International Stillbirth Research Alert


Issue 1, July 2009
 
Table of Contents

Introduction

Research summaries

  1. Conference proceedings International Stillbirth Alliance Annual Conference, 2008 (Oslo, Norway)
  2. Guidelines and reviews
  3. Causes and risk factors/Epidemiology
  4. Investigation/Classification/Audit
  5. Interventions
  6. Bereavement care

Complete reference list of relevant papers

Acknowledgments

ANZSA/ ISA Stillbirth Research Alert Protocol


Introduction

This Stillbirth Research Alert is a collaborative activity of the Australian and New Zealand Stillbirth Alliance (ANZSA*) and the International Stillbirth Alliance (ISA). The aim of the Stillbirth Research Alert is to provide plain language summaries of recent key papers addressing stillbirth. For further details about the Stillbirth Research Alert, ISA and ANZSA, please visit the ANZSA and the ISA websites at:

http://www.stillbirthalliance.org/anz  and http://www.stillbirthalliance.org

*ANZSA is ISA’s regional office for Australia and New Zealand.

Stillbirth Research Alert search period: Dec 2008-June 2009.
The full reference list of recent publications identified by the literature search is provided here. For details on the methods of the Stillbirth Research Alert please click here.


 
Because the Stillbirth Research Alert is compiled by ANZSA, studies undertaken in Australia and New Zealand are identified with this symbol in order to assist readers in ANZ.
 


Research summaries

1. Conference proceedings

International Stillbirth Alliance Annual Conference, 2008 (Oslo, Norway).


    Only a selection of abstracts is included in the Stillbirth Research Alert. 
Download the full conference proceedings in pdf here.    
 

Preparing for autopsy: A parent perspective.
Christoffersen L.

In this study, 40 parents were interviewed about their experiences with the health care system after they had experienced the loss of a baby through late stillbirth (death of a baby in late pregnancy). In the interview, parents were asked about important events surrounding the loss of their baby, particularly regarding the autopsy of their stillborn baby. It was found that parents were not prepared to make decisions when the question of autopsy was raised. Many parents suggested that the topic of autopsy should be introduced and discussed early, before birth. Parents also want to be informed of the details of the autopsy, including details about how the autopsy is performed, why it should be done as soon as possible, what happens to the baby’s organs, how the baby will look after autopsy, and if / when they can see their baby again after the autopsy. Parents indicated the importance of having their questions answered by qualified personnel. Many parents wanted the opportunity to see, hold, and care for their baby after the autopsy. Lastly, parents expressed a need for the hospital to go through the autopsy report with the parents.


Couples and grief: Couple relationships and intimacy after the loss of a child.
Dyregrov A.

This study examined sexuality and intimacy between couples following the loss of a baby. The study included both questionnaires and interviews. Around 300 members of two bereavement support organisations in Norway completed the questionnaires and ten couples were interviewed in detail. It was found that around two thirds of parents had continued sexual activity within three months after their baby’s death. Around one third of parents had less sexual activity. Compared to fathers, fewer mothers experienced sexual pleasure and almost a third of mothers said that this had been reduced since their baby’s death. It is suggested that spoken and written information might help families through the time after their baby’s death. This may lead to less conflict between parents, and better coping in couple relationships.


Do couples stay together after a baby dies? Marriage and cohabition outcomes after miscarriage and stillbirth.
Gold KJ, Sen A, Hayward RA.

The death of a baby places a lot of stress on the relationship of parents. While a lot of research has been done on parents who lost liveborn babies and older children, not as much has focussed on parents who have lost a baby through miscarriage or stillbirth. Therefore, this study aimed to examine the risk of separation or divorce in parent couples who experienced miscarriage or stillbirth. The study looked at a large survey of men and women in the United States. It was found that parents who had experienced any pregnancy loss were more likely to experience separation or divorce. More specifically, those parents who had experienced stillbirth showed a higher risk of separation or divorce than those who experienced a miscarriage.


Support for mothers, fathers and families after perinatal death: A Cochrane review.
Flenady V, Wilson T.


