Still births – eight years experience at Aga Khan University Hospital Karachi, Pakistan

Munim, Shama; Nawaz, Fauzia Haq; Ayub, Salma

doi:10.3109/14767058.2010.482619

Cited by 5 publications

(3 citation statements)

References 13 publications

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“…Early detection of fetal growth restriction as a potential cause of stillbirth could reduce the proportion of stillbirths with unknown cause of death from 40 to 50% to less than 20% [16, 24]. A hospital-based study from Pakistan reported that fetal growth restriction accounted for 18% of all stillbirths [25], which is higher than the 12.9% found in this study. Interestingly, intrauterine growth restriction (IUGR) was not considered an underlying cause of stillbirth by either healthcare providers or the expert panel.…”

Section: Discussionmentioning

confidence: 65%

Understanding cause of stillbirth: a prospective observational multi-country study from sub-Saharan Africa

Aminu

Bar-Zeev

White

et al. 2019

BMC Pregnancy Childbirth

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BackgroundEvery year, an estimated 2.6 million stillbirths occur worldwide, with up to 98% occurring in low- and middle-income countries (LMIC). There is a paucity of primary data on cause of stillbirth from LMIC, and particularly from sub-Saharan Africa to inform effective interventions. This study aimed to identify the cause of stillbirths in low- and middle-income settings and compare methods of assessment.MethodsThis was a prospective, observational study in 12 hospitals in Kenya, Malawi, Sierra Leone and Zimbabwe. Stillbirths (28 weeks or more) were reviewed to assign the cause of death by healthcare providers, an expert panel and by using computer-based algorithms. Agreement between the three methods was compared using Kappa (κ) analysis. Cause of stillbirth and level of agreement between the methods used to assign cause of death.ResultsOne thousand five hundred sixty-three stillbirths were studied. The stillbirth rate (per 1000 births) was 20.3 in Malawi, 34.7 in Zimbabwe, 38.8 in Kenya and 118.1 in Sierra Leone. Half (50.7%) of all stillbirths occurred during the intrapartum period.Cause of death (range) overall varied by method of assessment and included: asphyxia (18.5–37.4%), placental disorders (8.4–15.1%), maternal hypertensive disorders (5.1–13.6%), infections (4.3–9.0%), cord problems (3.3–6.5%), and ruptured uterus due to obstructed labour (2.6–6.1%). Cause of stillbirth was unknown in 17.9–26.0% of cases.Moderate agreement was observed for cause of stillbirth as assigned by the expert panel and by hospital-based healthcare providers who conducted perinatal death review (κ = 0.69; p < 0.0005). There was only minimal agreement between expert panel review or healthcare provider review and computer-based algorithms (κ = 0.34; 0.31 respectively p < 0.0005).ConclusionsFor the majority of stillbirths, an underlying likely cause of death could be determined despite limited diagnostic capacity. In these settings, more diagnostic information is, however, needed to establish a more specific cause of death for the majority of stillbirths. Existing computer-based algorithms used to assign cause of death require revision.

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Section: Discussionmentioning

confidence: 65%

Understanding cause of stillbirth: a prospective observational multi-country study from sub-Saharan Africa

Aminu

Bar-Zeev

White

et al. 2019

BMC Pregnancy Childbirth

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“…This study has almost comparable results in relation to maternal age, BMI, causes of intrauterine fetal deaths, macerated still births at the time of birth and vaginal deliveries, to the literature previously published from Pakistan except for the booking status of patients. [19][20][21][22] This study aimed to look only at antepartum intrauterine fetal deaths reporting to our center in the last 5 years and identifying the factors mainly responsible for antepartum period cases. The strength of the study was that it looked only one specific time period and had sufficient cases from last 5 years and very comprehensive information as detailed patient records were available.…”

Section: Discussionmentioning

confidence: 99%

Intrauterine fetal death: Five years’ experience in a secondary care hospital.

