The influence of antenatal and maternal factors on stillbirths and neonatal deaths in New South Wales, Australia

This study identified the influences of maternal socio-demographic and antenatal factors on stillbirths and neonatal deaths in New South Wales, Australia. Bivariate and multivariate analyses were used to explore the association of selected antenatal and maternal characteristics with stillbirths and neonatal deaths. The findings of this study showed that stillbirths and neonatal deaths significantly varied by infant sex, maternal age, Aboriginality, maternal country of birth, socioeconomic status, parity, maternal smoking behaviour during pregnancy, maternal diabetes mellitus, maternal hypertension, antenatal care, plurality of birth, low birth weight, place of birth, delivery type, maternal deaths and small gestational age. First-born infants, twins and infants born to teenage mothers, Aboriginal mothers, those who smoked during the pregnancy and those of lower socioeconomic status were at increased risk of stillbirths and neonatal deaths. The most common causes of stillbirths were conditions originating in the perinatal period: intrauterine hypoxia and asphyxia. Congenital malformations, including deformities and chromosomal abnormalities, and disorders related to slow fetal growth, short gestation and low birth weight were the most common causes of neonatal deaths. The findings indicate that very low birth weight (less than 2,000 g) contributed 75.6% of the population-attributable risks to stillbirths and 59.4% to neonatal deaths. Low gestational age (less than 32 weeks) accounted for 77.7% of stillbirths and 87.9% of neonatal deaths. The findings of this study suggest that in order to reduce stillbirths and neonatal deaths, it is essential to include strategies to predict and prevent prematurity and low birth weight, and that there is a need to focus on anti-smoking campaigns during pregnancy, optimizing antenatal care and other healthcare programmes targeted at the socially disadvantaged populations identified in this study.     

The role of oral glucose intolerance test in reducing pregnancy complications

The influence of glucose monitoring during pregnancy on newborn body weight, and complications during pregnancy and labor was assessed. We performed a retrospective analysis of macrosomal children, fetal growth, caesarean sections, malformations, still-births and the number of oral glucose tolerance test (OGTT) carried out in a five-year period. The proportion of women participating in OGTT tests increased from 20% to 40% (p<0.05) between 2000 and 2004. Gestation diabetes mellitus (GDM) proportions among pregnant women seen at the Department of Obstetrics and Gynecology at Slavonski Brod General Hospital, Croatia increased from 1% to 6.7% (p < 0. 05) during the observed period. Proportion of births identified as macrosomal decreased from 13.3% to 12.2% (p<0.05). Additionally, infant mortality and still-births along with other fetal and maternal complications declined during the same period. These results suggest that regular measurements of glucose tolerance during pregnancy may prevent preterm birth, decrease the proportion of macrosomal newborns, lower mortality and decrease fetal and maternal complication incidence during pregnancy and delivery.     

Congenital heart defects as a cause of still birth and infant mortality

Among 4,686 still-births and children died from 0 to 1 a in the German Democratic Republic in 1979 there were 307 (6.6%) isolated congenital heart diseases. We only analyzed 294 died infants. The first 5 diagnoses were: Hypoplastic left heart (all infants died within the first 28 d) 9.9%, Ventricular septal defect 9.9%, Transposition of great vessels 8.8%, Coarctation aorta 7.1%, Common truncus arteriosus 5.8%. The most important results are an interesting frequency with advancing years of mothers (3.4% in 10,000 mothers of live-births aged 16 a and less to 20.6% at the age of 40 a and over (see Fig. 1), 13% premature children (under 37 weeks of gestation), 23% children under 2,500 g birth weight, 55% boys and 45% girls. 80% of the above 294 infants died within the first 3 months.     