For families dealing with the death of a baby around the time of birth (perinatal death) it is important to get care that meets their needs. This review of randomised trials examined the effects of any form of medical, nursing, social or psychological support/ counselling for these families. The review included trials of any kind of support aimed to help with the acceptance of loss, specific counselling to deal with death, or any specialised psychological support/ counselling. It was concluded that there is not enough information available from randomised trials to decide if there are any benefits of these interventions for families after perinatal death. The authors concluded that further trials are needed.


Investigations of stillbirths.
Flenady V, Silver B, Incerpi M et al.

Stillbirth is a major public health problem in both poor and rich country settings. Yet, efforts to address stillbirth across the globe are limited because there is a lack of information on the causes and risk factors for stillbirth. This lack of information about stillbirths is often underpinned by inadequate approaches to data collection, and by what stillbirth classification system is used. Aside from these limitations, the value of any data collection on stillbirth depends on gathering all important information for each single case. This is best achieved through using a systematic approach to stillbirth data collection and to the review of these findings. In detail, this study discusses the importance of thoroughness of stillbirth investigation. A stillbirth investigation protocol is also proposed, taking into account the limited resources in poor country settings.


Risk factors for stillbirth in developing countries: A systematic review of the literature.
Say L.

This study is a review of the risk factors for stillbirth in developing countries, and discusses how these factors impact on low-income societies. Risk factors were divided into three broad categories; infections, other clinical conditions, and context-dependent conditions. A total of 33 studies from varying developing countries were included in the review. It was found that maternal socio-economic disadvantage, malnutrition, some medical diseases and a lack of care during pregnancy were the most important risk factors for stillbirth in a number of poor country settings. These risk factors together were estimated to contribute more than half the number of stillbirths in these countries. Therefore, it is suggested that interventions targeting these risk factors could help to reduce the large number of stillbirths in developing country settings.


Maternal perception of decreased fetal movements for detection of the fetus at risk: The Australian experience of the international FEMINA Collaboration.
Flenady V, Fr?en F, MacPhail J, Gilshenan K, Mahomed K, Gardener G, Chadha Y, Gray P, Fretts R, for the FEMINA collaboration.

When a mother notices that her baby is moving less than usual, this is referred to as decreased fetal movement (DFM). This observation has been shown to identify pregnancies that are at increased risk of stillbirth. This study was done across six hospitals in Queensland, Australia, between 2006 and 2008. The study aimed to determine the frequency of women with DFM and how women with DFM were treated (e.g. what tests were done). Between 2006 and 2008, 4-7% of women noticed DFM during their pregnancy. The majority of these women had a cardiotocograph undertaken and a smaller number of women had an ultrasound. Thirteen per cent of women who noticed DFM had babies with growth restriction. It was also found that around a third of women who noticed DFM waited for more than two days before contacting their health care provider. The authors recommend further well designed studies into the detection and management of women with DFM.


Potentially modifiable stillbirths in Australasia; A systematic review of the literature.
Flenady V, Koopmans L, Middleton P, Dodd J, Fretts R, Smith G, Gordon A, Fr?en JF.

A systematic review of the literature was done, to identify modifiable risk factors for stillbirth relevant to the Australian and New Zealand (ANZ) population. Modifiable risk factors were divided into three groups: maternal health and lifestyle, antenatal care, and factors related to (current and previous) pregnancy. The most commonly reported modifiable risk factors were obesity, smoking, and maternal age over 35. It was found that these risk factors together may account for up to 45% of stillbirths in ANZ. Other risk factors were also found, although they made a smaller contribution and were less consistent across studies. According to this study, maternal overweight and obesity, maternal age over 35 and smoking during pregnancy are priority areas to reduce the stillbirth rate in Australia and New Zealand.


2. Guidelines and reviews

Flenady V, King J, Charles A, Gardener G, Ellwood D, Day K, McGowan L, Kent A, Tudehope D, Richardson R, Conway L, Lynch K, Haslam R, Khong Y, for the Perinatal Society of Australia and New Zealand (PSANZ) Perinatal Mortality Group (PMG). PSANZ Clinical Practice Guideline for Perinatal Mortality. Second edition, version 2.2, Brisbane April 2009.

