scholarly journals Population based cohort study of fetal deaths, and neonatal and perinatal mortality at term within a Somali diaspora

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Stephen Contag ◽  
Rahel Nardos ◽  
Irina A. Buhimschi ◽  
Jennifer Almanza
Keyword(s):  
Cohort Study ◽  
Black Women ◽  
Perinatal Mortality ◽  
Gestational Age ◽  
Neonatal Death ◽  
Fetal Death ◽  
Hispanic Women ◽  
Place Of Birth ◽  
Death Rates ◽  
Somali Women

Abstract Background Somali women deliver at greater gestational age with limited information on the associated perinatal mortality. Our objective is to compare perinatal mortality among Somali women with the population rates. Methods This is a retrospective cohort study from all births that occurred in Minnesota between 2011 and 2017. Information was obtained from certificates of birth, and neonatal and fetal death. Data was abstracted from 470,550 non-anomalous births ≥37 and ≤ 42 weeks of gestation. The study population included U.S. born White, U.S. born Black, women born in Somalia or self-identified as Somali, and women who identified as Hispanic regardless of place of birth (377,426). We excluded births < 37 weeks and > 42 weeks, > 1 fetus, age < 18 or > 45 years, or women of other ethnicities. The exposure was documented ethnicity or place of birth, and the outcomes were live birth, fetal death, neonatal death prior to 28 days, and perinatal mortality rates. These were calculated using binomial proportions with 95% confidence intervals and compared using odds ratios adjusted (aOR) for diabetes, hypertension and maternal body mass index. Results The aOR [95%CI] for stillbirth rate in the Somali cohort was greater than for U.S. born White (2.05 [1.49–2.83]) and Hispanic women (1.90 [1.30–2.79]), but similar to U.S. born Black women (0.88 [0.57–1.34]). Neonatal death rates were greater than for U.S. born White (1.84 [1.36–2.48], U.S. born Black women (1.47 [1.04–2.06]) and Hispanic women (1.47 [1.05–2.06]). This did not change after analysis was restricted to those with spontaneous onset of labor. When analyzed by week, at 42 weeks Somali aOR for neonatal death was the same as for U.S. born White women, but compared against U.S. born Black and Hispanic women, was significantly lower. Conclusions The later mean gestational age at delivery among women of Somali ethnicity is associated with greater overall risk for stillbirth and neonatal death rates at term, except compared against U.S. born Black women with whom stillbirth rates were not different. At 42 weeks, Somali neonatal mortality decreased and was comparable to that of the U.S. born White population and was lower than that of the other minorities.

scholarly journals Population Based Cohort Study of Fetal Deaths, and Neonatal and Perinatal Mortality at Term Within a Somali Diaspora

2021 ◽  
Author(s):  
Stephen Contag ◽  
Rahel Nardos ◽  
Irina Buhimschi ◽  
Jennifer Almanza
Keyword(s):  
Cohort Study ◽  
Black Women ◽  
Neonatal Mortality ◽  
Perinatal Mortality ◽  
Neonatal Death ◽  
White Women ◽  
Fetal Death ◽  
Hispanic Women ◽  
Place Of Birth ◽  
Somali Women

