Maternal risk factors for cause-specific stillbirth and neonatal death

Abstract

Background.To study specific effects of four maternal risk factors: age, parity, educational level, smoking, for specific causes of stillbirth and neonatal death according to a previously described hierarchic classification. Methods. The study is based on 9,785 stillbirths or neonatal deaths among infants born in Sweden, 1983Sweden, -1995 and identified with various Swedish health registers. Statistical analysis is performed using Mantel-Haenszel analysis. Results. Some risk factors, known from the literature, were confirmed and could be quantified. In addition, high parity was shown to increase the risk for death associated with multiple births (ORΩ2.49, 95% CI 2.07-3.01) and low educational level seems to be protective for such death (ORΩ0.75, 95% CI 0.60-0.93). If the infant is SGA, the risk for death is higher at high than at low parity (1.70, 95% CI 1.19-2.43, and 1.0, 95% CI 1.06-1.15, respectively). Maternal smoking seems to aggravate the placental abruption because the death risk in the presence of abruption increases when the mother smoked (ORΩ1.74, 95% CI 45-2.08).Conclusions. The study shows that the groups of the classification system used (NICE) differ in their association with known risk factors for stillbirth and neonatal deaths and an analysis based on specific causes of death can therefore unravel risk factors hidden when total mortality is used. The computerized method of classification and the cause-of-death classification developed by us is clearly useful for such analyses which requires large materials.

Evaluation of causes of still birth in a tertiary care teaching hospital

“…Statistically, the association of causes of stillbirth with education was not significant. [13][14][15][16] A total of 30 women (5.5%) had associated medical problems. Diabetes (n = 19;3.5%) was most common followed by hypothyroidism (n = 8; 1.2%).…”

Descolamento prematuro da placenta

“…(B), cesárea prévia 9,10 (B), restrição do crescimento intra-uterino 5 (B), corioamnionite 5 (B) 11 (C), gemelidade 1,12 (B), diabetes melito 4 (B), tempo prolongado de rotura de membranas 5 (B), tabagismo 2,13 (A) 14,15 (B) 16 (D), etilismo e uso de drogas ilícitas, principalmente cocaína 17 (B) 18 (A). Estudos preliminares buscaram estabelecer novos marcadores para esta patologia obstétrica, como a trombomodulina 19 (C), homocisteína 20 (D) e achados da dopplervelocimetria da artéria uterina 21 (C).…”

Preventing stillbirths: Better data to inform interventions in Australia

“…Management for SGA involves accurate determination of gestational age and serial monitoring of fetal growth (using symphysis-fundal height measurement or ultrasound biometry). However, 121 controversy exists over the accuracy of symphysis-fundal height measurement especially in obese women [249] and the use of customised growth charts due to lack of high level evidence [250]. A number of interventions have been found to be effective in the prevention of SGA among women at increased risk, including: antiplatelet agents, smoking cessation, progesterone therapy, anti-thrombotic therapy and interventionist care in severe pre-eclampsia [251].…”

“…Accurate cause of death information is important not only for developing effective prevention strategies for stillbirth [121], but it is vital for parents faced with the loss of a baby. Having an accurate cause of death helps parents understand the circumstances surrounding the death of their baby; and aids in counselling regarding the risk of recurrence in future pregnancies [122,123].…”

“…The value of a death classification system is using available information to establish the likely cause of death which is important for developing strategies for prevention and for monitoring the impact of such strategies [121,147,148]. More specifically, classification of stillbirth helps to identify groups for closer investigation and ongoing monitoring, policy development for prevention and health service utilisation [148].…”