The PSANZ-PMG guidelines for perinatal mortality have been revised (including revisions to the PSANZ classifications for perinatal deaths) and are recommended for use as of 1st July 2009. To access the guidelines, please visit here.


ACOG Practice Bulletin No. 102: Management of stillbirth. Obstet Gynecol. 2009; 113: 748-61.
The bulletin contains practical guidelines aimed to assist clinicians in providing optimal care around the time of a stillbirth. Causes and risk factors for stillbirth in developing and developed countries are discussed and compared (i.e. ethnicity/ racial factors, medical diseases, obesity, multiple pregnancies, maternal age over 35 years, diseases and outcomes of past pregnancies, fetal growth restriction, placental abruption, chromosomal/ genetic abnormalities, infection and cord events). Recommendations for the investigation of stillbirth are made, including what tests are needed and how to discuss the topic of autopsy with parents. The timing and management of the birth of a stillborn baby is discussed, as well as support services and counselling. Recommendations are made for the management of future pregnancies, including stillbirth recurrence counselling, antepartum surveillance, fetal movement counting and the timing of delivery. For some of the recommendations made for the management of stillbirth there is good scientific evidence. For other recommendations scientific evidence is limited. Therefore these recommendations are based on consensus and expert opinion.


Goldenberg RL, McClure EM, Belizan JM. Commentary: reducing the world's stillbirths. BMC Pregnancy Childbirth. 2009; 9 Supplement 1: S1.
This commentary introduces a 6 paper literature review about the burden of stillbirth worldwide, while focussing on low income countries. The first paper gives an overview of the problem of stillbirth internationally, and introduces the topics covered by the series and the methods that were used. The other papers review the following: interventions to prevent stillbirth before and during pregnancy (paper 2&3), interventions used for screening and monitoring pregnant women (paper 4), and interventions to prevent stillbirth during childbirth (paper 5). The last paper (paper 6) reviews interventions to prevent stillbirth in a health system context using policies, programmes and research.


Lawn JE, Yakoob MY, Haws RA, Soomro T, Darmstadt GL, Bhutta ZA. 3.2 million stillbirths: epidemiology and overview of the evidence review. BMC Pregnancy Childbirth. 2009; 9 Supplement 1: S2.
Worldwide, about 3.2 million babies are stillborn each year. Yet, most of these deaths are unseen in global data tracking, in the international stillbirth policy dialogue and in programme implementation. There also hasn’t been a systematic analysis of the causes of stillbirth worldwide, and the many stillbirth classification systems in use are often complex and designed for high-income countries only. This first paper in the stillbirth review series outlines the problem of stillbirths worldwide. This paper also outlines issues with the availability of stillbirth data and data quality internationally, and it describes the methodology and framework which was used for this stillbirth review.


Yakoob MY, Menezes EV, Soomro T, Haws RA, Darmstadt GL, Bhutta ZA. Reducing stillbirths: behavioural and nutritional interventions before and during pregnancy. BMC Pregnancy Childbirth. 2009; 9 Supplement 1: S3.
Worldwide, most stillbirths happen in developing country settings. Stillbirths in these countries often happen before birth. Women's risk of stillbirth in developing country settings is increased because of the lack of care provided, poor nutrition of women, and because of some behaviours. Interventions could reduce stillbirth risk, but scientific evidence for the impact of interventions has not been carefully evaluated. This second paper of the review covers 12 interventions meant to reduce behavioural and social risk factors for stillbirth in developing country settings. These risk factors include: exposures to harmful practices and substances, maternal nutrition before and during pregnancy, and the use and quality of care. The review revealed that none of the 12 interventions covered in this paper clearly proved to reduce the number of stillbirths. Therefore, the authors argue that more studies in this area need to be done; particularly studies which aim to decrease tobacco use and tobacco exposure during pregnancy. The use of nutritional supplements such as vitamins and folic acid were also mentioned. Similarly, the authors argue more research must be done; in particular on the subject of balanced protein-energy supplementation during pregnancy.