Abstract Background: Delivery among Somali women occurs later, we have no information on the associated perinatal mortality. Our objective is to compare perinatal mortality among Somali women with the population rates.Methods: This is a retrospective cohort study 2011-2017. Information was obtained from certificates of birth, neonatal and fetal death through data use agreement signed between the Minnesota Department of Health and the University of Minnesota. Data derived from 470,550 non-anomalous births >20 weeks of gestation in Minnesota 2011-2017. We included all U.S. born White, U.S. born Black, women born in Somalia or self-identified as Somali, and women who identified as Hispanic regardless of place of birth (377,426), and excluded births <37 weeks and >42 weeks, > 1 fetus, age <18 or >45 years, or women of other ethnicities. The exposure was documented ethnicity or place of birth, and the outcomes were live birth, fetal death, neonatal death prior to 28 days, and perinatal mortality rates. These were calculated using binomial proportions with 95% confidence intervals and compared using odds ratios (aOR) adjusted for diabetes, hypertension and maternal body mass index.Results: The aOR for fetal and neonatal death in the Somali cohort was greater than for U.S. born White (aOR, 2.05 [95%CI: 1.49 - 2.83], aOR 1.84 [95%CI: 1.36 - 2.48]) and Hispanic women (aOR, 1.90 [95%CI: 1.30 - 2.79] and 1.47 [95%CI: 1.05 - 2.06] respectively). Limiting the analysis to those with spontaneous onset of labor (SOL) did not modify the results. This effect persisted up to 41 weeks after which the risk was similar to that of U.S. born White women but lower than for U.S. born Black women and Hispanic women.Conclusions: Despite greater mean gestational age, Somali fetal death rates are similar to population rates. Neonatal mortality is increased compared with White women, but similar to that of other minorities in Minnesota. Somali neonatal mortality decreased and was comparable to that of the White population after 41 weeks.

scholarly journals Stillbirth and neonatal mortality in a subsequent pregnancy following stillbirth: a population-based cohort study

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Janna W. Nijkamp ◽  
Anita C. J. Ravelli ◽  
Henk Groen ◽  
Jan Jaap H. M. Erwich ◽  
Ben Willem J. Mol
Keyword(s):  
Cohort Study ◽  
Gestational Age ◽  
Perinatal Outcome ◽  
Neonatal Death ◽  
Fetal Death ◽  
Subsequent Pregnancy ◽  
Early Gestation ◽  
Risk Of Recurrence ◽  
History Of ◽  
Obstetrical Management

Abstract Background A history of stillbirth is a risk factor for recurrent fetal death in a subsequent pregnancy. Reported risks of recurrent fetal death are often not stratified by gestational age. In subsequent pregnancies increased rates of medical interventions are reported without evidence of perinatal benefit. The aim of this study was to estimate gestational-age specific risks of recurrent stillbirth and to evaluate the effect of obstetrical management on perinatal outcome after previous stillbirth. Methods A retrospective cohort study in the Netherlands was designed that included 252.827 women with two consecutive singleton pregnancies (1st and 2nd delivery) between 1999 and 2007. Data was obtained from the national Perinatal Registry and analyzed for pregnancy outcomes. Fetal deaths associated with a congenital anomaly were excluded. The primary outcome was the occurrence of stillbirth in the second pregnancy stratified by gestational age. Secondary outcome was the influence of obstetrical management on perinatal outcome in a subsequent pregnancy. Results Of 252.827 first pregnancies, 2.058 pregnancies ended in a stillbirth (8.1 per 1000). After adjusting for confounding factors, women with a prior stillbirth have a two-fold higher risk of recurrence (aOR 1.96, 95% CI 1.07–3.60) compared to women with a live birth in their first pregnancy. The highest risk of recurrence occurred in the group of women with a stillbirth in early gestation between 22 and 28 weeks of gestation (a OR 2.25, 95% CI 0.62–8.15), while after 32 weeks the risk decreased. The risk of neonatal death after 34 weeks of gestation is higher in women with a history of stillbirth (aOR 6.48, 95% CI 2.61–16.1) and the risk of neonatal death increases with expectant obstetric management (aOR 10.0, 95% CI 2.43–41.1). Conclusions A history of stillbirth remains an important risk for recurrent stillbirth especially in early gestation (22–28 weeks). Women with a previous stillbirth should be counselled for elective induction in the subsequent pregnancy at 37–38 weeks of gestation to decrease the risk of perinatal death.

