Fetal deaths in the United States, 1997 vs 1991

Yuan, Hongliang; Platt, Robert W.; Morin, Lucie; Joseph, K. S.; Kramer, Michael S.

doi:10.1016/j.ajog.2004.12.002

Cited by 38 publications

(39 citation statements)

References 71 publications

(115 reference statements)

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“…31 Studies in the USA and Canada have linked increasing induction of labour at term to declining fetal mortality rates. 30,32 However, an assessment of these practices must include all pregnancies, as more active policies to induce postterm pregnancies tend to be associated with more active intervention for all pregnancies. Several recent studies report that decreasing postterm rates are accompanied by a shift to the left of the gestational-age distribution and a concomitant increase in the proportion of elective caesarean deliveries and inductions of labour at 38 and 39 weeks as well as late preterm births.…”

Section: Discussionmentioning

confidence: 99%

Variation in rates of postterm birth in Europe: reality or artefact?

Zeitlin

Blondel

Alexander

et al. 2007

BJOG

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Objective To compare rates of postterm birth in Europe.Design Analysis of data from vital statistics, birth registers, and national birth samples collected for the PERISTAT project.Setting Thirteen European countries.Population All live births or representative samples of births for the year 2000 or most recent year available.Methods Comparison of national and regional rates of postterm birth. Other indicators (birthweight, deliveries with a non-spontaneous onset and mortality) were used to assess the validity of postterm rates.Main outcome measures The proportion of births at 42 completed weeks of gestation or later.Results Postterm rates varied greatly, from 0.4% (Austria, Belgium) to over 7% (Denmark, Sweden) of births. Higher postterm rates were associated with a greater proportion of babies with birthweight 4500 g or more. Fetal and early neonatal mortality rates were higher among postterm births than among births at 40 weeks. Countries with higher proportions of births with a nonspontaneous onset of labour had lower postterm birth rates. The shapes of the gestational-age distributions at term varied. In some countries, there was a sharp cutoff in deliveries at 40 weeks, while elsewhere this occurred at 41 weeks.Conclusions These results suggest that practices for managing pregnancies continuing beyond term differ in Europe and raise questions about the health and other impacts in countries with markedly high or low postterm rates. Some variability in these rates may also be due to methods for determining gestational age, which has broader implications for international comparisons of gestational age, including rates of postterm and preterm births and small-for-gestational-age newborns.

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Section: Discussionmentioning

confidence: 99%

Variation in rates of postterm birth in Europe: reality or artefact?

Zeitlin

Blondel

Alexander

et al. 2007

BJOG

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“…Interestingly, in recent years, increased reporting, especially at the lower gestational ages, makes it difficult to understand trends over time. For example, Yuan and colleagues suggest that the stillbirth rates reported nationally would have decreased further over time than they have, except for increased reporting of stillbirths at very early gestational age in recent years 6 . Similar results were reported for Alabama 7 .…”

Section: Introductionmentioning

confidence: 97%

Stillbirth: a review

Goldenberg

Kirby

Culhane

2004

Journal of Maternal-Fetal and Neonatal Medicine

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Stillbirth occurs in nearly 1% of all births in the USA, and is one of the most common but least studied adverse pregnancy outcomes. The many risk factors for and causes of stillbirth are presented. Over the past several decades, the rate of stillbirth has been substantially reduced, with the reduction most apparent in those stillbirths previously occurring at term and/or in labor. Reductions have occurred because of reductions in risk factors (i.e. prevention of Rh disease and better control of diabetes), better antepartum monitoring of those with risk factors followed by early delivery for those fetuses found to be at risk (i.e. growth restriction, maternal pre-eclampsia), better intrapartum fetal monitoring, increases in Cesarean section for those at risk, and early detection of congenital anomalies followed by termination prior to the time that these early fetal deaths are classified as stillbirths. Finally, the value of using fetal autopsy and placental examination to determine the cause of death accurately, both for research purposes and for patient counseling in future pregnancies, is explored.

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“…Few studies explored the possibility of a relationship between brain injury and ATI, and those that did were performed in neonates [32,33], Neonates who died with cerebral WMIs were shown to be more likely to have ATI than were those dying without WMIs [32], A radiographic study in living preterm neonates showed that those with early onset postnatal ATIs were more likely to develop WMIs, as defined by an echolucency, suggesting the possibility that the ATI and neonatal WMI are not independent phenomena but have common antecedents [33], Most mothers in our study were African-American (86%), and although this study highlights morbidity associated with African-American mothers, the conclu sions may apply only to this ethnic group. There is a higher rate of stillbirth in African-Americans than in whites [34][35][36], Although the explanation for that difference is not known, possible reasons include disparity in socioeconomic status, limited access to medical care, and higher rates of maternal medical disorders, including hypertension and obesity [34], Further study is required to determine whether the high frequencies of ATI and brain injury reported in this study are related to ethnicity.…”

Section: Discussionmentioning

confidence: 80%

Acute Thymic Involution in Unexplained Third Trimester Stillbirth: Frequency, Grade, and Correlation with Neuropathologic Injury

2015

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Many 3rd-trimester stillbirths are unexplained, including the time course of the illness. Histologic acute thymic involution (ATI), when graded, correlates with duration of acute illness (grade 0, <12 hours; grade 4, >72 hours). Histologic brain injury is also common in stillbirth. We investigated ATI in unexplained stillbirth and correlated it with neuropathologic injury by identifying 58 autopsies of unexplained, 3rd-trimester stillborns (preterm, n = 24; term, n = 34) that included brain examination and graded ATI from 0 (resting state) to 4 (pronounced lymphodepletion). Gray matter injury (GMI) and white matter injury (WMI) were classified as older, recent, or absent, and ATI was correlated with GMI, WMI, thymic weight, and clinical data. Nine cases (16%) had ATI grade 0-1; 19 (33%), grade 2; 24 (41%), grade 3; and 6 (10%), grade 4. Older GMI and WMI were present in 39 (67%) and 10 (17%) stillborns, respectively. Higher ATI grade correlated significantly with older GMI (P < 0.001) and WMI (P = 0.014). The ATI grade was higher in the small-for-gestational stillborns compared with the appropriate- or large-for-gestational stillborns (P = 0.017) but did not correlate significantly with gestational age or other clinical or demographic factors evaluated. The ATI grades 2-4 were found in 84% of the stillborns, consistent with onset of acute illness between 24 and >72 hours before demise. Higher ATI grade correlated significantly with older brain injury, suggesting similar time of onset and shared underlying pathophysiologic events, the specific nature of which remains unclear.

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Fetal deaths in the United States, 1997 vs 1991

Cited by 38 publications

References 71 publications

Variation in rates of postterm birth in Europe: reality or artefact?

Variation in rates of postterm birth in Europe: reality or artefact?

Stillbirth: a review

Acute Thymic Involution in Unexplained Third Trimester Stillbirth: Frequency, Grade, and Correlation with Neuropathologic Injury

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