Menezes EV, Yakoob MY, Soomro T, Haws RA, Darmstadt GL, Bhutta ZA. Reducing stillbirths: prevention and management of medical disorders and infections during pregnancy. BMC Pregnancy Childbirth. 2009; 9 Supplement 1: S4.
Approximately two thirds of the 3.2 million stillbirths each year, happen before birth. Unrecognised, untreated or inadequately treated infections and maternal conditions are known to increase the risk of stillbirth. This third paper covers 16 interventions to prevent stillbirths at a community level in developing country settings. Only a few studies were identified which focussed on stillbirth or perinatal death as pregnancy outcomes. It was found that interventions such as heparin treatment for certain maternal conditions, syphilis screening and treatment, and bed nets for the prevention of malaria directly reduced the number of stillbirths. Therefore, it was suggested that these interventions are included into all care programs in developing country settings. For other interventions (i.e. anti-helminthic treatment, management of cholestasis, and preventative treatment of malaria) more studies are needed as it was unclear that these interventions directly reduced the number of stillbirths. This review also found some evidence for a number of newly recognised risk factors for stillbirth, including periodontal disease. Large randomised trials are needed to test interventions addressing these factors.


Haws RA, Yakoob MY, Soomro T, Menezes EV, Darmstadt GL, Bhutta ZA. Reducing stillbirths: screening and monitoring during pregnancy and labour. BMC Pregnancy Childbirth. 2009; 9 Supplement 1: S5.
This fourth paper assessed 14 screening and monitoring interventions during pregnancy and childbirth for their impact on stillbirth rates. Evidence came from 221 studies. It was found that there was a lack of evidence demonstrating the direct impact of any screening procedure on stillbirth incidence. Some interventions, such as fetal movement monitoring (KICK counting) and Doppler monitoring, showed some evidence of decreasing stillbirth rates in women with high-risk pregnancies. Yet, the use of formal fetal movement monitoring was not recommended. The authors urged for more properly designed studies to assess the usefulness of most screening and monitoring interventions.


Darmstadt GL, Yakoob MY, Haws RA, Menezes EV, Soomro T, Bhutta ZA. Reducing stillbirths: interventions during labour. BMC Pregnancy Childbirth. 2009; 9 Supplement 1: S6.
Each year, about a million stillbirths happen during childbirth (intrapartum stillbirth). Most of these deaths happen in poor country settings. Intrapartum stillbirths are associated with no, insufficient or delayed care during pregnancy. This last paper in the series discusses 8 interventions aimed to reduce stillbirths during childbirth. Review of the literature identified 230 studies. Few studies were able to demonstrate the effectiveness of interventions for reducing intrapartum stillbirth and perinatal mortality rates. However, it was found that operative delivery, especially Caesarean section, decreased intrapartum stillbirth rates. For overdue pregnancies, labour induction showed strong evidence of reducing intrapartum stillbirth rates. Other interventions such as magnesium sulphate for pre-eclampsia and eclampsia and planned caesarean section were also discussed. Yet, in developed country settings, interventions such as planned caesarean section may not be possible. Some interventions (such as amnioinfusion and hyperoxygenation) may reduce intrapartum stillbirth, however more research is needed to test their effectiveness.


3. Causes and risk factors/Epidemiology

Anthony S, Jacobusse GW, van der Pal-de Bruin KM, Buitendijk S, Zeitlin J. Do differences in maternal age, parity and multiple births explain variation in fetal and neonatal mortality rates in Europe? - Results from the Euro-Peristat project. Paediatric & Perinatal Epidemiology. 2009 23: 292-300.
Stillbirth and neonatal death rates are very different across Europe. This study investigated whether older age of the mother, first pregnancies and multiple pregnancies contributed to these differences. Twelve countries participated in the EURO-PERISTAT project. This study found that between the 12 countries there was a big difference in stillbirth and neonatal death rates, and also in the number of mothers over 35, first pregnancies and multiple births. These characteristics all increased the risk of stillbirth and neonatal death. Yet, the association between older age of the mother and stillbirth became less clear as the number of older mothers in the population in countries increased. The authors suggest that further research should explore why the negative effect of older maternal age decreases as delayed childbearing becomes more common in the population. A possible explanation would the changing social characteristics of older mothers and possibly a change in the pregnancy care provided to these women.


