NSIDRC Journal Article Alert — May 7, 2010
Prepared by the National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center at Georgetown University.
These articles have been selected from PubMed, a service of the National Library of Medicine that includes over 19 million citations from MEDLINE and other life science journals for biomedical articles back to 1948. PubMed includes links to full text articles and other related resources.
Availability of full-text journal articles is often limited to subscribers or through inter-library loan. Please see your local library for copies of these articles, or view PubMed's How to Get the Journal Article or Partners in Information Access for the Public Health Workforce's How to Access Journal Articles for more details.
Sudden Infant Death
1. Boldo E, Medina S, Oberg M, Puklová V, Mekel O, Patja K,
Dalbokova D, Krzyzanowski M, Posada M
Health impact assessment of environmental tobacco smoke in
European children: sudden infant death syndrome and asthma
episodes
Public Health Rep. 2010 May-Jun;125(3):478-87
National Epidemiology Centre, Carlos III Health Institute, Madrid, Spain. eiboldo@isciii.es
2. Al-Adnani M, Cohen MC, Scheimberg I
Gastro-oesophageal reflux disease and sudden infant death:
Mechanisms behind an under-recognised association
Pediatr Dev Pathol. 2010 Apr 29. [Epub ahead of print]
1 Sheffield Children's NHS Foundation Trust.
Abstract We present 4 cases of sudden infant death where we
believe that gastro-oesophageal reflux was a contributory,
if not a causative, factor. Two of our patients had documented
gastro-oesophageal reflux disease during life and all four
cases showed histological evidence of gastro-oesophageal reflux.
No other cause of death was identified in any of the patients.
Gastro-oesophageal reflux can cause sudden death in a vulnerable
infant during a critical period of development through failure
of "autoresuscitation" mechanisms.
Miscarriage/Stillbirth/Prenatal Issues
1. Alanis MC, Goodnight WH, Hill EG, Robinson CJ, Villers
MS, Johnson DD
Maternal super-obesity (body mass index >/= 50) and adverse
pregnancy outcomes
Acta Obstet Gynecol Scand. 2010 May 4. [Epub ahead of print]
Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston USA.
Abstract Objective. To determine if pregnancy complications are increased in super-obese (a body mass index (BMI) of 50 or more) compared to other, less obese parturients. Design. Cross-sectional study. Setting and population. All 19,700 eligible women, including 425 (2.2%) super-obese women with singleton births between 1996 and 2007 delivering at a tertiary referral center, identified using a perinatal research database. Methods. Bivariate and trend analyses were used to assess the relation between super-obesity and various pregnancy complications compared to other well-established BMI categories. Adjusted odds ratios (ORs) were calculated using multivariable logistic regression techniques. Main outcome measures. Outcomes for adjusted and unadjusted analyses were small-for-gestational age (SGA) birth, large-for-gestational age (LGA) birth, preeclampsia, gestational diabetes mellitus (GDM), fetal death, preterm birth, placental abruption, cesarean delivery, and Apgar scores < 7. Results. Compared to all other obese and non-obese women, super-obese women had the highest rates of preeclampsia, GDM, LGA, and cesarean delivery (all p < 0.05 for trend test). Super-obesity was also associated with a 44% reduction in SGA compared to all other women (OR 0.55, 95% confidence interval (CI) 0.40-0.76) and a 25% reduction compared to other, less obese women (OR 0.75, 95% CI 0.54-1.03). Super-obesity was positively associated with LGA, GDM, preeclampsia, cesarean delivery, and a 5-minute Apgar score < 7 compared to all other women after controlling for important confounders. Conclusion. Super-obesity is associated with higher rates of pregnancy complications compared to women of all other BMI classes, including other obese women.
2. Saleemuddin A, Tantbirojn P, Sirois K, Crum CP, Boyd TK,
Tworoger S, Parast M
Obstetric and Perinatal Complications in Placentas with Fetal
Thrombotic Vasculopathy
Pediatr Dev Pathol. 2010 May 3. [Epub ahead of print]
1 Brigham and Women's Hospital.
Abstract Objective: Fetal thrombotic vasculopathy (FTV) is a placental lesion characterized by regionally distributed avascular villi, and is often accompanied by upstream thrombosis in placental fetal vessels. Previous studies, using pre-selected populations, have shown associations of this lesion with adverse neurodevelopmental outcomes and potentially obstructive lesions of the umbilical cord. We investigated the prevalence of obstetric complications, perinatal disease, and placental abnormalities in cases with FTV.Methods: 113 cases of placentas with FTV were identified in our pathology database over an 18-year period. 216 placentas without the diagnosis of FTV, frequency matched on year of birth, were selected as controls. Electronic medical records and pathology reports were used to extract maternal and gestational age, method of delivery, neonatal outcome, lesions of the umbilical cord, obstetric complications, and fetal abnormalities. Results: Placentas with FTV were associated with a nine-fold increase in rate of stillbirth and a two-fold increase in intrauterine growth restriction. The increase in pregnancy-induced hypertension/preeclampsia was not significant when adjusted for maternal and gestational age. While the rate of potentially obstructive cord lesions was similar in both groups, there was an almost 6-fold increase in the presence of oligohydramnios in FTV placentas, compared to controls. Finally, FTV was associated with a six-fold increase in fetal cardiac abnormalities.Conclusions: FTV is associated with significantly higher rate of obstetric and perinatal complications. This study points to abnormal fetal circulation, either in the form of congenital heart disease or oligohydramnios predisposing to cord compression, as a risk factor for FTV.