Incidences of Feto-Fetal Transfusion Syndrome and Perinatal Outcomes in Triplet Gestations with Monochorionic Placentation

2016 ◽  
Vol 40 (3) ◽  
pp. 181-186 ◽  
Author(s):  
Yuka Sato ◽  
Keisuke Ishii ◽  
Tae Yokouchi ◽  
Takeshi Murakoshi ◽  
Kenji Kiyoshi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Neonatal Death ◽  
Intraventricular Hemorrhage ◽  
Retrospective Cohort ◽  
Fetal Death ◽  
Periventricular Leukomalacia ◽  
Neurological Complication ◽  
Perinatal Outcomes ◽  
Grade 3 ◽  
Poor Outcomes

Introduction: This study aimed to determine the incidences of feto-fetal transfusion syndrome (FFTS) and perinatal outcomes in triplet gestations with monochorionic placentation. Materials and Methods: In this retrospective cohort study, we evaluated the incidences of FFTS and perinatal outcomes at 28 days of age in cases of triplet gestations with monochorionic placentation who visited our centers before 16 weeks of gestation and delivered over a period of 11 years. Results: In 41 triplet gestations (17 monochorionic triamniotic, 22 dichorionic triamniotic, 1 dichorionic diamniotic, and 1 monochorionic monoamniotic), the incidence of FFTS was 17.1%, and the median gestational age at FFTS diagnosis was 19 weeks. In 123 triplets, the incidences of fetal death and neonatal death at 28 days of age were 8.1 and 0.9%, respectively. None of the surviving infants had grade 3 or 4 intraventricular hemorrhage, while cystic periventricular leukomalacia occurred in 6 of 113 infants (5.3%). The incidence of poor outcomes (death or any major neurological complication at 28 days of age) was 13.8%. Discussion: Seventeen percent of triplet pregnancies with monochorionic placentation developed FFTS, and 14% had a poor outcome. Therefore, triplet gestations with monochorionic placentation should be followed carefully.

WEIGHT IN RELATION TO FETAL AND NEWBORN MORTALITY; INFLUENCE OF SEX AND COLOR

PEDIATRICS ◽  
1950 ◽  
Vol 6 (3) ◽  
pp. 329-342
Author(s):  
LEONA BAUMGARTNER ◽  
VIVIAN PESSIN ◽  
MYRON E. WEGMAN ◽  
SYLVIA L. PARKER
Keyword(s):  
Birth Weight ◽  
Neonatal Death ◽  
Fetal Death ◽  
Average Weight ◽  
Weight Group ◽  
Extrinsic Factors ◽  
Death Rates ◽  
Live Births ◽  
Lower Weight ◽  
Weight Groups

Analysis was made of 209,055 live births, 6978 fetal deaths subsequent to 20 weeks of gestation, and 5048 neonatal deaths, reported in New York City in 1939 and 1940. Comparison was made of fetal death rates per 1000 unborn children in each weight group by means of a modified life table method and of neonatal death rates per 1000 live births in each birth-weight group, for the two sexes and for the white and nonwhite races. For all infants, fetal death rates, so calculated, are relatively low and neonatal death rates very high in the lower weight groups. Both rates go up sharply in the higher weight groups, indicating that infants much over average weight are not good risks. Lower fetal death rates were observed for females in the weight groups below 3000 gm. and for males in the weight groups above 3000 gm. Neonatal death rates were lower for females throughout. The implication appears to be that relative maturity is more important than size in regard to variation in fetal death rate. Comparison by race indicates consistently higher nonwhite fetal death rates for nonwhite infants in all weight groups. Neonatal death rates were similar for white and nonwhite infants in the lower weight groups but higher for nonwhite infants in the upper weight groups. A study in 22 hospitals, giving presumably better care than the city-wide average, showed lower neonatal rates for the nonwhite infants in the lower weight groups. It is inferred that comparisons of observed mortality differences by race must consider differences between the races in regard to extrinsic factors such as economic status, nutrition and care. For practical purposes a uniform criterion of birth weight, 2500 gm., should be maintained in the diagnosis of prematurity. Using a method of combining fetal and neonatal mortality experience to measure the total risk to unborn children of different weights, it was possible to calculate "best birth weights." These were found to be about 120 gm. lower for female than for male, and about 160 gm. lower for nonwhite than for white births.

