Assessment of “fresh” versus “macerated” as accurate markers of time since intrauterine fetal demise in low‐income countries

Gold, Katherine J.; Abdul-Mumin, Abdul Razak S.; Boggs, Martha E.; Opare‐Addo, Henry S.; Lieberman, Richard W.

doi:10.1016/j.ijgo.2013.12.006

Cited by 83 publications

(69 citation statements)

References 18 publications

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“…Third, we acknowledge the suboptimal dating criteria for estimation of gestational age due to late presentation to antenatal care and limited ultrasound availability in our setting. Finally, the definitions of antepartum and intrapartum stillbirth are determined by observation at the time of delivery, and previous studies have indicated that this method may overestimate intrapartum stillbirths . That the association between prior CD and both types of stillbirths remained consistent is reassuring, and suggests that such biases may have had minimal impact.…”

Section: Discussionmentioning

confidence: 99%

Risk of stillbirth among Zambian women with a prior cesarean delivery

Castillo

Vwalika

Stoner

et al. 2018

Intl J Gynecology & Obste

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Section: Discussionmentioning

confidence: 99%

Risk of stillbirth among Zambian women with a prior cesarean delivery

Castillo

Vwalika

Stoner

et al. 2018

Intl J Gynecology & Obste

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“…Classification in pre- and intra-hospital stillbirths was a useful, more achievable, and simple alternative to ‘fresh’ versus ‘macerated’ stillbirths, which, as in a study from Ghana, was found unreliable [55]. Moreover, intra-hospital stillbirths may be seen as an even stronger indicator of intra-hospital quality of care than ‘fresh’ stillbirths.…”

Section: Discussionmentioning

confidence: 99%

Stillbirths and quality of care during labour at the low resource referral hospital of Zanzibar: a case-control study

Maaløe

Housseine

Bygbjerg

et al. 2016

BMC Pregnancy Childbirth

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BackgroundTo study determinants of stillbirths as indicators of quality of care during labour in an East African low resource referral hospital.MethodsA criterion-based unmatched unblinded case-control study of singleton stillbirths with birthweight ≥2000 g (n = 139), compared to controls with birthweight ≥2000 g and Apgar score ≥7 (n = 249).ResultsThe overall facility-based stillbirth rate was 59 per 1000 total births, of which 25 % was not reported in the hospital’s registers. The majority of singletons had birthweight ≥2000 g (n = 139; 79 %), and foetal heart rate was present on admission in 72 (52 %) of these (intra-hospital stillbirths). Overall, poor quality of care during labour was the prevailing determinant of 71 (99 %) intra-hospital stillbirths, and median time from last foetal heart assessment till diagnosis of foetal death or delivery was 210 min. (interquartile range: 75–315 min.). Of intra-hospital stillbirths, 26 (36 %) received oxytocin augmentation (23 % among controls; odds ratio (OR) 1.86, 95 % confidential interval (CI) 1.06–3.27); 15 (58 %) on doubtful indication where either labour progress was normal or less dangerous interventions could have been effective, e.g. rupture of membranes. Substandard management of prolonged labour frequently led to unnecessary caesarean sections. The caesarean section rate among all stillbirths was 26 % (11 % among controls; OR 2.94, 95 % CI 1.68–5.14), and vacuum extraction was hardly ever done. Of women experiencing stillbirth, 27 (19 %) had severe hypertensive disorders (4 % among controls; OR 5.76, 95 % CI 2.70–12.31), but 18 (67 %) of these did not receive antihypertensives. An additional 33 (24 %) did not have blood pressure recorded during active labour. When compared to controls, stillbirths were characterized by longer admissions during labour. However, substandard care was prevalent in both cases and controls and caused potential risks for the entire population. Notably, women with foetal death on admission were in the biggest danger of neglect.ConclusionsIntrapartum management of women experiencing stillbirth was a simple yet strong indicator of quality of care. Substandard care led to perinatal as well as maternal risks, which furthermore were related to unnecessary complex, time consuming, and costly interventions. Improvement of obstetric care is warranted to end preventable birth-related deaths and disabilities.Trial registrationThis is the baseline analysis of the PartoMa trial, which is registered on ClinicalTrials.org (NCT02318420, 4th November 2014).Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-1142-2) contains supplementary material, which is available to authorized users.

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“…Perinatal events included stillbirth, perinatal death and neonatal death. Stillbirth was classified as macerated where the fetus showed skin and soft tissue changes suggesting death occurred before the start of the delivery, and fresh where the fetus lacked such skin changes. Neonatal deaths were divided into early (within 7 days after delivery) and late (between 8 and 28 days after delivery) deaths.…”

Section: Methodsmentioning

confidence: 99%

Caesarean section performed by medical doctors and associate clinicians in Sierra Leone

Duinen

Kamara

Hagander

et al. 2019

British Journal of Surgery

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Background Many countries lack sufficient medical doctors to provide safe and affordable surgical and emergency obstetric care. Task‐sharing with associate clinicians (ACs) has been suggested to fill this gap. The aim of this study was to assess maternal and neonatal outcomes of caesarean sections performed by ACs and doctors. Methods All nine hospitals in Sierra Leone where both ACs and doctors performed caesarean sections were included in this prospective observational multicentre non‐inferiority study. Patients undergoing caesarean section were followed for 30 days. The primary outcome was maternal mortality, and secondary outcomes were perinatal events and maternal morbidity. Results Between October 2016 and May 2017, 1282 patients were enrolled in the study. In total, 1161 patients (90·6 per cent) were followed up with a home visit at 30 days. Data for 1274 caesarean sections were analysed, 443 performed by ACs and 831 by doctors. Twin pregnancies were more frequently treated by ACs, whereas doctors performed a higher proportion of operations outside office hours. There was one maternal death in the AC group and 15 in the doctor group (crude odds ratio (OR) 0·12, 90 per cent confidence interval 0·01 to 0·67). There were fewer stillbirths in the AC group (OR 0·74, 0·56 to 0·98), but patients were readmitted twice as often (OR 2·17, 1·08 to 4·42). Conclusion Caesarean sections performed by ACs are not inferior to those undertaken by doctors. Task‐sharing can be a safe strategy to improve access to emergency surgical care in areas where there is a shortage of doctors.

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Assessment of “fresh” versus “macerated” as accurate markers of time since intrauterine fetal demise in low‐income countries

Cited by 83 publications

References 18 publications

Risk of stillbirth among Zambian women with a prior cesarean delivery

Risk of stillbirth among Zambian women with a prior cesarean delivery

Stillbirths and quality of care during labour at the low resource referral hospital of Zanzibar: a case-control study

Caesarean section performed by medical doctors and associate clinicians in Sierra Leone

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