Hvas AM, Ingerslev J, Salvig JD. Thrombophilia risk factors are associated with intrauterine foetal death and pregnancy-related venous thromboembolism. Scand J Clin Lab Invest. 2009; 69: 288-94.
This paper investigates the relationship between pregnancy complications and the presence of risk factors for thrombophilia. From 1996-2006, 414 women with 885 pregnancies were examined for inherited and acquired thrombophilia because they had complications during their pregnancies. Among these 885 pregnancies, the proportion of fetal deaths was very high, especially in the first trimester of pregnancy. One in four women had a thromboembolic event during their pregnancy or experienced pre-eclampsia on at least one occasion. Fetal growth restriction and placental abruption were other common pregnancy complications. Nearly one third of women had at least one thrombophilia risk factor, Factor V Leiden heterozygosity being the most common risk factor. Overall, thrombophilia was found to be considerably more common in women with pregnancy complications in comparison to the general population.


Warland J, McCutcheon H & Baghurst P. Placental position and late stillbirth: a case-control study. Journal of Clinical Nursing, 2009;18:1602-1606.
Few studies in the past have looked at the relationship between placental position and outcomes of pregnancy. This study aimed to find out whether there is a relationship between the position of the placenta and the risk of stillbirth. The position of the placenta in 124 pregnancies which resulted in stillbirth was compared with the placental position in 243 pregnancies which had good outcomes (healthy babies). It was found that women with a placenta located at the back of the uterine wall were more likely to have a stillbirth than women with their placenta located in any other position. Because very little research has been done in this area, the authors express the need for more well designed studies which confirm these outcomes.


Engmann C, Matendo R, Kinoshita R, et al. Stillbirth and early neonatal mortality in rural Central Africa. Int J Gynaecol Obstet. 2009; 105: 112-7.
This study was undertaken to develop a register of all births, including stillbirths and early neonatal deaths. This register was then used to determine the number of fresh and macerated stillbirths delivered in the northwest of the Democratic Republic of Congo, in rural central Africa. Birth outcomes were collected from 4 rural health districts. A total of 8230 women were included in the study. The early neonatal death rate was 32 deaths per 1000 live births. Similarly, the stillbirth rate was 33 stillbirths per 1000 deliveries, with a ratio of fresh to macerated stillbirths of 4:1. The majority of deaths occurred in neonates weighing 1500 grams or more. Mothers who were single or did not receive prenatal care, and low birthweight, premature, or male babies were at a higher risk for early neonatal death and stillbirth. Early neonatal death prevention should be targeted at babies weighing above 1500 grams at birth because these babies have an overall high chance of survival. Also, because the ratio of fresh to macerated stillbirths was nearly 10-fold higher than expected, improving intrapartum care should be a priority in rural areas.


4. Investigation/Classification/Audit

Kidron D, Bernheim J, Aviram R. Placental Findings Contributing to Fetal Death, a Study of 120 Stillbirths between 23 and 40 Weeks Gestation. Placenta. 2009.
When a baby is stillborn, autopsy and an examination of the placenta help to identify the cause of death. This paper reviews the reports of 120 autopsies and placenta examinations, to examine causes of stillbirth relating to the placenta. The majority of deaths were found to be related to abnormalities in maternal and fetal blood supply. Some stillbirths were caused by inflammatory lesions (12%). For some deaths an explanation could not be found (8%). For the majority of stillbirths (88%) a direct cause, or a major contributor to the death, was found in the placenta. Therefore, the authors urge that apart from autopsy, close examination of the placenta is very important for identifying the cause of stillbirth.


Headley E, Gordon A, Jeffery H. Reclassification of unexplained stillbirths using clinical practice guidelines. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2009 49: 285-9.
Almost one third of all stillbirths in Australia are unexplained. When a cause of death is unknown, it is harder for grieving parents and their families to deal with their loss. It may also be harder to prevent stillbirth from happening in the future. A set of guidelines were developed by the Perinatal Society of Australia and New Zealand (PSANZ) to help clinicians with the management and investigation of stillbirth. The study looked at 86 stillbirths born between 2005 and 2008. A cause of death was first classified as it appeared on the death certificates. These deaths were then reclassified using the PSANZ guidelines. It was found that after using the guidelines, the number of initially unexplained stillbirths reduced. Thus, initially unexplained stillbirths require better investigation. The use of the PSANZ guidelines may help to reclassify initially unexplained stillbirths into other categories.


