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

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.

The utility of delivery ward register data for determining the causes of perinatal mortality in one specialized and one general hospital in south Ethiopia

Background Globally, the burden of perinatal mortality is high. Reliable measures of perinatal mortality are necessary for planning and assessing prenatal, obstetric, and newborn care services. However, accurate record-keeping is often a major challenge in low resource settings. In this study we aimed to assess the utility of delivery ward register data, captured at birth by healthcare providers, to determine causes of perinatal mortality in one specialized and one general hospital in south Ethiopia. Methods Three years (2014–2016) of delivery register for 13,236 births were reviewed from July 12 to September 29, 2018, in two selected hospitals in south Ethiopia. Data were collected using a structured pretested data extraction form. Descriptive statistics assessed early neonatal mortality rate, stillbirth rate, perinatal mortality rate and causes of neonatal deaths. Factors associated with early neonatal deaths and stillbirths were examined using logistic regression. The adjusted odds ratios with a 95% confidence interval were reported to show the strength of the association. Result The perinatal mortality ratio declined from 96.6 to 75.5 per 1000 births during the three-year study period. Early neonatal mortality and stillbirth rates were 29.3 per 1000 live births and 55.2 per 1000 total births, respectively. The leading causes of neonatal death were prematurity 47.5%, and asphyxia 20.7%. The cause of death for 15.6% of newborns was not recorded in the delivery registers. Similarly, the cause of neonatal morbidity was not recorded in 1.5% of the delivery registers. Treatment given for 94.5% of neonates were blank in the delivery registers, so it is unknown if the neonates received treatment or not. Factors associated with increased early neonatal deaths were maternal deaths and complications, vaginal births, APGAR scores less than 7 at five minutes and low birth weight (2500 g). Maternal deaths and complications and vaginal births were associated with increased stillbirths. Conclusion Our findings show that an opportunity exists to identify perinatal death and newborn outcomes from the delivery ward registers, but some important neonatal outcomes were not recorded/missing. Efforts towards improving the medical record systems are needed. Furthermore, there is a need to improve maternal health during pregnancy and birth, especially neonatal care for those neonates who experienced low APGAR scores and birth weight to reduce the prevalence of perinatal deaths.

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

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.

Experience in the diagnosis of group B Streptococcus infections in pregnant women and newborns in a perinatal center

Serogroup B streptococci (Streptococcus agalactiae) are one of the main etiological agents responsible for the occurrence of severe perinatal infections in both postpartum women and newborns. The experience of microbiological diagnostics of infections caused by streptococcus serogroup B (GBS) according to the data of the microbiological laboratory of the perinatal center is generalized. In the study of biomaterial from patients, the proportion of positive cultures of Streptococcus agalactiae was 2.2% in cervical samples, 8.8% in vaginal contents, 6.6%; 2.8% and 0.7% in amniotic fluid, placenta and urine, respectively. In 57% of cases, GBS was released at a concentration of more than 5 lg / ml and in 73% of cases as part of polymicrobial associations with other opportunistic microorganisms. In the biomaterial from newborns, GBS was found in 2.5% of positive findings in blood samples, 4.6% in tracheobronchial lavages and 2.7% in detachable skin of the armpit when taking material immediately after childbirth and 1, 1% and 0.7%, respectively, during examination in the second stage of nursing. 5 cases of GBS isolation in newborns ended in early neonatal mortality with definitive diagnoses of congenital pneumonia and IUI of newborns, while there was only partial coincidence of the results of microbiological studies of the genital tract of the mother and biomaterials from the newborn. Relatively frequent findings of GBS in newborns of the high-risk group in intensive care unit indicate intrauterine infection with this pathogen. The examination of smears from the cervical canal is not informative in relation toGBS infection in comparison with the examination of the vaginal contents and recto-vaginal smears. The results of the introduction of microbiological screening and its effectiveness in real practice to prevent the development of early and late forms of GBS infections in newborns require further analysis.