Effect of short-term hypothyroidism on reproduction in the bitch

Hypothyroidism in bitches has been reported to cause a variable interestrus interval, infertility, abortion, and stillbirth. The objective of this study was to evaluate the effect of experimentally induced hypothyroidism in bitches on fertility, pregnancy, parturition, and neonatal health. Eighteen healthy multiparous bitches were used; hypothyroidism was induced (by radioiodine administration) in nine bitches and the remaining nine served as untreated controls. After breeding, bitches were evaluated for pregnancy, fetal resorption, gestation length, litter size, duration and strength of uterine contractions (during parturition), interval between delivery of pups, viability of pups at birth, periparturient survival, and weight of pups at birth through 4 weeks of age. Bitches were bred a median of 19 weeks after induction of hypothyroidism. All bitches became pregnant and delivered term litters. There was no difference in the interestrus interval, litter size, or gestation length between hypothyroid and control bitches. Duration of uterine contractions was longer, but contraction strength was weaker in hypothyroid than control bitches; however, the interval between delivery of pups was not affected. Periparturient puppy mortality was significantly higher in litters from hypothyroid bitches. Viability scores and weight at birth were significantly lower in pups from hypothyroid bitches than controls. There was no difference between groups in pup weight gain during the first 4 weeks, in the interval from birth to the eyes opened, or to the onset of walking. Although hypothyroidism of relatively short duration did not affect fertility, it prolonged parturition and reduced pup survival in the periparturient period.     

Factor affecting body mass of young fat dormics (Glis glis) at weaning and by hibernation

This paper describes the factors affecting body mass at weaning and by hibernation of young fat dormice (Glis glis) We studied a free-living population in 1991 and 1992 in a mixed forest where 100 nest-boxes were placed. In the two years, 128 females used the nest-boxes to give birth and rear their litters and more than 900 dormice have been individually marked. Body mass of young at weaning was positively correlated to body mass of the mother in both years and to birth date in 1991, while litter size was negatively correlated to body mass of the young in 1992 only, when birth took place about two weeks later than in 1991. On the contrary, by the time of hibernation, young born later weighed significantly less than those born earlier in the season, and heavier young at weaning remained heavier by hibernation, while maternal body mass and litter size did not significantly affect body mass of young at this stage. Body mass of the mother was negatively related to the date of parturition and early breeding females lost weight during lactation, while females that bred later did not. It seems, therefore, that early breeding carries a cost that only females in good condition can afford. It appears that females may follow two strategies: those in poor body condition will delay pregnancy so that lactation occurs when environmental feeding conditions are at their best; those in good condition will breed earlier, since they can afford to lose weight during lactation. Their young will have more time to grow before hibernation and the mothers themselves will have a longer period of time for restoring their fat reserves.     

Risk of Early-Onset Neonatal Infection with Maternal Infection or Colonization: A Global Systematic Review and Meta-Analysis

Background

Neonatal infections cause a significant proportion of deaths in the first week of life, yet little is known about risk factors and pathways of transmission for early-onset neonatal sepsis globally. We aimed to estimate the risk of neonatal infection (excluding sexually transmitted diseases [STDs] or congenital infections) in the first seven days of life among newborns of mothers with bacterial infection or colonization during the intrapartum period.

Methods and Findings

We searched PubMed, Embase, Scopus, Web of Science, Cochrane Library, and the World Health Organization Regional Databases for studies of maternal infection, vertical transmission, and neonatal infection published from January 1, 1960 to March 30, 2013. Studies were included that reported effect measures on the risk of neonatal infection among newborns exposed to maternal infection. Random effects meta-analyses were used to pool data and calculate the odds ratio estimates of risk of infection. Eighty-three studies met the inclusion criteria. Seven studies (8.4%) were from high neonatal mortality settings. Considerable heterogeneity existed between studies given the various definitions of laboratory-confirmed and clinical signs of infection, as well as for colonization and risk factors. The odds ratio for neonatal lab-confirmed infection among newborns of mothers with lab-confirmed infection was 6.6 (95% CI 3.9–11.2). Newborns of mothers with colonization had a 9.4 (95% CI 3.1–28.5) times higher odds of lab-confirmed infection than newborns of non-colonized mothers. Newborns of mothers with risk factors for infection (defined as prelabour rupture of membranes [PROM], preterm <37 weeks PROM, and prolonged ROM) had a 2.3 (95% CI 1.0–5.4) times higher odds of infection than newborns of mothers without risk factors.

Conclusions

Neonatal infection in the first week of life is associated with maternal infection and colonization. High-quality studies, particularly from settings with high neonatal mortality, are needed to determine whether targeting treatment of maternal infections or colonization, and/or prophylactic antibiotic treatment of newborns of high risk mothers, may prevent a significant proportion of early-onset neonatal sepsis. Please see later in the article for the Editors'' Summary     

Perinatal mortality: a continuing collaborative regional survey.