Flenady V, Fr?en JF, Pinar H, Torabi R, Saastad E, Guyon G, Russell L, Charles A, Harrison C, Chauke L, Pattinson R, Koshy R, Bahrin S, Gardener G, Day K, Petersson K, Gordon A, Gilshenan K. An Evaluation of classification systems for stillbirth. BMC Pregnancy and Childbirth 2009, 9:24.
This study evaluates the performance of six classification systems for stillbirth currently in use internationally. The main aim of this study was to inform the development of an internationally accepted approach to the classification of stillbirths. Systems evaluated in this study were; Amended Aberdeen, Extended Wigglesworth, PSANZ-PDC, ReCoDe, Tulip and CODAC. The classification systems were applied to 857 stillbirths across seven countries (including two developing country settings). The CODAC system performed best in terms of retaining important information and ease of use. PSANZ-PDC and ReCoDe performed well overall. Tulip performed best in terms of inter-observer agreement. Aberdeen and Wigglesworth showed very poor agreement and resulted in the highest proportion of unexplained stillbirths. CODAC and Tulip resulted in the lowest proportion of unexplained stillbirths. The authors concluded that the Extended Wigglesworth and Amended Aberdeen systems cannot be recommended for stillbirth classification. It was also recommended to further investigate the performance of classification systems in the context of developing country settings. The investigators acknowledged ISA in facilitating this project.


Froen JF, Pinar H, Flenady V, Bahrin S, Charles A, Chauke L, Day K, Duke CW, Facchinetti F, Fretts RC, Gardener G, Gilshenan K, Gordijn SJ, Gordon A, Guyon G, Harrison C, Koshy R, Pattinson RC, Petersson K, Russell L, Saastad E, Smith GC, Torabi R. Causes of death and associated conditions (CODAC) - a utilitarian approach to the classification of perinatal deaths. BMC Pregnancy Childbirth. 2009,9(1):22.
This paper discusses a new classification system for stillbirths and neonatal deaths (CODAC is Version II). This classification system was tested in 7 populations including 2 developing countries (see the previous study by Flenady et al). Areas of improvement were identified and included the ability to preserve existing information and the ease of use of the classification system. This study presents the new version of the CODAC classification system for perinatal death (CODAC version II). CODAC is designed to accommodate both the main cause of death as well as 2 associated conditions contributing to the death. It is suggested that not only the causes of death are reported, but also of common scenarios of combined conditions and events contributing to the death.


Gordijn SJ, Korteweg FJ, Erwich JJ, Holm JP, van Diem MT, Bergman KA, Timmer A. A multi-layered approach for the analysis of perinatal mortality, using different classification systems. Eur J Obstet Gynecol Reprod Biol. 2009; 144: 99-104.
There are many classification systems for perinatal death, but none have been universally accepted. This article presents a systematic, multilayered approach for the analysis of perinatal deaths. This approach is based on a combination of existing classification systems and records information regarding the death on three different levels; information related to the moment of death (or “when”), conditions associated with the death (“what”) and the cause of death (“why”). Most classification systems focus on only one level of information at the time. This multi-layered approach for the analysis and classification of perinatal mortality is possible by using combinations of existing systems. This approach is useful for in depth analysis of perinatal mortality in the developed world as well as in poor country settings, where resources to investigate death are often limited.


5. Interventions

See the BMC “Global Stillbirth” series in the Guidelines and reviews section.


6. Bereavement care

Cacciatore J, Radestad I, Frederik Froen J et al. Effects of contact with stillborn babies on maternal anxiety and depression. Birth. 2008; 35: 313-20.
After stillbirth, some guidelines encourage mothers to see and hold their babies. Doing this may also be distressing for women. This paper investigates if seeing and holding a stillborn baby affects increases the risk of anxiety and depression the next pregnancy. It also investigates if there are any long-term effects. Thirty seven organisations helped recruiting women who had experienced stillbirth. Anxiety and depressive symptoms were assessed using a 25-Item Check List. When compared with pregnant women who did not see or hold their baby, non-pregnant women who did see and hold their stillborn baby had fewer symptoms of anxiety and less depression. Pregnant women also had less depressive symptoms, but had more symptoms of anxiety if they had seen and held their baby. The authors conclude that, overall, mothers of stillborn babies who had seen and held their baby had fewer anxieties and depressive symptoms compared with women who had not seen or held their baby. Yet, in this study it was recognised that this beneficial effect of seeing and holding a stillborn baby may be temporarily reversed during a subsequent pregnancy.