Small for gestational age and perinatal mortality at term: An audit in a Dutch national cohort study

2017 ◽  
Vol 215 ◽  
pp. 62-67 ◽  
Author(s):  
Martine Eskes ◽  
Adja J.M. Waelput ◽  
Sicco A. Scherjon ◽  
Klasien A. Bergman ◽  
Ameen Abu-Hanna ◽  
...  
Keyword(s):  
Cohort Study ◽  
Perinatal Mortality ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
National Cohort

scholarly journals Elective induction of labour and caesarean section in low-moderate risk nulliparous women: a retrospective cohort study

2021 ◽  
Author(s):  
Sarah Butler ◽  
Euan Wallace ◽  
Andrew Bisits ◽  
Roshan Selvaratnam ◽  
Mary-Ann Davey
Keyword(s):  
Cohort Study ◽  
Perinatal Mortality ◽  
Gestational Age ◽  
Preliminary Analysis ◽  
Retrospective Cohort ◽  
Expectant Management ◽  
Moderate Risk ◽  
Caesarean Birth ◽  
Nulliparous Women ◽  
Elective Induction

Objective: To evaluate whether elective induction of labour (eIOL) influences the rate of caesarean birth in uncomplicated pregnant women at term, compared to expectant management. Design: Retrospective cohort study. Setting: Births in Victoria between 2010 and 2018. Population: Term, singleton, vertex births from low-moderate risk pregnancies (n=396,164). Methods: Preliminary analyses compared eIOL at 37 weeks with expectant management both beyond that gestational age (preliminary analysis I) and at that gestational age and beyond (preliminary analysis II). Similar comparisons were made for eIOL at 38, 39, 40 and 41 weeks’ gestation and expectant management. The primary analysis repeated these comparisons, limiting the population to nulliparous women whose recorded indication for induction did not include one of a specified list of conditions. Chi-square tests and multivariable logistic regression were used. Adjusted odds ratios and 99% confidence intervals were reported. P<0.01 denoted statistical significance. Main Outcome Measures: Unplanned caesarean birth, perinatal mortality Results: The proportion of nulliparous, low-moderate risk women who underwent IOL ≥37 weeks’ gestation in Victoria increased from 24.6% in 2010 to 30.0% in 2018 (p-value <0.001). eIOL in nulliparous women was associated with an increased odds of caesarean birth when performed at 38 (aOR 1.23((1.13-1.32)), 39 (aOR 1.31((1.23-1.40)), 40 (aOR 1.42((1.35-1.50)), and 41 weeks’ gestation (aOR 1.43((1.35-1.51)). Perinatal mortality was rare in both groups and non-significantly lower in the induced group at most gestations. Conclusions: eIOL was associated with an increased odds of caesarean birth from 38 weeks’ gestation and a decrease in the odds of perinatal mortality.

scholarly journals Natimortalidade no hospital materno infantil de Barra do Corda-MA

2020 ◽  
Vol 10 (30) ◽  
pp. 98-105
Author(s):  
Luciane Dos Santos da Silva ◽  
Maria Hulda Lopes dos Santos ◽  
Rosane Pereira Martins ◽  
Nilson Dos Santos Loiola
Keyword(s):  
Risk Factors ◽  
Prenatal Care ◽  
Perinatal Mortality ◽  
Gestational Age ◽  
Medical Records ◽  
Fetal Death ◽  
Death Risk ◽  
Factors Associated ◽  
Factores De Riesgo ◽  
Child Hospital

