospital was approached for recruitment as controls to generate a 2:1 ratio of controls to cases. Data on potential risk factors were retrieved from medical records including health passports, delivery records, and treatment charts. Statistical differences in background and social characteristics of cases and controls were determined by t-test and chi-squared (or fisher's exact test) for quantitative and categorical variables respectively. Binary logistic regression analysis was completed to determine any associations between risk factors and stillbirth/early neonatal mortality.Results: During the study period, 366 women delivering at the hospitals were enrolled as cases and 711 women delivering at the hospitals were enrolled as controls. During the study period, records from both hospitals indicated that the estimated stillbirth and neonatal mortality rates were30.7 per 1000. Neonatal causes (43.4%) were the most common, followed by antepartum (32.5%) and intrapartum (24.5%). Risk factors for stillbirths and early neonatal mortality were low maternal education (aOR 1.747, 95%CI 1.098-2.780), high parity (aOR 1.114, 95%CI .058- 2.484), previous stillbirth (aOR 9.447, 95%CI 6.245-14.289), previous preterm birth (aOR 3.620, 95%CI 2.363-5.546), and previous child with congenital abnormality (aOR 2.190, 95% 1.228-3.905), and antepartum hemorrhage during pregnancy (aOR 3.273, 95% 1.523-7.031).Conclusion: Antepartum hemorrhaging is the only risk factor in our study amenable for direct intervention. Efforts should be maximized to improve patient education and antenatal and obstetric services, particularly for women who have a history of obstetric complications identified as risk factors. Moreover, the most significant cause of mortality was asphyxia-related causes. It is imperative that obstetric capacity in rehabilitation services are strengthened and for further studies to investigate the high burden of asphyxia at these tertiary hospitals to better tailor interventions.

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Reduction in Perinatal Mortality after Implementation of HBB Training at a District Hospital in Mali

Journal of Tropical Pediatrics ◽

10.1093/tropej/fmz072 ◽

2019 ◽

Vol 66 (3) ◽

pp. 315-321

Author(s):

M Innerdal ◽

I Simaga ◽

H Diall ◽

M Eielsen ◽

S Niermeyer ◽

...

Keyword(s):

Mortality Rate ◽

Neonatal Mortality ◽

Perinatal Mortality ◽

District Hospital ◽

Neonatal Mortality Rate ◽

Neonatal Deaths ◽

Live Births ◽

Early Neonatal Mortality ◽

Helping Babies Breathe ◽

Before And After

Abstract Background Mali has a high neonatal mortality rate of 38/1000 live births; in addition the fresh stillbirth rate (FSR) is 23/1000 births and of these one-third are caused by intrapartum events. Objectives The aims are to evaluate the effect of helping babies breathe (HBB) on mortality rate at a district hospital in Kati district, Mali. Methods HBB first edition was implemented in April 2016. One year later the birth attendants were trained in HBB second edition and started frequent repetition training. This is a before and after study comparing the perinatal mortality during the period before HBB training with the period after HBB training, the period after HBB first edition and the period after HBB second edition. Perinatal mortality is defined as FSR plus neonatal deaths in the first 24 h of life. Results There was a significant reduction in perinatal mortality rate (PMR) between the period before and after HBB training, from 21.7/1000 births to 6.0/1000 live births; RR 0.27, (95% CI 0.19–0.41; p < 0.0001). Very early neonatal mortality rate (24 h) decreased significantly from 6.3/1000 to 0.8/1000 live births; RR 0.12 (95% CI 0.05–0.33; p = 0.0006). FSR decreased from 15.7/1000 to 5.3/1000, RR 0.33 (95% CI 0.22–0.52; p < 0.0001). No further reduction occurred after introducing the HBB second edition. Conclusion HBB may be effective in a local first-level referral hospital in Mali.

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