It's a Long Walk: Lasting Effects of Maternity Ward Openings on Labour Market Performance

Being born in a hospital versus having a traditional birth attendant at home represents the most common early life policy change worldwide. By applying a difference-in-differences approach to register-based individual-level data on the total population, this paper explores the long-term economic effects of the opening of new maternity wards as an early life quasi-experiment. It first finds that the reform substantially increased the share of hospital births and reduced early neonatal mortality. It then shows sizable long-term effects on labour income, unemployment, health-related disability and schooling. Small-scale local maternity wards yield a larger social rate of return than large-scale hospitals.

Analysis of the gestational period and perinatal outcomes in women after surgical treatment of the cervix

Background. The purpose was to conduct a comparative analysis of the course of pregnancy and perinatal outcomes in women who underwent treatment of the cervix using various organ preserving surgical methods. Material and methods. We examined 250 women of reproductive age who underwent excision or ablative treatment of the cervix before pregnancy. The subjects were divided into five groups depending on the cervix treatment method. The study used general clinical examination protocols outlined in the regulations № 417 and № 676 issued by the Ministry of Health of Ukraine. The results. The most frequent complications of pregnancy in the patients with cervical surgery were: threatened abortion, threatened of preterm birth, anemia, low placentation, placental dysfunction, and low levels of amniotic fluid. Childbirth complications in women who underwent excision or ablation treatment of the cervix before pregnancy predominantly consisted of labor abnormalities, premature amniotic sac rupture, fetal distress, tears of the cervix and perineum. Among the complications of the postpartum period, there were isolated cases of subinvolution of the uterus, lochiometers, metroendometritis, and lactostasis. There were no cases of intrapartum and early neonatal mortality among the newborns. Conclusions. Given the high frequency of gestational and postpartum complications in women after organ-sparing surgical treatment of the cervix, it is necessary to choose the least harmful approach. The lowest incidence of complications during pregnancy, intra and postnatal periods was observed in the women who underwent laser vaporization and radio-wave ablation.

DYNAMICS OF PERINATAL LOSSES IN ALMATY

Динамика и уровень перинатальной смертности за последние десятилетие свидетельствовали о том, что в г. Алматы имеет устойчивую тенденцию к снижению до 8,8‰ к 2019 году. В структуре перинатальной смертности большая часть приходится на антенатальную (5,5-6,5‰); около трети - на раннюю неонатальную смертность (3,2 до 2,3‰). В структуре причин неонатальных потерь наблюдалось устойчивое снижение дыхательных и сердечно-сосудистых нарушений в 2,3-3,8 раза - с 5 до 1,3‰, врожденных аномалий с 4,4 до 0,9‰, неонатальные потери от инфекционных болезней остаются стабильными. Сохраняющие риски инфекционной патологии, особенно в беспрецедентной ситуации в период пандемии диктуют необходимость пересмотра подходов к оказанию перинатальной помощи населению и разработкой новой концепции перинатальной помощи с существенными изменениями в подходах инфекционного контроля, развития превентивной перинатологии с более эффективной антенатальной охраной здоровья плода. The dynamics and level of perinatal mortality over the past decade testified to the fact that in Almaty it has a steady downward trend to 8.8 ‰ by 2019. In the structure of perinatal mortality, most of it falls on antenatal (5.5-6.5 ‰); about a third - for early neonatal mortality (3.2 to 2.3 ‰). In the structure of the causes of neonatal losses, there was a steady decrease in respiratory and cardiovascular disorders by 2.3-3.8 times - from 5 to 1.3 ‰, congenital anomalies from 4.4 to 0.9 ‰, neonatal losses from infectious diseases remain stable. The persisting risks of infectious pathology, especially in an unprecedented situation during a pandemic, dictate the need to revise approaches to providing perinatal care to the population and develop a new concept of perinatal care with significant changes in approaches to infection control, thedevelopment of preventive perinatology with more effective antenatal fetal health care.