Estudar a natimortalidade é importante por avaliar a vida intra-uterina e refletir possíveis agravos ocorridos na gestação. Objetivou-se estudar os fatores de riscos associados à natimortalidade ocorrida no Hospital Materno Infantil de Barra do Corda - MA de 2017 à 2018. A pesquisa bibliográfica foi realizada em bases indexadas. Demais dados foram obtidos nos prontuários de atendimento do hospital e tabulados nos softwares Excel e BioEstat 5.0. Evidenciou-se que o preenchimento dos prontuários de atendimento ocorreu de forma deficiente, principalmente com relação ao pré-natal e às informações sociodemográficas. Dentre os 70 casos analisados 28 ocorreram entre indígenas, a idade gestacional média dos conceptos foi de 34,6 semanas e houve um maior número de casos em gestantes com 21 anos. Concluiu-se que há a necessidade de rever os procedimentos de atendimento, bem como intensificar as ações de realização e acompanhamento pré-natal, principalmente nas áreas indígenas.Descritores: Morte Fetal, Fatores de Risco, Epidemiologia. Natimortality at the children’s maternal hospital of Barra do Corda-MAAbstract: Studying perinatal mortality is important because it evaluates intrauterine life and reflects possible problems occurring during the pregnancy. The objective of this study was to study the risk factors associated with perinatal mortality occurred at the Barra do Corda Maternal and Child Hospital - MA from 2017 to 2018. The bibliographic research was performed in indexed databases. Other data were obtained from the hospital's medical records and tabulated in Excel and BioEstat 5.0 software. It was evidenced that the filling of the medical records occurred in a poorly way, especially regarding prenatal care and sociodemographic information. Among the 70 cases analyzed 28 occurred among indigenous, the average gestational age of the concepts was 34.6 weeks and there was a higher number of cases in 21-year-old pregnant women. It was concluded that there is a need to review the care procedures, as well as intensify the actions of prenatal care and monitoring, especially in indigenous areas.Descriptors: Fetal Death, Risk Factors, Epidemiology. Natimortalidad en el hospital materno infantil Barra do Corda-MAResumen: Estudiar la muerte fetal es importante porque evalúa la vida intrauterina y refleja los posibles problemas que ocurren durante el embarazo. El objetivo de este estudio fue estudiar los factores de riesgo asociados con la muerte fetal ocurridos en el Hospital Materno Infantil Barra do Corda - MA de 2017 a 2018. La búsqueda bibliográfica se realizó en bases de datos indexadas. Otros datos se obtuvieron de los registros de atención hospitalaria y se tabularon en el software Excel y BioEstat 5.0. Se evidenció que el llenado de los registros médicos se produjo de manera deficiente, especialmente con respecto a la atención prenatal y la información sociodemográfica. Entre los 70 casos analizados, 28 ocurrieron entre mujeres indígenas, la edad gestacional promedio de la descendencia fue de 34.6 semanas y hubo un mayor número de casos en mujeres embarazadas de 21 años. Se concluyó que es necesario revisar los procedimientos de atención, así como intensificar las acciones de atención prenatal y monitoreo, especialmente en áreas indígenas.Descriptores: Muerte Fetal, Factores de Riesgo, Epidemiologia.

scholarly journals Platelet Counts throughout Uncomplicated Pregnancies

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 2256-2256 ◽  
Author(s):  
Jessica A. Reese ◽  
David R. Deschamps ◽  
Jennifer J. McIntosh ◽  
Eric J. Knudtson ◽  
Jennifer D. Peck ◽  
...  
Keyword(s):  
Platelet Count ◽  
Black Women ◽  
Pregnant Women ◽  
Ethnic Groups ◽  
Confidence Intervals ◽  
Gestational Age ◽  
Hispanic Women ◽  
Platelet Counts ◽  
The Mean ◽  
Race Ethnicity