Arshad M, Horsfall A, Yasin R. Pregnancy loss - the Islamic perspective. British Journal of Midwifery. 2004; 12: 481-4.
When a baby dies, clinicians who are dealing with families from an unfamiliar religion or culture, may feel helpless because of their lack of knowledge and understanding. In return, affected families may be left unsatisfied with the care provided. This article aims to raise awareness and provide information for clinicians when supporting Muslim families after pregnancy loss. An understanding of specific Islamic requirements and rituals will assist both professionals and families alike in providing client-centred care.


Complete reference list of relevant papers

2009 (Jan-June 10th)

  • ACOG Practice Bulletin No. 102: management of stillbirth. Obstet Gynecol. 2009; 113: 748-61.
  • Ananth CV, Liu S, Joseph KS, et al. A comparison of foetal and infant mortality in the United States and Canada. International Journal of Epidemiology. 2009; 38: 480-9.
  • Anderson EL, Reti IM, Anderson EL, Reti IM. ECT in pregnancy: a review of the literature from 1941 to 2007. Psychosomatic Medicine. 2009; 71: 235-42.
  • Anthony S, Jacobusse GW, van der Pal-de Bruin KM, Buitendijk S, Zeitlin J, Factors E-PWGoR. Do differences in maternal age, parity and multiple births explain variation in fetal and neonatal mortality rates in Europe? - Results from the Euro-Peristat project. Paediatric & Perinatal Epidemiology. 2009;23: 292-300.
  • Arnold JL, de Costa CM, Howat PW. Timing of transfer for pregnant women from Queensland Cape York communities to Cairns for birthing. Med J Aust. 2009; 190: 594-6.
  • Assaf S, Khawaja M, DeJong J, Mahfoud Z, Yunis K. Consanguinity and reproductive wastage in the Palestinian Territories. Paediatric & Perinatal Epidemiology. 2009; 23: 107-15.
  • Benhadi N, Wiersinga WM, Reitsma JB, Vrijkotte TG, Bonsel GJ, Vrijkotte TGM. Higher maternal TSH levels in pregnancy are associated with increased risk for miscarriage, fetal or neonatal death. European Journal of Endocrinology. 2009; 160: 985-91.
  • Breton MC, Beauchesne MF, Lemiere C, Rey E, Forget A, Blais L. Risk of perinatal mortality associated with asthma during pregnancy. Thorax. 2009; 64: 101-6.
  • Cacciatore J, Schnebly S, Froen JF. The effects of social support on maternal anxiety and depression after stillbirth. Health Soc Care Community. 2009; 17: 167-76.
  • Cham M, Sundby J, Vangen S. Fetal outcome in severe maternal morbidity: too many stillbirths. Acta Obstet Gynecol Scand. 2009; 88: 343-9.
  • Cham M, Sundby J, Vangen S, Cham M, Sundby J, Vangen S. Fetal outcome in severe maternal morbidity: too many stillbirths. Acta Obstetricia et Gynecologica Scandinavica. 2009; 88: 343-9.
  • Chigbu CO, Okezie OA, Odugu BU, Chigbu CO, Okezie OA, Odugu BU. Intrapartum stillbirth in a Nigerian tertiary hospital setting. International Journal of Gynaecology & Obstetrics. 2009; 104: 18-21.
  • Darmstadt GL, Yakoob MY, Haws RA, Menezes EV, Soomro T, Bhutta ZA. Reducing stillbirths: interventions during labour. BMC Pregnancy Childbirth. 2009; 9 Suppl 1: S6.
  • de Meiros APP, Gouveia N, Machado RPP, et al. Traffic-related air pollution and perinatal mortality: a case-control study. Environmental Health Perspectives. 2009; 117: 127-32.
  • Engmann C, Matendo R, Kinoshita R, et al. Stillbirth and early neonatal mortality in rural Central Africa. Int J Gynaecol Obstet. 2009; 105: 112-7.
  • Ferdynus C, Quantin C, Abrahamowicz M, et al. Can birth weight standards based on healthy populations improve the identification of small-for-gestational-age newborns at risk of adverse neonatal outcomes? Pediatrics. 2009; 123: 723-30.
