Miscarriage, stillbirth and neonatal mortality in the extreme preterm birth window of gestation in a limited-resource setting on the Thailand-Myanmar border: A population cohort study

Abstract

The WHO definition of stillbirth uses 28 weeks' gestation as the Background: cut-point, but also defines extreme preterm birth as 24 to <28 weeks' gestation. This presents a problem with the gestational limit of miscarriage, and hence reporting of stillbirth, preterm birth and neonatal death. The objective of this study is to provide a synopsis of the outcome of a population cohort of pregnancies on the Thailand-Myanmar border between 24 to <28 weeks' gestation.Records from the Shoklo Malaria Research Unit Antenatal Clinics Methods: were reviewed for pregnancy outcomes in the gestational window of 24 to <28 weeks, and each record, including ultrasounds reports, were reviewed to clarify the pregnancy outcome. Pregnancies where there was evidence of fetal demise prior to 24 weeks were classified as miscarriage; those viable at 24 weeks' gestation and born before 28 weeks were coded as births, and further subdivided into live-and stillbirth.Between 1995 and 2015, in a cohort of 49,931 women, 0.6% (318) of Results: outcomes occurred from 24 to <28 weeks' gestation, and 35.8% (114) were miscarriages, with confirmatory ultrasound of fetal demise in 45.4% (49/108). Of pregnancies not ending in miscarriage, 37.7% (77/204) were stillborn and of those born alive, neonatal mortality was 98.3% (115/117). One infant survived past the first year of life. Congenital abnormality rate was 12.0% (23/191). Ultrasound was associated with a greater proportion of pregnancy outcome being coded as birth.In this limited-resource setting, pregnancy outcome from 24 to Conclusion:<28 weeks' gestation included: 0.6% of all outcomes, of which one-third were <28 weeks' gestation included: 0.6% of all outcomes, of which one-third were miscarriages, one-third of births were stillborn and mortality of livebirths approached 100%. In the scale-up to preventable newborns deaths, at least initially, greater benefits will be obtained by focusing on the greater number of viable newborns with a gestation of 28 weeks or more.

Born too soon in a resource-limited setting: A 10-year mixed methods review of a special care baby unit for refugees and migrants on the Myanmar-Thailand border

“…These communities provided readily accessible, unskilled labor to help fuel Thailand's local border economy and further its affluence relative to its western neighbor. This narrative contextualizes this study's findings, contrasting a refugee yet reachable population with a mobile, migrant one-both constrained by overlapping and nuanced externalities (40,41,52,54,75) that inform the adaptation, maintenance, and improvement of evidence-based provision of newborn care (12,21,25,39,42,44,46,51,(76)(77)(78). Although a very specific setting, this study may provide insights to researchers, clinicians, and program managers promoting newborn health that are applicable to their context.…”

“…Additional information related to morbidity-specific conditions of interest was extracted from the medical records by medical staff and doctors with SCBU experience. We excluded neonates born and hospitalized in a tertiary hospital, those born at home and not subsequently hospitalized in SMRU clinics, those born in SMRU clinics but transferred to tertiary hospitals for further care, or those receiving palliative care ( 61 ). Data extraction was performed by following a pre-coded form and then entered to an electronic database by unique identification number.…”