Abstract It is widely believed that platelet counts decrease during uncomplicated pregnancies, an observation described as gestational thrombocytopenia. However, of the 17 articles identified by our systematic literature review that statistically evaluated platelet counts during uncomplicated pregnancies, only 8 reported a significant decrease, while the remaining 9 articles reported no change. Among the 8 articles reporting decreased platelet counts, the clinical importance was not described. Lower platelet counts may be a physiologic phenomenon of normal pregnancy and represent a small decrease in all women or lower platelet counts may be a pathologic condition and represent a larger decrease in only some women. Our aim was to use electronic medical record data to evaluate platelet counts throughout pregnancy in a large population of women with uncomplicated pregnancies. We included women with uncomplicated pregnancies, ages 13-51, who delivered at the University of Oklahoma Health Sciences Center (OUHSC) between 1/1/2011 and 8/19/2014. If a woman had more than one pregnancy during the study period, we only included her first uncomplicated pregnancy. We excluded women with hypertension, preeclampsia, diabetes, placenta previa, hematologic disorders, cancer or steroid treatment, illegal drug use, premature delivery, stillbirth, women whose delivery gestational age was missing and women who did not have a platelet count at delivery. We used linear mixed models to characterize the change in platelet count during pregnancy and to determine if the change varied by racial/ethnic groups. A comparison group of nonpregnant white, black, and Hispanic women ages 13-51 was derived from the National Health and Nutrition Examination Survey (NHANES) database, excluding women with hypertension, diabetes, and/or cancer. Of 15,723 pregnancies, 8,148 women with one uncomplicated singleton pregnancy and a platelet count at delivery were included; 4,665 (57%) women had a least one previous platelet count during gestation at OUHSC. The median age at the time of delivery for the 8,148 women was 27 years, 46% were white, 13% black, 26% Hispanic, and 15% other races. The mean platelet count decreased significantly throughout pregnancy for white, black, and Hispanic women (Figure, p<0.0001). Mean platelet counts were significantly lower even in the first trimester, at a mean gestational age of 8 weeks, compared to non-pregnant women from NHANES (n=5,920). Compared to the white and Hispanic women, black women had higher mean platelet counts throughout gestation and at delivery, similar to the non-pregnant women. At delivery, the mean platelet counts were significantly different among all three groups of women (p<0.0001) with black women having the highest (222,000/µL; 95% CI=218-225; median=216; range=50-449), white women intermediate (215,000/µL; 95% CI=213-216; median=209; range=60-552) and Hispanic women having the lowest (207,000/µL; 95% CI=205-209; median=202; range=67-451). The mean platelet counts of all 3 race/ethnic groups at delivery were normally distributed indicated by the symmetrical distribution and by the similarity of mean and median values. Data for platelet counts at 4-8 weeks postpartum were available for only 181 (2.2%) women. For these women, the mean platelet count increased significantly from 217,000/µL at delivery to 262,000/µL postpartum (mean difference=44,000/µL; 95% CI=36-53). Conclusion Among women with uncomplicated pregnancies, mean platelet counts decrease significantly, compared to non-pregnant women, throughout pregnancy in all 3 race/ethnic groups. At delivery, the mean platelet counts for the 3 race/ethnic groups were significantly different, with black women having the highest and Hispanic women having the lowest. Platelet counts at delivery were normally distributed, suggesting that the platelet counts of all women decrease similarly and that lower platelet counts are a normal physiologic change during pregnancy. Figure 1. Mean platelet counts and 95% confidence intervals by gestational age stratified by race/ethnicity for women with uncomplicated pregnancies who delivered at OUHSC compared to the mean platelet counts and 95% confidence intervals for non-pregnant US women from NHANES (N) stratified by race/ethnicity. Figure 1. Mean platelet counts and 95% confidence intervals by gestational age stratified by race/ethnicity for women with uncomplicated pregnancies who delivered at OUHSC compared to the mean platelet counts and 95% confidence intervals for non-pregnant US women from NHANES (N) stratified by race/ethnicity. Disclosures No relevant conflicts of interest to declare.

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