Causal analysis of fetal death in high-risk pregnancies

Aguinaga, Mónica; Valdespino, Yolotzin; Medina, Daniela; Sosa, Salvador Espino Y; Sevilla, R; Miranda, Osvaldo; Acevedo, Sandra; Monroy, Irma E; Helguera, Addy C; Pérez, Javier; Mariscal, Luisa F; Murillo, Mauricio R; Lara, Rosa Martha Meda; Armijos, Jessica C; Rogel, Gabriela; Cardona, Jorge A Martínez

doi:10.1515/jpm-2020-0352

Cited by 4 publications

(4 citation statements)

References 15 publications

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“…In agreement with the results of this study, E . coli , Staphylococcus and Listeria were identified as pathogens present in the amniotic space in an investigation of the role of infections in stillbirths [ 48 ]. Additionally, a prospective study comparing the umbilical cord microbiomes of stillbirths and livebirths found six taxa uniquely present in stillbirths; of these, Bacteroides was the only taxon common within the findings of this work [ 49 ].…”

Section: Discussionmentioning

confidence: 99%

Insights into the Genital Microbiota of Women Who Experienced Fetal Death in Utero

Holliday,

Uddipto,

Castillo

et al. 2023

Microorganisms

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The aim of this work was to achieve a better understanding of the bacterial pathogens associated with stillbirths that would serve to inform clinical interventions directed at reducing this adverse pregnancy outcome. A prospective observational study was conducted with the participation of 22 women from northern Peru, of whom 11 experienced fetal death in utero and 11 delivered preterm births. Swabs were taken from the vagina, placenta, amniotic fluid and axilla of the infant at birth by Caesarean section. The bacterial populations in the vagina and the amniotic space of each participant were determined by employing the amplicon sequencing of the V4 region of the 16S rRNA genes. The sequence data were analysed using bioinformatics tools. The work showed differences in the composition of the genital microbiomes of women who experienced preterm birth or fetal death in utero. There were no differences in the alpha diversity between the genital microbiotas of both groups of women, but there were more different taxa in the vagina and amniotic space of the preterm participants. Lactobacillus spp. was less abundant in the stillbirth cases. E. coli/Shigella, Staphylococcus, Gardnerella, Listeria and Bacteroides taxa were associated with the stillbirths. In each woman, there was a minimal concordance between the bacterial populations in the vagina and amniotic space.

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Section: Discussionmentioning

confidence: 99%

Insights into the Genital Microbiota of Women Who Experienced Fetal Death in Utero

Holliday,

Uddipto,

Castillo

et al. 2023

Microorganisms

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“…By using the ICD-PM, these studies facilitate essential insight into perinatal death causes and helped raise global awareness of perinatal mortality and the complexity of classifying its causes. The ICD-PM is currently considered the gold standard and is often favoured over other classification tools because it facilitates the lowest rate of unspecified causes and because it is the only tool that classifies death by time of death and separates maternal and foetal conditions into two entities [21][22][23]25,29,30].…”

Section: Discussionmentioning

confidence: 99%

“…This leads to inconsistent classification and globally incomparable data. For example, a growth restricted foetus of a mother with pre-eclampsia dies due to asphyxia following a placental abruption before labour, can be classified as A3 'antepartum hypoxia', A4 'Other specified antepartum disorder', or A5 'Disorder related to foetal growth' [29][30][31].…”

Section: Reported Challenge Case Example or Explanation Suggested Ame...mentioning

confidence: 99%

The global use of the International Classification of Diseases to Perinatal Mortality (ICD-PM): A systematic review

et al. 2022

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BackgroundThe World Health Organization launched the International Classification of Diseases for Perinatal Mortality (ICD-PM) in 2016 to uniformly report on the causes of perinatal deaths. In this systematic review, we aim to describe the global use of the ICD-PM by reporting causes of perinatal mortality and summarizing challenges and suggested amendments. MethodsWe systematically searched MEDLINE, Embase, Global Health, and CINAHL databases using key terms related to perinatal mortality and the classification for causes of death. We included studies that applied the ICD-PM and were published between January 2016 and June 2021. The ICD-PM data were extracted and a qualitative analysis was performed to summarize the challenges of the ICD-PM. We applied the PRISMA guidelines, registered our protocol at PROSPERO [CRD42020203466], and used the Appraisal tool for Cross-Sectional Studies (AXIS) as a framework to evaluate the quality of evidence. ResultsThe search retrieved 6599 reports. Of these, we included 15 studies that applied the ICD-PM to 44 900 perinatal deaths. Most causes varied widely; for example, "antepartum hypoxia" was the cause of stillbirths in 0% to 46% (median = 12%, n = 95) in low-income settings, 0% to 62% (median = 6%, n = 1159) in middle-income settings and 0% to 55% (median = 5%, n = 249) in high-income settings. Five studies reported challenges and suggested amendments to the ICD-PM. The most frequently reported challenges included the high proportion of antepartum deaths of unspecified cause (five studies), the inability to determine the cause of death when the timing of death is unknown (three studies), and the challenge of assigning one cause in case of multiple contributing conditions (three studies). ConclusionsThe ICD-PM is increasingly being used across the globe and gives health care providers insight into the causes of perinatal death in different settings. However, there is wide variation in reported causes of perinatal death across comparable settings, which suggests that the ICD-PM is applied inconsistently. We summarized the suggested amendments and made additional recommendations to improve the use of the ICD-PM and help strengthen its consistency.Registration PROSPERO [CRD42020203466].

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“…A study from a tertiary care centre in Mexico considered placental and/or fetal infection as probable cause of death in 15.1% of stillbirths. The pathogens identified were E. coli, Staphylococcus warnerii, Enterobacter spp., Klebsiella pneumoniae, Listeria monocytogenes, M. tuberculosis, C. albicans, Candida krusei, CMV, and Zika virus [166].…”

Section: Stillbirthmentioning

confidence: 99%

The Vaginal Microbiome during Pregnancy in Health and Disease

Mendz

2023

Applied Microbiology

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This study appraises the progress in the understanding of the composition of the vaginal microflora with a focus on the microbiome during pregnancy. This knowledge is presented with the background of the global health contribution, along with the importance of these microbial communities to pregnancy. A brief review of current methods employed to investigate the structure of these microbial populations is included. Two types of studies, cross-sectional and longitudinal, have been used to characterise the vaginal microbiota; both types are reviewed since they provide information that serves to piece together a more complete picture of the vaginal microflora and its changes during pregnancy. The identity of microbes present in the vagina are examined in the context of health and disease, and, more specifically, in the setting of pregnancy outcomes. The protective role of lactobacilli in maintaining a healthy vaginal environment is evaluated, with analyses of the different roles of various Lactobacillus spp. Classifications of the vaginal microbiota into vagitypes in non-pregnant and pregnant women are discussed. The associations of specific taxa with three adverse pregnancy results, namely, miscarriage, stillbirth, and preterm birth, are examined in some detail. Longitudinal studies investigating changes in the bacterial community composition and taxa abundance demonstrate that this microbiota decreases in richness and diversity relative to those present in non-pregnant microbiomes. Notwithstanding the significant effort made to characterise the vagina bacterial microbiota, a large number of issues remain to be fully understood.

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Causal analysis of fetal death in high-risk pregnancies

Cited by 4 publications

References 15 publications

Insights into the Genital Microbiota of Women Who Experienced Fetal Death in Utero

Insights into the Genital Microbiota of Women Who Experienced Fetal Death in Utero

The global use of the International Classification of Diseases to Perinatal Mortality (ICD-PM): A systematic review

The Vaginal Microbiome during Pregnancy in Health and Disease

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