Forensic Aspects of Perinatal Deaths

Cohen, Marta C.; Scheimberg, Irene

doi:10.1177/1925362118797725

Cited by 12 publications

(6 citation statements)

References 68 publications

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“…These reference values may also be used to help resolve medico-legal issues related to neonatal death due to trauma (infanticide/fresh neonatal homicide), medical misadventure, negligence, and in deaths where natural and traumatic causes co-exist. 25 Women with high pre-pregnancy BMI have been reported to deliver heavyweight placentae, 26 in keeping with the present study (P < 0.001), but BMI in the present study was calculated at the earliest antenatal visit in the first trimester followed the missed menstrual period. Women with a higher pre-pregnancy BMI are at risk of several obstetric complications (e.g., gestational diabetes mellitus, preeclampsia, and large-for-gestational-age babies) associated with higher morbidity for both mother and child.…”

Section: Discussionsupporting

confidence: 77%

Placental weight and its relationship with the birth weight of term infants and body mass index of the mothers

et al. 2023

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Objective Placental pathology is a well-known cause of perinatal and neonatal mortality and morbidity, and may correlate with placental growth, which can be assessed indirectly by anthropometric placental measurements. The aim of this cross-sectional study was to investigate mean placental weight and its relationship with birthweight and maternal body mass index (BMI). Methods Fresh (not formalin fixed) consecutively delivered placentae of term newborns (37–42 weeks), collected between February 2022 and August 2022, and the mothers and newborns, were included. Mean placental weight, birthweight and maternal BMI were calculated. Pearson’s correlation coefficient, linear regression, and one-way analysis of variance were used to analyse continuous and categorical data. Results Out of 390 samples, 211 placentae (with 211 newborns and mothers) were included in this study after exclusion criteria were applied. Mean placental weight was 494.45 ± 110.39 g, and mean term birth weight/placental weight ratio was 6.21 ± 1.21 (range, 3.35–11.62 g). Placental weight was positively correlated with birthweight and maternal BMI, but not with newborn sex. Linear regression effect estimation of placental weight on birthweight revealed a medium correlation ( R2 = 0.212; formula, 1.4553 × X + 2246.7, where X is placental weight [g]). Conclusion Placental weight was revealed to positively correlate with birthweight and maternal BMI.

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Section: Discussionsupporting

confidence: 77%

Placental weight and its relationship with the birth weight of term infants and body mass index of the mothers

et al. 2023

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“…Of note, macerated stillbirths were those with findings suggestive of death greater than 8-24 h prior to delivery (e.g. skin desquamation) whereas fresh stillbirths were those without such findings [10,11]. Control patients, collected in a 2:1 ratio, were the admissions immediately prior and immediately after the perinatal death case that had liveborn neonates who survived to discharge and was not discovered to have died within 28 days of delivery.…”

Section: Methodsmentioning

confidence: 99%

Identifying risk factors for perinatal death at Tororo District Hospital, Uganda: a case-control study

Tesfalul

Natureeba

Day

et al. 2020

BMC Pregnancy Childbirth

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Background: Sub-Saharan Africa faces a disproportionate burden of perinatal deaths globally. However, data to inform targeted interventions on an institutional level is lacking, especially in rural settings. The objective of this study is to identify risk factors for perinatal death at a resource-limited hospital in Uganda. Methods: This is a retrospective case-control study at a district hospital in eastern Uganda using birth registry data. Cases were admissions with stillbirths at or beyond 24 weeks or neonatal deaths within 28 days of birth. Controls were admissions that resulted in deliveries immediately preceding and following each case. We compared demographic and obstetric factors between cases and controls to identify risk factors for perinatal death. Subgroup analysis of type of perinatal death was also performed. Chi square, Fisher's exact, t-test, and Wilcoxon-Mann-Whitney rank sum tests were utilized for bivariate analysis, and multiple logistic regression for multivariate analysis. Results: From January 2014 to December 2014, there were 185 cases of perinatal death, of which 36% (n = 69) were macerated stillbirths, 40% (n = 76) were fresh stillbirths, and 25% (n = 47) were neonatal deaths. The rate of perinatal death among all deliveries at the institution was 35.5 per 1000 deliveries. Factors associated with increased odds perinatal death included: prematurity (adjusted odds ratio (aOR) 19.7, 95% confidence interval (CI) 7.2-49.2), breech presentation (aOR 7.0, CI 1.4-35.5), multiple gestation (aOR 4.0, CI 1.1-13.9), cesarean delivery (aOR 3.8, CI 2.3-6.4) and low birth weight (aOR 2.5, CI 1.1-5.3). Analysis by subtype of perinatal death revealed distinct associations with the aforementioned risk factors, in particular for antepartum hemorrhage, which was only associated with fresh stillbirths (aOR 6.7, CI 1.6-28.8), and low birth weight. Conclusions: The rate of perinatal death at our rural hospital site was higher than national targets, and these deaths were associated with prematurity, low birth weight, breech presentation, multiple gestation, and cesarean delivery. This data and the approach utilized to acquire it can be leveraged to inform targeted interventions to reduce the rate of stillbirths and neonatal deaths in similar low resource settings.