Khan

Jamil

Chanderparkash

et al. 2021

TPMJ

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Objectives: The objectives of this study were to estimate the prevalence, preoperative, and operative risk factors associated with the higher risk of SSI in gynecologic cancer patients undergoing surgery in a tertiary care facility in a developing country. Study Design: Retrospective Study. Setting: Obstetrics and Gynecology Department, Agha Khan Hospital for Women Garden Karachi, Pakistan. Period: Jan 2012 to Dec 2016. Material & Methods: Retrospective review of medical records of patients over a period of five years from Jan 2012 to Dec 2016 was done. Results: The study consisted of 56 cases of intrauterine fetal demise out of 4813 number of deliveries which occurred during the study duration. Overall estimated rate of intrauterine fetal demise was 11.6 %( 56/4813). Approximately 33.9% of cases did not have a clear cause of fetal death identified and hence were un-explained. In 56 cases, 28.6% had some form of congenital abnormality identified on ultrasound, 7.1% (n=4) had anemia, 23.2% (n=13) IUGR, 5.4% (n=3) placental abruption and 1.8% (n=1) of gestational diabetes and around 83.9% (n=47) had normal vaginal delivery and 8 were delivered by LSCS and only 1 patient had instrumental delivery. Fetal characteristics identified 50% (n=28) were males and 50% (n=28) were females. 4 fetuses were born with tight cord around their neck 58.1% were macerated stillbirths (n=25) while 32.6% were fresh stillbirth. Conclusion: Antepartum intrauterine fetal death or stillbirths in the third trimester, affect the entire family. We conclude from our study that quality antenatal care with health education and timely interventions can reduce the number of intrauterine fetal deaths thus reducing the psychological sequelae.

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“…The per capita income in Karachi is approximately $1,427. At AKUH, the first antenatal visit is usually in the first trimester, at which time a dating scan is performed 47 . Nuchal translucency screening is offered to high-risk women and a fetal anomaly scan is offered between 19–23 weeks’ gestation.…”

Section: Methodsmentioning

confidence: 99%

Deep clinical and biological phenotyping of the preterm birth and small for gestational age syndromes: The INTERBIO-21st Newborn Case-Control Study protocol

et al. 2019

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Background: INTERBIO-21st is Phase II of the INTERGROWTH-21st Project, the population-based, research initiative involving nearly 70,000 mothers and babies worldwide coordinated by Oxford University and performed by a multidisciplinary network of more than 400 healthcare professionals and scientists from 35 institutions in 21 countries worldwide. Phase I, conducted 2008-2015, consisted of nine complementary studies designed to describe optimal human growth and neurodevelopment, based conceptually on the WHO prescriptive approach. The studies generated a set of international standards for monitoring growth and neurodevelopment, which complement the existing WHO Child Growth Standards. Phase II aims to improve the functional classification of the highly heterogenous preterm birth and fetal growth restriction syndromes through a better understanding of how environmental exposures, clinical conditions and nutrition influence patterns of human growth from conception to childhood, as well as specific neurodevelopmental domains and associated behaviors at 2 years of age. Methods: In the INTERBIO-21st Newborn Case-Control Study, a major component of Phase II, our objective is to investigate the mechanisms potentially responsible for preterm birth and small for gestational age and their interactions, using deep phenotyping of clinical, growth and epidemiological data and associated nutritional, biochemical, omic and histological profiles. Here we describe the study sites, population characteristics, study design, methodology and standardization procedures for the collection of longitudinal clinical data and biological samples (maternal blood, umbilical cord blood, placental tissue, maternal feces and infant buccal swabs) for the study that was conducted between 2012 and 2018 in Brazil, Kenya, Pakistan, South Africa, Thailand and the UK. Discussion: Our study provides a unique resource for the planned analyses given the range of potentially disadvantageous exposures (including poor nutrition, pregnancy complications and infections) in geographically diverse populations worldwide. The study should enhance current medical knowledge and provide new insights into environmental influences on human growth and neurodevelopment.

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Still births – eight years experience at Aga Khan University Hospital Karachi, Pakistan

Cited by 5 publications

References 13 publications

Understanding cause of stillbirth: a prospective observational multi-country study from sub-Saharan Africa

Understanding cause of stillbirth: a prospective observational multi-country study from sub-Saharan Africa

Intrauterine fetal death: Five years’ experience in a secondary care hospital.

Deep clinical and biological phenotyping of the preterm birth and small for gestational age syndromes: The INTERBIO-21st Newborn Case-Control Study protocol

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