A collaborative survey of perinatal mortality in each district of the Northern region set up in July 1980 was able to obtain information on 99% of all the registered perinatal deaths among babies born in 1981-2 to mothers resident in the region. There were 12.4 perinatal deaths/1000 births over this two year period, but 41% of the stillbirths and early neonatal deaths were of babies with a lethal malformation or weighing less than 1000 g at birth (or both). All causes of perinatal mortality had become less common than they had been at the time of the National Birthday Trust survey in 1958, though there had been a relatively small decrease in the number of deaths due to malformation (in the absence of any neural tube defect) and in the number of stillbirths of normally developed fetuses: 36% of the antepartum stillbirths among non-malformed singleton fetuses were associated with poor fetal growth (weight below the fifth centile at birth) and 21% were due to sudden unexplained placental abruption.     

Breeding biology of weddell seals (Leptonychotes weddellii) at Drescher Inlet,riiser larsen ice shelf,Antarctica

Summary The breeding biology of Weddell seals (Leptonychotes weddellii) was studied at Drescher Inlet (Antarctica) during the austral late winter and spring 1986. The whelping season was estimated to last about 40 days, with a peak in pupping at late October. No post natal mortality was observed during the whole study. The attachment between parous females and their pups was strong during the first five weeks after parturition. From the third week on mothers spent more time in the water than the pups. Data on daily peak haul-out time of pups, post natal presence of pups on the ice and distribution of births during the whelping season, indicate that censuses should be carried out between 12.00 hours and 16.00 hours local time and during three weeks after the peak of the pupping season. Pups weaned between 6 and 7 weeks of age. Hormone concentrations (oestradiol-17 and progesterone) indicated that females did not come into oestrus during lactation. Throughout the whole lactation period the mother dominates the relationship with her pup. Growth of the pups was linear during the first 5 weeks post partum, during which period birth weight (x=29.1kg) increased more than 3 1/2 times. Until the 6th week of age the pups gained on average 2.6 kg/day, the respective weight loss in cows was 5.8 kg/day. The latter represents an average loss of nearly 38% of the initial weight at parturition. During the course of lactation, suckling frequency decreased, whereas the length of each bout increased resulting in an approximately constant total suckling duration per week. Of the energy used by females during the first 5 weeks, 52% was consumed by pups. Pups only took milk and the cows did not feed at all during the whole period of observation. Therefore the realized growth in pups, 10 g/min of suckling, was totally derived from energy stored by the cows.     

新生儿低血糖症的高危因素及临床防治探讨

目的：探讨新生儿低血糖症的高危因素及临床防治。方法：对2010年1月．2012年8月我院收治的有低血糖高危因素的267例新生儿的临床资料进行回顾性分析。结果：检出低血糖83例,无特异性临床症状;惠有新生儿窒息、新生儿缺氧缺血性脑病、早产儿及小于胎龄儿及糖尿病母亲娩出的新生儿发生低血糖症的发生率较高。早产儿、低出生体重儿、巨大儿低血糖症的发生率显著高于正常胎儿,P〈0．05。结论：对于有低血糖症的高危因素的患儿应严密监测血糖情况,尽早进行防治,避免因低血糖造成脑损伤。     

腹主动脉球囊置入术治疗凶险性前置胎盘疗效和对血清AFP、CK表达以及手术结局的影响

摘要 目的：探讨与分析腹主动脉球囊置入术治疗凶险性前置胎盘疗效和对血清AFP、CK表达以及手术结局的影响。方法：将2019年1月到2021年12月在本院住院剖宫产的凶险性前置胎盘产妇153例作为研究对象,对照组48例为剖宫产术,研究组105例为剖宫产术前行腹主动脉球囊置入术。检测两组血清甲胎蛋白（AFP）、肌酸激酶（CK）表达水平,记录手术结局。结果：所有产妇都顺利完成治疗与分娩,无死亡产妇与新生儿。研究组的产后出血量较对照组低（P<0.05）,而产前出血量在两组对比无差异（P>0.05）。两组新生儿体重对比无差异（P>0.05）,研究组的1 min Apgar评分、5 min Apgar评分较对照组高,而呼吸窘迫综合征发生率较对照组低（P<0.05）。两组手术后3 d的血清AFP与CK含量明显低于术前,研究组也显著低于对照组（P<0.05）。研究组出院时的满意度为94.29 %,明显高于对照组的79.17 %（P<0.05）。结论：腹主动脉球囊置入术治疗凶险性前置胎盘能促进降低血清AFP与CK含量,能促进产妇与新生儿恢复健康,提高产妇的满意度。     