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“…skin desquamation) whereas fresh stillbirths were those without such findings. 10,11 Control patients, collected in a 2:1 ratio, were the admissions immediately prior and immediately after the perinatal death case that had liveborn neonates who survived to discharge and was not discovered to have died within 28 days of delivery. We utilized this approach to account for temporal factors such as hospital census, staffing ratios, and medication availability which can be more variable in resource-limited settings.…”

Section: Methodsmentioning

confidence: 99%

Identifying risk factors for perinatal death at Tororo District Hospital, Uganda: a case-control study

Tesfalul

Natureeba

Day

et al. 2020

Preprint

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Background Sub-Saharan Africa faces a disproportionate burden of perinatal deaths globally. However, data to inform targeted interventions on an institutional level is lacking, especially in rural settings. The objective of this study is to identify risk factors for perinatal death at a resource-limited hospital in Uganda. Methods This is a retrospective case-control study at a district hospital in eastern Uganda using birth registry data. Cases were admissions with stillbirths at or beyond 24 weeks or neonatal deaths within 28 days of birth. Controls were admissions that resulted in deliveries immediately preceding and following each case. We compared demographic and obstetric factors between cases and controls to identify risk factors for perinatal death. Subgroup analysis of type of perinatal death was also performed. Chi square, Fisher's exact, t-test, and Wilcoxon-Mann-Whitney rank sum tests were utilized for bivariate analysis, and multiple logistic regression for multivariate analysis. Results From January 2014 to December 2014, there were 185 cases of perinatal death, of which 36% (n=69) were macerated stillbirths, 40% (n=76) were fresh stillbirths, and 25% (n=47) were neonatal deaths. The rate of perinatal death among all deliveries at the institution was 35.5 per 1,000 deliveries. Factors associated with increased odds perinatal death included: prematurity (adjusted odds ratio (aOR) 19.7, 95% confidence interval (CI) 7.2-49.2), breech presentation (aOR 7.0, CI 1.4-35.5), multiple gestation (aOR 4.0, CI 1.1 – 13.9), cesarean delivery (aOR 3.8, CI 2.3 – 6.4) and low birth weight (aOR 2.5, CI 1.1-5.3). Analysis by subtype of perinatal death revealed distinct associations with the aforementioned risk factors, in particular for antepartum hemorrhage, which was only associated with fresh stillbirths (aOR 6.7, CI 1.6-28.8), and low birth weight. Conclusions The rate of perinatal death at our rural hospital site was higher than national targets, and these deaths were associated with prematurity, low birth weight, breech presentation, multiple gestation, and cesarean delivery. This data and the approach utilized to acquire it can be leveraged to inform targeted interventions to reduce the rate of stillbirths and neonatal deaths in similar low resource settings.

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Forensic Aspects of Perinatal Deaths

Cited by 12 publications

References 68 publications

Placental weight and its relationship with the birth weight of term infants and body mass index of the mothers

Placental weight and its relationship with the birth weight of term infants and body mass index of the mothers

Identifying risk factors for perinatal death at Tororo District Hospital, Uganda: a case-control study

Identifying risk factors for perinatal death at Tororo District Hospital, Uganda: a case-control study

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