Preterm birth, stillbirth and early neonatal mortality during the Danish COVID-19 lockdown

Using provisional or opportunistic data, three nationwide studies (The Netherlands, the USA and Denmark) have identified a reduction in preterm or extremely preterm births during periods of COVID-19 restrictions. However, none of the studies accounted for perinatal deaths. To determine whether the reduction in extremely preterm births, observed in Denmark during the COVID-19 lockdown, could be the result of an increase in perinatal deaths and to assess the impact of extended COVID-19 restrictions, we performed a nationwide Danish register-based prevalence proportion study. We examined all singleton pregnancies delivered in Denmark during the COVID-19 strict lockdown calendar periods (March 12–April 14, 2015-2020, N = 31,164 births) and the extended calendar periods of COVID-19 restrictions (February 27–September 30, 2015-2020, N = 214,862 births). The extremely preterm birth rate was reduced (OR 0.27, 95% CI 0.07 to 0.86) during the strict lockdown period in 2020, while perinatal mortality was not significantly different. During the extended period of restrictions in 2020, the extremely preterm birth rate was marginally reduced, and a significant reduction in the stillbirth rate (OR 0.69, 0.50 to 0.95) was observed. No changes in early neonatal mortality rates were found.Conclusion: Stillbirth and extremely preterm birth rates were reduced in Denmark during the period of COVID-19 restrictions and lockdown, respectively, suggesting that aspects of these containment and control measures confer an element of protection. The present observational study does not allow for causal inference; however, the results support the design of studies to ascertain whether behavioural or social changes for pregnant women may improve pregnancy outcomes. What is Known:• The aetiologies of preterm birth and stillbirth are multifaceted and linked to a wide range of socio-demographic, medical, obstetric, foetal, psychosocial and environmental factors.• The COVID-19 lockdown saw a reduction in extremely preterm births in Denmark and other high-income countries. An urgent question is whether this reduction can be explained by increased perinatal mortality. What is New:• The reduction in extremely preterm births during the Danish COVID-19 lockdown was not a consequence of increased perinatal mortality, which remained unchanged during this period.• The stillbirth rate was reduced throughout the extended period of COVID-19 restrictions.

Early Neonatal Mortality’s Determinants in the Neonatology Department of Mohamed V Hospital in Tangier, Morocco

Objective: This study aims to identify the determinants of early neonatal mortality in the neonatology department of Mohamed V hospital in Tangier.Material and methods: This is a prospective study including all newborns hospitalized and deceased in the pediatric department of the hospital Mohammed V from June 1 to December 31, 2019. The recorded cases were processed and analyzed by SPSS software.Results: 529 newborns were hospitalized in the pediatric department during the study period, of which 92 died (17.39%) between 0 and 7 days. Four leading causes justified this frequency: prematurity occupies first place (59%), followed by perinatal asphyxia (22%), neonatal infection (15%) in third place, congenital malformations (3%) in fourth place. Parturients aged between 20 and 35 years are the most affected (76%). The majority of women (71.4%) in our series had not undergone prenatal consultation (PNC) or had done so in insufficient numbers.Conclusion: Neonatal mortality remains high. Improvement of this situation requires education of women, reinforcement of surveillance before, during pregnancy, during delivery, and the postpartum period, as well as effective management of premature newborns in the first week of life, should improve the neonatal prognosis by reducing the intra-hospital incidence of neonatal mortality in our setting.

Preterm labor – an unresolved problem of the XXI century

The article discusses one of the most significant problems in the modern obstetric practice – preterm labor (PL). The upward trend in PL worldwide is related to an increase number of multiple pregnancies due to in vitro fertilization (IVF). PL is one of the main causes of early neonatal mortality and disability in children, also increases the survival rate of newborns with extremely low birth weight, and therefore it significantly changes the structure of surviving premature infants' morbidity. The greatest threat is represented by the «threshold» stages of the disease, with the development of which the process becomes almost irreversible and requires immediate treatment. To improve the perinatal outcomes of PL, the authors draw attention to two problems: first of them – to understand the mechanism of PL, the second one-to work out tactics that allow to carry out measures that can delay, prevent the distress syndrome, and improve fetal condition at any stage of the disease. Key words: preterm birth, in vitro fertilization, quality of life, retinopathy of prematurity.