Evidence for Sex-Biased Behavioral Maternal Investment in the Gray Mouse Lemur (Microcebus murinus)

To study sex-differential allocation of maternal behavior in Microcebus murinus, I recorded behavioral patterns on 21 litters from parturition to the weaning period. After a pregnancy of 61.5 ± 0.9 days, females may produce from one to four young per litter. Litters were weaned in 40 days by mothers. Behavioral observations at the beginning of the nocturnal activity period demonstrated that close contacts between mothers and infants were more frequent in multiparous mothers than in primiparous ones (p < .01). Time in close contact with offspring aged >15 days old compared to contacts with neonates is significantly lower only in single-sex litters and is more marked for all-female litters (p < .01). Mother's approaches toward mixed litters or all-male litters were always significantly greater than approaches toward all-female litters (p = .04). However, mother's approaches within mixed sex litters were not biased toward either sex (p = .7). Males in a litter may be interpreted as a stimulator of maternal behavior. Similarly, using retrieving tests of 15-min duration, a significant maternal preference for male neonates is evident. Latency to first retrieval is significantly shorter in multiparous females than in primiparous ones (p < .05) independent of size and sex ratio of the litter. For multiparous females only, male neonates were chosen first for retrieval more often than females (p < .05). Finally, the calls of young played a stimulator effect on maternal retrieving (p < .001). Accordingly multiparous mothers exhibit more interest in their young, which appears to be biased toward male neonates.     

Treatment of Early Breast Cancer: A Report after Ten Years of a Clinical Trial

A controlled clinical trial has been carried out to compare radical mastectomy with wide excision (extended tylectomy) in the treatment of early breast cancer. Only patients aged 50 and over were included and 370 entered the trial during a period of 10 years. Postoperative radiotherapy was given in each case. In patients with clinically involved axillary nodes there was a significantly higher incidence of local and distant recurrence in those having a wide excision, and the survival of these patients was significantly less than those who had a radical mastectomy. In patients with clinically uninvolved nodes, although there was a significantly higher incidence of local recurrence in those having a wide excision, there was no increased incidence of distant recurrence and the survival rate was similar to those having a radical mastectomy.     

Maternal group B streptococcus infection, neonatal outcome and the role of preventive strategies

To determine the newborn infection rate with group B streptococcus infection (GBS) before and after American Academy of Pediatrics Protocol (AAP) implementation in Croatia, antenatal risk factors, neonatal outcome and necessity for introducing national policy for intrapartum chemoprophylaxis. To evaluate the role of intrapartum chemoprophylaxis in preterm labor at < 37 weeks of gestation, premature rupture of membranes at < 37 weeks of gestation, fever during labor, ruptures of membranes > 18 hours before delivery and previous delivery of a sibling with GBS disease. A total of 784 neonates admitted to the Neonatal Intensive Care Unit, from 1 January 2005 to 31 December 2005. 60 (10/1000 live born) developed early-onset infection (EOGBS). The dominant presentation for EOGBS was sepsis (65%), pneumonia (32.2%) and meningitis (3%). Mean gestational age was 34.5 (+/- 5.3) weeks. There were 2 neonatal deaths (3%) in EOGBS, both preterm. EOGBS disease was associated with following risk factors: rupture of the membranes > 12 hours (49.3%), chorioamnionitis (11.9%), status post cerclage (10.4%), diabetes mellitus (4.5%), delivery out of hospital (3%), uroinfection (1.5%). After AAP implementation the incidence of GBS infection decreased from 15/1000 to 10/1000 of live born infants. The mortality from EOGBS dropped from 5% to 3%. The incidence of GBS infection in our study was considerably higher than in all current reports. Reasons for that can be inadequate perinatal screen in some parts of the country and no established policy for intrapartum antibiotic treatment of women with risk factors. Our results documented that intrapartum chemo-prophylaxis for GBS infection significantly reduces perinatal mortality due to neonatal infection and sepsis.     