3. Sham AH, Yiu MC, Ho WB
Psychiatric morbidity following miscarriage in Hong Kong
Gen Hosp Psychiatry. 2010 May-Jun;32(3):284-93. Epub 2010 Feb
20
Department of Psychiatry, United Christian Hospital, Hong Kong 852. skh663@ha.org.hk
OBJECTIVE: The aim of this study is to examine the pattern of psychiatric morbidity up to 3 months following miscarriage and to identify the risk factors of post-miscarriage depressive disorder among Chinese women in Hong Kong. METHOD: This is a longitudinal cohort study. Women were interviewed immediately after miscarriage to collect psychiatric and sociodemographic data. Three months later, 161 subjects (89%) were assessed by a 12-item General Health Questionnaire (GHQ-12) and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) as screening and diagnostic instruments, respectively. RESULTS: Three months after miscarriage, 10% of subjects suffered depressive disorder, 1.2% were diagnosed with anxiety disorder not otherwise specified, and another two subjects each suffered obsessive compulsive disorder (0.6%) and posttraumatic stress disorder (0.6%), respectively. Risk factors of post-miscarriage depression included younger age, history of infertility and past history of depression. CONCLUSIONS: Given the local annual figure of more than 7000 first-trimester miscarriages, about 900 local women suffer post-miscarriage psychiatric disorder each year. This finding may prompt general hospitals in Hong Kong to screen for post-miscarriage psychiatric disorders, particularly depression. Copyright 2010 Elsevier Inc. All rights reserved.
4. Olive DL, Pritts EA
Fibroids and reproduction
Semin Reprod Med. 2010 May;28(3):218-27. Epub 2010 Apr 22
Wisconsin Fertility Institute, Middleton, Wisconsin 53562, USA. lapskyboy@aol.com
Uterine fibroids are commonly seen in women with reproductive disorders such as infertility, spontaneous abortion (SAB), and obstetric complications. Although it is certain that these tumors can occasionally cause such pathophysiology, it is critical to understand the rate of such occurrences, the degree of causality of the fibroids, and our ability to ameliorate the problems via surgical treatment. Evaluation of the available data is hampered by poor quality studies, heterogeneity of the disease, and confounding factors affecting outcomes. Nevertheless, the best available evidence suggests the following: (1) Submucous myomas decrease fertility and increase SAB rates; myomectomy is likely to be of value; (2) intramural myomas may decrease fertility, but the issue is less clear; they do seem to increase rates of miscarriage; there is no solid evidence that myomectomy restores the patient to normal; (3) subserosal myomas do not impair fertility but may enhance the rate of SAB; and (4) fibroids increase the risk of several obstetric complications, including cesarean delivery, malpresentation, postpartum hemorrhage, retained placenta, intrauterine growth retardation, preterm labor, placenta previa, and abruption. Higher quality studies are desperately needed to add confidence to these tenuous conclusions. Thieme Medical Publishers.
5. Gold KJ, Sen A, Hayward RA
Marriage and cohabitation outcomes after pregnancy loss
Pediatrics. 2010 May;125(5):e1202-7. Epub 2010 Apr 5
University of Michigan, Department of Family Medicine, Ann
Arbor, MI 48104-1213, USA. ktgold@umich.edu
Abstract
OBJECTIVE: The goal was to evaluate marriage and cohabitation outcomes for couples who experienced a live birth or fetal death at any gestational age. METHODS: For married and cohabitating women who experienced live births, miscarriages, or stillbirths, we conducted a survival analysis (median follow-up period: 7.8 years), by using data from the National Survey of Family Growth, to examine the association between birth outcomes and subsequent relationship survival. The Cox proportional-hazards models controlled for multiple independent risk factors known to affect relationship outcomes. The main outcome measure was the proportion of intact marriages or cohabitations over time. RESULTS: Of 7770 eligible pregnancies, 82% ended in live births, 16% in miscarriages, and 2% in stillbirths. With controlling for known risk factors, women who experienced miscarriages (hazard ratio: 1.22 [95% confidence interval: 1.08-1.38]; P = .001) or stillbirths (hazard ratio: 1.40 [95% confidence interval: 1.10-1.79]; P = .007) had a significantly greater hazard of their relationship ending, compared with women whose pregnancies ended in live births. CONCLUSIONS: This is the first national study to establish that parental relationships have a higher risk of dissolving after miscarriage or stillbirth, compared with live birth. Given the frequency of pregnancy loss, these findings might have significant societal implications if causally related.
