Stillbirths and neonatal deaths in appropriate, small and large birthweight for gestational age fetuses

Vashevnik, Stas; Walker, Susan P.; Permezel, Michael

doi:10.1111/j.1479-828x.2007.00742.x

Cited by 86 publications

(43 citation statements)

References 12 publications

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“…Some women fi nd a perinatal mortality rate of 1.4 per 1000 births after 39 weeks of gestation [106] and a cerebral palsy rate of 0.45 -3 per 1000 births extremely high and although only 10 % of these are felt to have an intrapartum origin [10] , these numbers play an important part in women ' s choice for CS [110] . Other women fi nd the unpredictability of a vaginal birth and the risks of instrumental vaginal deliveries and emergency CS unacceptable.…”

Section: The Changing Attitude Of Women To Csmentioning

confidence: 99%

To ‘C’ or not to ‘C’?/Caesarean delivery upon maternal request: a review of facts, figures and guidelines

D’Souza

Arulkumaran

2012

Journal of Perinatal Medicine

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The last few decades have seen an unrelenting rise in caesarean section (CS) rates. In addition to an increase in numbers of CS performed worldwide, there has also been a change in the indications for CS, a reflection of changing times. A new dilemma facing obstetricians is the increasing demand for CS in the absence of any medical indication (caesarean delivery on maternal request - CDMR). The paucity of evidence either in favour or against, the poor understanding of long-term health and financial implications and the complex ethical issues surrounding CDMR make counselling extremely challenging. Needless to say, CDMR has generated enormous interest both in the media and among health-care providers, and many national and international bodies have now issued guidelines on the topic. In this editorial, we have aimed to explore the factors responsible for the increase in CDMR rates, assess the safety and cost implications of CS and review the recent guidelines and recommendations on CDMR.

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Section: The Changing Attitude Of Women To Csmentioning

confidence: 99%

To ‘C’ or not to ‘C’?/Caesarean delivery upon maternal request: a review of facts, figures and guidelines

D’Souza

Arulkumaran

2012

Journal of Perinatal Medicine

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“…Of the three million lives lost to stillbirth each year, over half are growth restricted. 4 The SGA fetus is at four times the risk of perinatal death compared with its appropriately grown counterpart, 5 and stillbirth rates are more than doubled when FGR remains undetected. 4 SGA fetuses are more likely to become compromised under the hypoxic challenge of labour, with increased rates of caesarean section for nonreassuring fetal status and neonatal acidaemia.…”

Section: Introductionmentioning

confidence: 98%

Shining light in dark corners: Diagnosis and management of late‐onset fetal growth restriction

MacDonald

McCarthy

Walker

2015

Aust NZ J Obst Gynaeco

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Fetal growth restriction (FGR) is the single biggest risk factor for stillbirth. In the absence of any effective treatment for fetal growth restriction, the mainstay of management is close surveillance and timely delivery. While such statements are almost self-evident, the daily clinical challenge of late-onset fetal growth restriction remains; the competing priorities of minimising stillbirth risk, while avoiding excessive obstetric intervention and the neonatal sequelae of iatrogenic preterm birth. This dilemma is made harder because the tools for late-onset FGR diagnosis and surveillance compare poorly to those used in early-onset FGR; screening tests in early pregnancy have limited predictive value; most cases escape clinical detection, a phenomenon set to worsen given the obesity epidemic; there is a failure of consensus on the definition of small for gestational age, and ancillary tools, such as umbilical artery Doppler--of value in identification of preterm FGR--are less useful in the late-preterm period and at term. Most importantly, the problem is common; 96% of all births occur after 32 weeks. This means a poor noise/signal ratio of any test or management algorithm will inevitably have large clinical consequences. Into such a dark corner, we cast some light; a summary on diagnostic criteria, new developments to improve the diagnosis of late-onset FGR and a suggested approach to management.

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“…Timing of elective caesarean delivery is a complex issue. There are factors (mainly related to pulmonary maturity) suggesting delay until 39 weeks’ gestation, and others (mainly related to unexplained stillbirth 6 , 7 ) supporting the traditional timing between 38 weeks and 38 weeks and 6 days. A large randomised controlled trial (RCT) or a carefully conducted observational study employing propensity scoring would be required to provide a solid evidence base.…”

mentioning

confidence: 87%

A plea for professional independence

Dietz

Stokes

2012

Medical Journal of Australia

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Stillbirths and neonatal deaths in appropriate, small and large birthweight for gestational age fetuses

Abstract: The risk of stillbirth per week of gestational age and neonatal death rates do not differ significantly between AGA and LGA fetuses and neonates. The SGA fetus is at significantly greater risk of both stillbirth and neonatal death, particularly with advancing gestational age.

Cited by 86 publications

References 12 publications

To ‘C’ or not to ‘C’?/Caesarean delivery upon maternal request: a review of facts, figures and guidelines

To ‘C’ or not to ‘C’?/Caesarean delivery upon maternal request: a review of facts, figures and guidelines

Shining light in dark corners: Diagnosis and management of late‐onset fetal growth restriction

A plea for professional independence

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