Acute Histologic Chorioamnionitis Is a Risk Factor for Adverse Neonatal Outcome in Late Preterm Birth after Preterm Premature Rupture of Membranes

Background

The objective of this study was to determine whether acute histologic chorioamnionitis is associated with adverse neonatal outcomes in late preterm infants who were born after preterm PROM.

Methodology/Principal Findings

The relationship between the presence of acute histologic chorioamnionitis and adverse neonatal outcome was examined in patients with preterm PROM who delivered singleton preterm newborns between 34 weeks and 36 6/7 weeks of gestation. Nonparametric statistics were used for data analysis. The frequency of acute histologic chorioamnionitis was 24% in patients with preterm PROM who delivered preterm newborns between 34 weeks and 36 6/7 weeks of gestation. Newborns born to mothers with histologic chorioamnionitis had significantly higher rates of adverse neonatal outcome (74% vs 51%; p<0.005) than those without histologic chorioamnionitis. This relationship remained significant after adjustment for gestational age at preterm PROM, gestational age at delivery, and exposure to antenatal corticosteroids.

Conclusions/Significance

The presence of acute histologic chorioamnionitis is associated with adverse neonatal outcome in late preterm infants born to mothers with preterm PROM.     

The outcome of twin pregnancies complicated by single fetal death after 20 weeks of gestation.

A retrospective study involving 972 twin births was conducted to evaluate the maternal and fetal outcomes of twin pregnancies complicated by single fetal death. The incidence of single fetal death in twin pregnancies after 20 weeks was 3.3%. Preterm birth rates for 37 and 32 gestational weeks were 81.3% and 41.6% respectively. The median interval between the diagnosis of fetal death and the delivery was 11 days (range 1-27 days). Eighteen (56%) infants were delivered by cesarean and 14 (43%) vaginally. Twin-twin transfusion syndrome (TTTS) was the cause of single fetal death in 8 of 32 twin pregnancies (25%). Ten of the surviving co-twins were lost in the neonatal period (31.3%) and half of those neonatal deaths were due to TTTS. TTTS is the major contributor for perinatal mortality in same-sex twins complicated by single fetal death. The death of one twin in utero should not be the only indication for preterm delivery, and in case of severe prematurity with a stable intrauterine environment; expectant management may be advisable until fetal lung maturation ensues.     

Maternal behaviour of undernourished mother rats

Undernourished mother rats were given daily meals throughout most or all of pregnancy and lactation, comprising about half the amount of a good quality diet taken by controls. Their daily pattern of nest occupation and desertion during lactation was quite different from that of controls. Retrieving tests were carried out at 4, 6, 8 and 10 days after parturition. Underfed mothers were less efficient than controls in retrieving their young on days 8 and 10, and were less likely to lick their young during the test period. They also spent much more time rearing on their hind legs. Among undernourished females the number of young retrieved was negatively correlated with duration of rearing. The significance of the differences in maternal behaviour for offspring development is discussed.     

Reducing Neonatal Mortality in India: Critical Role of Access to Emergency Obstetric Care

Background

Neonatal mortality currently accounts for 41% of all global deaths among children below five years. Despite recording a 33% decline in neonatal deaths between 2000 and 2009, about 900,000 neonates died in India in 2009. The decline in neonatal mortality is slower than in the post-neonatal period, and neonatal mortality rates have increased as a proportion of under-five mortality rates. Neonatal mortality rates are higher among rural dwellers of India, who make up at least two-thirds of India''s population. Identifying the factors influencing neonatal mortality will significantly improve child survival outcomes in India.

Methods

Our analysis is based on household data from the nationally representative 2008 Indian District Level Household Survey (DLHS-3). We use probit regression techniques to analyse the links between neonatal mortality at the household level and households'' access to health facilities. The probability of the child dying in the first month of birth is our dependent variable.

Results

We found that 80% of neonatal deaths occurred within the first week of birth, and that the probability of neonatal mortality is significantly lower when the child''s village is closer to the district hospital (DH), suggesting the critical importance of specialist hospital care in the prevention of newborn deaths. Neonatal deaths were lower in regions where emergency obstetric care was available at the District Hospitals. We also found that parental schooling and household wealth status improved neonatal survival outcomes.

Conclusions

Addressing the main causes of neonatal deaths in India – preterm deliveries, asphyxia, and sepsis – requires adequacy of specialised workforce and facilities for delivery and neonatal intensive care and easy access by mothers and neonates. The slow decline in neonatal death rates reflects a limited attention to factors which contribute to neonatal deaths. The suboptimal quality and coverage of Emergency Obstetric Care facilities in India require urgent attention.     

Influence of prenatal photoperiod on postnatal prolactin secretion in red deer (Cervus elaphus).

Plasma prolactin concentrations were higher (P < 0.001) in newborn red deer calves whose mothers had been maintained for the last 14 weeks of gestation in long days (18 h light) (group L, n = 9) than in those whose mothers had been kept over the same period in short days (6 h light) (group S, n = 5). After transfer of all hinds and suckled calves on the day of birth to constant intermediate daylength (12 h light), prolactin concentrations decreased exponentially (P < 0.001) in group L calves, but not in group S, during the first 21 days. Thereafter, prolactin fell to a nadir in group L calves and rose to peak values in group S calves at 8-12 weeks post partum (P = 0.003), before converging again by 14 weeks. The pattern of prolactin secretion over the first 14 weeks of life was therefore significantly affected by prenatal photoperiod. Plasma prolactin concentrations in the adult hinds were higher (P < 0.001) in group L than group S at 4-10 weeks before parturition; they were similarly high around parturition and fell thereafter to baseline values after 7 weeks. These results provide evidence that deer fetuses respond to photoperiodic information, thereby acquiring a photoperiodic history in utero that influences postnatal responses to photoperiod.     

Some Factors Influencing the Losses of Pigs Prior to Weaning

Analyses of the records of 244 litters of purebred Yorkshire, Landrace, the crosses, backcrosses and crisscrosses of these two breeds were carried out to evaluate some of the factors influencing the losses of piglets prior to weaning. There were differences in percentage survival between mating systems, with crossbred Landrace x Yorkshire piglets showing the highest rate of survival.A direct relationship existed between the duration of farrowing and the incidence of stillbirths. The incidence of stillbirths was higher for male piglets than for female piglets.Litter size at birth and weight loss of sow from parturition to weaning were important factors in determining litter size at weaning. Litter size at birth however, exerted a more important influence on litter performance than weight loss. Age of sow had no significant effect on the number of piglets alive at weaning and implied that gilts were apparently as good mothers as sows. From computed least squares estimates, it was implied that in general, piglets of low birthweights had much less chance of survival than those born with heavier weights.     

Maternal, neonatal and community factors influencing neonatal mortality in Brazil

Child mortality (the mortality of children less than five years old) declined considerably in the developing world in the 1990s, but infant mortality declined less. The reductions in neonatal mortality were not impressive and, as a consequence, there is an increasing percentage of infant deaths in the neonatal period. Any further reduction in child mortality, therefore, requires an understanding of the determinants of neonatal mortality. 209,628 birth and 2581 neonatal death records for the 1998 birth cohort from the city of S?o Paulo, Brazil, were probabilistically matched. Data were from SINASC and SIM, Information Systems on Live Births and Deaths of Brazil. Logistic regression was used to find the association between neonatal mortality and the following risk factors: birth weight, gestational age, Apgar scores at 1 and 5 minutes, delivery mode, plurality, sex, maternal education, maternal age, number of prior losses, prenatal care, race, parity and community development. Infants of older mothers were less likely to die in the neonatal period. Caesarean delivery was not found to be associated with neonatal mortality. Low birth weight, pre-term birth and low Apgar scores were associated with neonatal death. Having a mother who lives in the highest developed community decreased the odds of neonatal death, suggesting that factors not measured in this study are behind such association. This result may also indicate that other factors over and above biological and more proximate factors could affect neonatal death.