6. Wong EY, Ray R, Gao DL, Wernli KJ, Li W, Fitzgibbons ED,
Camp JE, Heagerty PJ, De Roos AJ, Holt VL, Thomas DB, Checkoway
H
Physical activity, physical exertion, and miscarriage risk
in women textile workers in Shanghai, China
Am J Ind Med. 2010 May;53(5):497-505
Department of Epidemiology, School of Public Health and Community
Medicine, University of Washington, Seattle, Washington, USA.
evawong@u.washington.edu
Abstract
BACKGROUND: Strenuous occupational physical activity and physical demands may be risk factors for adverse reproductive outcomes. METHODS: A retrospective study in the Shanghai, China textile industry study collected women's self-reported reproductive history. Occupational physical activity assessment linked complete work history data to an industry-specific job-exposure matrix. Odds ratios (OR) and 95% confidence intervals (CI) were estimated by multivariate logistic regression for the first pregnancy outcome and utilized generalized estimating equations to consider all pregnancies per woman. RESULTS: Compared with women employed in sedentary jobs, a reduced risk of miscarriage was found for women working in jobs with either light (OR 0.18, 95% CI: 0.07, 0.50) or medium (OR 0.24, 95% CI: 0.08, 0.66) physical activity during the first pregnancy and over all pregnancies (light OR 0.32, 95% CI: 0.17, 0.61; medium OR 0.43, 95% CI: 0.23, 0.80). Frequent crouching was associated with elevated risk (OR 1.82, 95% CI: 1.14, 2.93; all pregnancies per woman). CONCLUSIONS: Light/medium occupational physical activity may have reduced miscarriage risk, while specific occupational characteristics such as crouching may have increased risk in this cohort. 2010 Wiley-Liss, Inc.
7. Greer IA
Antithrombotic therapy for recurrent miscarriage?
N Engl J Med. 2010 Apr 29;362(17):1630-1. Epub 2010 Mar 24
Comment on:
N Engl J Med. 2010 Apr 29;362(17):1586-96.
8. Kaandorp SP, Goddijn M, van der Post JA, Hutten BA, Verhoeve
HR, Hamulyák K, Mol BW, Folkeringa N, Nahuis M, Papatsonis
DN, Büller HR, van der Veen F, Middeldorp S
Aspirin plus heparin or aspirin alone in women with recurrent
miscarriage
N Engl J Med. 2010 Apr 29;362(17):1586-96. Epub 2010 Mar 24
Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Comment in:
N Engl J Med. 2010 Apr 29;362(17):1630-1.
BACKGROUND: Aspirin and low-molecular-weight heparin are prescribed for women with unexplained recurrent miscarriage, with the goal of improving the rate of live births, but limited data from randomized, controlled trials are available to support the use of these drugs. METHODS: In this randomized trial, we enrolled 364 women between the ages of 18 and 42 years who had a history of unexplained recurrent miscarriage and were attempting to conceive or were less than 6 weeks pregnant. We then randomly assigned them to receive daily 80 mg of aspirin plus open-label subcutaneous nadroparin (at a dose of 2850 IU, starting as soon as a viable pregnancy was demonstrated), 80 mg of aspirin alone, or placebo. The primary outcome measure was the live-birth rate. Secondary outcomes included rates of miscarriage, obstetrical complications, and maternal and fetal adverse events. RESULTS: Live-birth rates did not differ significantly among the three study groups. The proportions of women who gave birth to a live infant were 54.5% in the group receiving aspirin plus nadroparin (combination-therapy group), 50.8% in the aspirin-only group, and 57.0% in the placebo group (absolute difference in live-birth rate: combination therapy vs. placebo, -2.6 percentage points; 95% confidence interval [CI], -15.0 to 9.9; aspirin only vs. placebo, -6.2 percentage points; 95% CI, -18.8 to 6.4). Among 299 women who became pregnant, the live-birth rates were 69.1% in the combination-therapy group, 61.6% in the aspirin-only group, and 67.0% in the placebo group (absolute difference in live-birth rate: combination therapy vs. placebo, 2.1 percentage points; 95% CI, -10.8 to 15.0; aspirin alone vs. placebo -5.4 percentage points; 95% CI, -18.6 to 7.8). An increased tendency to bruise and swelling or itching at the injection site occurred significantly more frequently in the combination-therapy group than in the other two study groups. CONCLUSIONS: Neither aspirin combined with nadroparin nor aspirin alone improved the live-birth rate, as compared with placebo, among women with unexplained recurrent miscarriage. (Current Controlled Trials number, ISRCTN58496168.) 2010 Massachusetts Medical Society
9. Christiansen OB, Steffensen R, Nielsen HS
The impact of anti-HY responses on outcome in current and subsequent
pregnancies of patients with recurrent pregnancy losses
J Reprod Immunol. 2010 May;85(1):9-14. Epub 2010 Mar 21
The Fertility Clinic 4071, University Hospital Copenhagen, