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1. Conference
proceedings
The ISA conference was held in Oslo on the 5-7 November 2008. The proceedings of this
conference, General Assembly minutes and summaries of scientific
meetings will all be published on the ISA website (www.stillbirthalliance.org)
shortly.
2.
Overviews/Guidelines
No publications in this category were
found in the search.
3. Risk
factors/Causes
Ghosh GS, Gudmundsson S. “Nuchal
cord in post-term pregnancy - relationship to suspected intrapartum
fetal distress indicating operative intervention.” J Perinat Med. 2008
Jan 23; [Epub ahead of print]
A nuchal cord occurs when the umbilical cord wraps 360˚ around the fetal
neck. A study was conducted to determine if Doppler ultrasound
examination for nuchal cord could improve the outcome of post-term
pregnancies. A nuchal cord was identified in 34% of the monitored
pregnancies. However, there were no significant differences between the
pregnancies with and without a nuchal cord. The results of the study
suggested that Doppler ultrasound of nuchal cord would not be a useful
tool for improving the outcome of post-term pregnancies. A larger sample
size may be required to confirm the results from the study.
Lee YM, Wylie BJ, Simpson LL, D'Alton ME. “Twin chorionicity and the
risk of stillbirth.” Obstet Gynecol. 2008 Feb;111(2 Pt 1):301-8.
When a woman is pregnant with twins, the risk of stillbirth and other
obstetric complications is increased. This study compares in utero
survival between two different types of twins, monochorionic-diamniotic
and dichorionic-diamniotic. A dichorionic-diamniotic twin pregnancy
occurs when each cell develops separately its own placenta (chorion) and
its own sac (amnion). Monochorionic-diamniotic twins are twins who share
one placenta, but each have their own amniotic sacs.
Data from 1000 consecutive twin pairs was analysed, giving the results
that monochorionic-diamniotic twins were at a higher risk of stillbirth
than dichorionic-diamniotic twins, with rates of 3.6% and 1.1%
respectively.
Black M, Shetty A, Bhattacharya S. “Obstetric outcomes subsequent to
intrauterine death in the first pregnancy.” BJOG. 2008
Jan;115(2):269-74.
The objective of this study was to examine the obstetric outcomes in the
pregnancy subsequent to intrauterine death compared to those pregnancies
that followed a previous live birth.
The results of this study showed that while women with a previous
stillbirth have a live birth in the subsequent pregnancy, they are still
a high-risk group with an increased incidence of adverse maternal and
neonatal outcomes, such as pre-eclampsia, placental abruption and
prematurity in comparison to women who have had a previous live birth.
Rawlinson WD, Hall B, Jones CA, Jeffery HE, Arbuckle SM, Graf N, et
al. “Viruses and other infections in stillbirth: what is the evidence
and what should we be doing?” Pathology. 2008 Feb;40(2):149-60.
The exact causes of almost half of all stillbirths are unknown. Recent
evidence suggests that some of cases of stillbirth may have viruses
contributing to the babies death, either alone or in combination with
other infections. This article describes some of the causes of
stillbirth including clinical, epidemiological as well as viral and
other infectious agents. It summarise some of the recent molecular
techniques used to detect the presence of any infection in the placenta
and/or stillborn baby. These tests can identify several infectious
agents such as Cytomegalovirus, Varicella Zoster Virus, Herpes Viruses
and others. Finally the article describes whether the actual infectious
agent causes the death of the baby or whether there maybe other
interacting causes of the baby’s death. These tests may assists to
assign a correct cause of death for some of these stillborn babies.
Having a correct diagnosis is a benefit to assists parents in their
decision making for future pregnancies.
Toal M, Keating S, Machin G, Dodd J, Lee Adamson S, Windrim RC,
Kingdom JCP. “Determinants of adverse perinatal outcome in high-risk
women with abnormal uterine artery Doppler images.” American Journal of
Obstetrics and Gynecology 2008;198:330.e1-330.e7.
The placenta is essential for successful pregnancy. These investigators
looked at placental shape and texture using ultrasound at 19-23 weeks
gestation to predict poor pregnancy outcomes including stillbirth. They
looked at 60 patients with abnormal blood flow in the uterine artery
which is associated with poor pregnancy outcome. They found that
abnormal placental size and shape was associated with lower birthweight,
increased risk of preterm delivery and stillbirth. The population under
study had a high rate of pregnancy complications and 83% had evidence of
placental abnormality on microscopic assessment of the placentas. They
concluded that placental size and shape might be able to predict which
women are at risk of pregnancy complications. The researchers also
stated that present imaging of the placenta has significant limitations.
Strandberg-Larsen K, Nielsen NR, Gronbaek M, Andersen PK, Olsen J,
Andersen AM. “Binge drinking in pregnancy and risk of fetal death.”
Obstet Gynecol. 2008 Mar;111(3):602-9.
Drinking is considered binge drinking when there is an intake of five or
more drinks on one single occasion. This study examines whether the
frequency and timing of binge drinking episodes during the first 16
weeks of pregnancy increase the risk of fetal death.
89 201 women from 1996 to 2002 participated in this study, and results
showed that while binge drinking three or more times during pregnancy is
associated with an increased risk of stillbirth, neither the frequency
nor timing of binge drinking was associated with an increased risk of
spontaneous abortion.
Huang L, Sauve R, Birkett N, Fergusson D, van Walraven C. “Maternal
age and risk of stillbirth: a systematic review.” CMAJ. 2008 Jan
15;178(2):165-72.
The number of women who delay childbirth to their late 30s and beyond
has increased significantly over the past several decades, and studies
regarding the relation between older maternal age and the risk of
stillbirth have yielded inconsistent conclusions. This paper is a
systematic review of previous publications on maternal age and risk of
stillbirth to explore whether older maternal age is associated with an
increased risk of stillbirth.
After analysing the data from the relevant articles found, results
showed that women with advanced maternal age have an increased risk of
stillbirth, but the magnitude of the increased risk is not clear.
4.
Investigation/audit/classification
Papiernik E, Zeitlin J, Delmas D,
Draper ES, Gadzinowski J, Künzel W, Cuttini M, Di Lallo D, Weber T,
Kollée L, Bekaert A, Bréart G; MOSAIC Research Group. “Termination of
pregnancy among very preterm births and its impact on very preterm
mortality: results from ten European population-based cohorts in the
MOSAIC study.” BJOG. 2008 Feb;115(3):361-8.
MOSAIC stands for Models of OrganiSing Access to Intensive Care for very
preterm babies. Ten regions from nine European countries participated in
this study.
The objective was to determine the impact of pregnancy termination, and
causes for termination, on mortality rates in Europe by evaluating
births during 22-31 weeks. The existing regional differences in policies
and reporting procedures for screening of congenital anomalies and the
legality and timing of pregnancy terminations led to the inability to
adequately compare study results. International reporting policies are
needed so that comparisons can be made.
Walsh CA, McMenamin MB, Foley ME, Daly SF, Robson MS, Geary MP.
“Trends in intrapartum fetal death, 1979-2003.” Am J Obstet Gynecol.
2008 Jan;198(1):47 e1-7.
This study was undertaken to analyse trends in intrapartum fetal death
and rates of perinatal autopsy over a 25 year period (1979-2003) in
Dublin, Ireland.
Results of this long-term study shows that there was a significant
decrease in the rate of intrapartum fetal death in the 25 year period
studied. This has primarily resulted from a reduction in deaths
attributable to intrapartum hypoxia, of which rates have fallen
dramatically. Also found in this study was the concerning outcome that
rates of perinatal autopsy had also fallen significantly from 1979-2003.
5. Bereavement
Bryant H. “Maintaining patient
dignity and offering support after miscarriage.” Emerg Nurse. 2008
Feb;15(9):26-9.
The care received by women and their partners at the time of miscarriage
has a major impact on their grieving process. Nurses who attend to women
during this time therefore need to meet both the physical and
psychological needs of the women they are caring for. They also need to
meet and understand the needs of their partners as well as any attending
extended family members. Time, respect and information should be given
to all.
Privacy and time are especially important and simple measures can be
taken to ensure that they are achieved in any Emergency Department.
Locks and “engaged” signs on doors, with the examination couch facing
away from the door can have extremely positive benefits to the woman, as
can adequate screening and proper draping.
Staff should also have proper training, access to relevant leaflets and
a positive line of referral to work to. They should also ensure that
sanitary products and examination trolleys are kept “topped up” and
refilled after every patient.
These simple measures can help to ensure that women, their partners and
their families experiencing miscarriage are treated with the dignity and
respect that they both need and deserve.
Chan MF, Lou F, Arthur DG, Cao F, Wu LH, Li P, Sagara-Rosemeyer M;
Chung LYF, Lui L. “Investigating factors associate to nurses' attitudes
towards perinatal bereavement care.” J Clin Nurs. 2008 Feb;17(4):509-18.
Death is a taboo subject in Chinese Culture and is not routinely
discussed. Open displays of emotion are not widely seen, which may lead
bereaved parents not openly showing their need for support.
Hospitals in Hong Kong have recently developed perinatal bereavement
support to offer bereaved parents emotional care. This study was
designed to explore nurses’ attitudes towards perinatal bereavement care
and to examine factors associated with such attitudes.
Key findings include:
1. A need for increased knowledge and experience around perinatal
bereavement.
2. A need for improved communication skills and greater support from
colleagues.
3. The nurses themselves need psychological help and support to enable
them to support the bereaved parents.
4. The nurses need to be able to discuss and debrief their experiences
with their colleagues.
5. Supportive care practices need to be understood, implemented and
practiced by all nurses, with a mentoring approach being a key factor in
this.
In Addition it was found that:
1. Most nurses had a positive attitude towards caring for bereaved
parents.
2. More than 89% of the nurses agreed that parents should have time to
grieve and recognized that perinatal bereavement support provided
psychological and emotional support to the parents.
3. Most nurses believed that they should be well informed so that they
can help the parents to make informed choices.
4. Most of the nurses recognized that they needed further training to
provide this care.
Stratton K, Lloyd L. “Hospital-based interventions at and following
miscarriage: literature to inform a research-practice initiative.” Aust
N Z J Obstet Gynaecol. 2008 Feb;48(1):5-11. Review.
Miscarriage is a common form of reproductive loss with an estimated one
in five pregnancies resulting in this. Because of this, it is often
under acknowledged by the community and health professionals, leading to
dissatisfaction with care following miscarriage. Evidence suggests that
the care provided in hospital can have a significant effect on the
emotional and physical recovery from a miscarriage, so this literature
review aims to determine any evidence-based guidelines for
hospital-based medical and psychological services following a
miscarriage.
Barr P, Cacciatore J. “Problematic emotions and maternal grief.”
Omega (Westport). 2007-2008;56(4):331-48.
This study examines the relation of personality proneness to
“problematic social emotions” – envy, jealousy, shame and guilt to
maternal grief following a miscarriage, stillbirth, neonatal death or
infant/child death.
441 women participated in this study and results showed that all four
problematic emotions correlated with maternal grief - particularly envy,
jealousy and guilt.
6.
Intervention/Prevention
Ortendahl M, Nasman P. “Quitting smoking is perceived to have an
effect on somatic health among pregnant and non-pregnant women.” J
Matern Fetal Neonatal Med. 2008 Apr;21(4):239-46
A group of 80 women in Bulgaria was interviewed about how they expected
that continued smoking would affect their health in the future. The
group included pregnant and non-pregnant women and among both the
pregnant and the non-pregnant women were women with the intention to
quit smoking and women not having the intention to quit. The women were
asked for the probability of health consequences related to their own
physical health, consequences related to the pregnancy and consequences
related to mood and social relations.
The greatest effect of intending to quit smoking on expected future
health consequences was found in the consequences related to the
physical health. The factor of pregnancy did not have a great influence
on these results. The authors conclude that the effect of smoking on the
physical health of women should be stressed in health promotion, also
for pregnant women.
Heazell AE, Green M, Wright C, Flenady VJ, Frøen JF. “Midwives' and
obstetricians' knowledge and management of women presenting with
decreased fetal movements.” Acta Obstetricia et Gynecologica
Scandinavica. 2008;87(3):331-339.
Decreased fetal movements are associated with increased risk of
stillbirth and intrauterine growth restriction; this study investigated
views of 129 obstetricians and 94 midwives in the UK about decreased
fetal movements using a postal questionnaire.
The primary finding of this study was that there was wide variation in
clinical practice. The majority of respondents enquired about the
presence of fetal movements after 28 weeks gestation, but there was
little agreement on a definition of decreased fetal movements with a
maternal perception of decreased movements for 24 h gaining the greatest
acceptance. Few practitioners used formal fetal movement counting, with
the majority of respondents stating they were ineffective in the
prevention of IUGR or IUFD and led to increased intervention. There was
large variation in the knowledge of associations with DFM and management
of women presenting with DFM. The variation in practice may result from
a lack of robust evidence on which to base the provision of care. More
research is needed to provide evidence to direct the management of women
presenting with DFM.
Mbonye AK, Bygbjerg IC; Magnussen P. “Intermittent preventive
treatment of malaria in pregnancy: the incremental cost-effectiveness of
a new delivery system in Uganda.” Trans R Soc Trop Med Hyg. 2008
Jul;102(7):685-93. Epub 2008 May 29.
Malaria is the leading cause of morbidity and mortality in Uganda,
mainly affecting pregnant women and young children. This study was
undertaken to determine whether traditional birth attendants, drug-shop
vendors, community reproductive-health workers or adolescent peer
mobilisers could administer intermittent preventive treatment for
malaria to pregnant women.
Supplementation with Multiple Micronutrients Intervention Trial
(SUMMIT) Study Group, Shankar AH, Jahari AB, Sebayang SK, Aditiawarman,
Apriatni M, Harefa B, Muadz H, Soesbandoro SD, Tjiong R, Fachry A,
Shankar AV, Atmarita, Prihatini S, Sofia G. “Effect of maternal multiple
micronutrient supplementation on fetal loss and infant death in
Indonesia: a double-blind cluster-randomised trial.” Lancet. 2008 Jan
19;371(9608):215-27.
In developing countries, nutrient supplementation for pregnant women is
generally restricted to provision of iron and folic acid, as there is
little evidence of the effects of multiple micronutrients on fetal loss
and infant death. This study investigates the effect of maternal
supplementation with multiple micronutrients compared with iron and
folic acid on fetal loss and infant death, randomly assigning 262
midwives to distribute supplements to 31 290 pregnant women. Results
showed that multiple micronutrients can reduce the incidence of early
infant mortality and other adverse obstetric outcomes.
EXTRA READING
Volume 32, Issue 4, Pages 231-322 (August 2008) of Seminars in
Perinatology has an extremely relevant and valuable selection of
studies on topics such as stillbirth, fetal movement and fetal growth
restriction. Some articles found in this issue are “Epidemiology of
Stillbirth and Fetal Central Nervous System Injury.” (Salihu HM),
“Management of decreased fetal movements.” (Frøen JF et al.) and
“Antepartum testing for women with previous stillbirth.” (Weeks, JW).
Volume 22, Issue 4, Pages 313-359 (July 2008) of the Journal of
Paediatric and Perinatal Epidemiology features an important
collection of studies such as “Maternal use of oral contraceptives and
risk of fetal death.” (Jellesen R et al.), “The impact of past pregnancy
experience on subsequent perinatal outcomes” (Hutcheon JA et al.) and
“Health-risk behaviours: examining social disparities in the occurrence
of stillbirth” (Goy J et al.)
Volume 35, Issue 3 (September 2008) of the Journal of Obstetric
and Gynecology Clinics in North America includes a number of
articles and studies on prenatal care such as “Nutrition During
Pregnancy” (Cox JT) and “Childbirth Education and Birth Plans” (Bailey
JM).
Volume 199, Issue 3, pages 209-326 (September 2008) of the
American Journal of Obstetrics and Gynecology includes studies on a
broad range of topics under stillbirth, for example “Biophysical profile
in the treatment of intrauterine growth-restricted fetuses who weigh
<1000 g” (Kaur S et al.), “Identifying the causes of stillbirth: a
comparison of four classification systems” (Vergani P et al.) and “Risk
factors for uteroplacental vascular compromise and inflammation” (Baker
M et al.).
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