  • Franz MB, Lack N, Schiessl B, et al. Stillbirth following previous cesarean section in Bavaria/Germany 1987-2005. Archives of Gynecology & Obstetrics. 2009; 279: 29-36.
  • Froen JF, Pinar H, Flenady V, et al. Causes of death and associated conditions (CODAC) - a utilitarian approach to the classification of perinatal deaths. BMC Pregnancy Childbirth. 2009; In Press.
  • Garg S, Punia RP, Basu S, Mohan H, Bal A. Comparison of needle autopsy with conventional autopsy in neonates. Fetal & Pediatric Pathology. 2009; 28: 139-50.
  • Gilligan C, Sanson-Fisher RW, D'Este C, Eades S, Wenitong M. Knowledge and attitudes regarding smoking during pregnancy among Aboriginal and Torres Strait Islander women. Med J Aust. 2009; 190: 557-61.
  • Gissler M, Alexander S, MacFarlane A, et al. Stillbirths and infant deaths among migrants in industrialized countries. Acta Obstetricia et Gynecologica Scandinavica. 2009; 88: 134-48.
  • Goldenberg RL, McClure EM, Althabe F. Commentary: improving important pregnancy outcomes. Birth. 2009; 36: 51-3.
  • Goldenberg RL, McClure EM, Belizan JM. Commentary: reducing the world's stillbirths. BMC Pregnancy Childbirth. 2009; 9 Suppl 1: S1.
  • Gordijn SJ, Korteweg FJ, Erwich JJ, et al. A multilayered approach for the analysis of perinatal mortality using different classification systems. Eur J Obstet Gynecol Reprod Biol. 2009; 144: 99-104.
  • Hasegawa J, Matsuoka R, Ichizuka K, Sekizawa A, Okai T. Ultrasound diagnosis and management of umbilical cord abnormalities. Taiwan J Obstet Gynecol. 2009; 48: 23-7.
  • Haws RA, Yakoob MY, Soomro T, Menezes EV, Darmstadt GL, Bhutta ZA. Reducing stillbirths: screening and monitoring during pregnancy and labour. BMC Pregnancy Childbirth. 2009; 9 Suppl 1: S5.
  • Headley E, Gordon A, Jeffery H. Reclassification of unexplained stillbirths using clinical practice guidelines. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2009 49: 285-9.
  • Herbert D, Lucke J, Dobson A, Herbert D, Lucke J, Dobson A. Pregnancy losses in young Australian women: findings from the Australian Longitudinal Study on Women's Health. Womens Health Issues. 2009; 19: 21-9.
  • Howard J, Hall B, Brennan LE, et al. Utility of newborn screening cards for detecting CMV infection in cases of stillbirth. Journal of Clinical Virology. 2009; 44: 215-8.
  • Howitz MF, Simonsen J, Krause TG, et al. Risk of adverse birth outcome after group B meningococcal disease: results from a Danish national cohort. Pediatric Infectious Disease Journal. 2009; 28: 199-203.
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Dec 2008

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Acknowledgments

A special thanks to the Mater Health Services and Mater Foundation in providing support for the secretariat of ANZSA and ISA.

A special thanks to volunteers Jeroen Meewisse and Madeleine Kavanagh who generously donated their time and assisted in compiling plain language sumaries. In addition to the project team we would like to acknowledge Dominique Rossouw (research assistant, MMRC) for her assistance with reference management. We would like to also thank the ANZSA Research and the Public Awareness and Health Promotion Committees and the Scientific Advisory Committee (SAC) and the Parent Advisory Committee (PAC) from the ISA for their comments and feedback.
 


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International Stillbirth Alliance (c) 2009    

Australian and New Zealand Stillbirth Alliance (c) 2009