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1. Conference proceedings
International Stillbirth Alliance
Annual Conference, 2008 (Oslo, Norway).
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Only a selection of abstracts is included in the
Stillbirth Research Alert.
Download the full conference proceedings in pdf
here.
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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.
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Complete reference list of relevant papers
2009 (Jan-June 10th)
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ACOG Practice Bulletin No. 102: management
of stillbirth. Obstet Gynecol. 2009; 113: 748-61.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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Cham M, Sundby J, Vangen S. Fetal outcome in
severe maternal morbidity: too many stillbirths. Acta
Obstet Gynecol Scand. 2009; 88: 343-9.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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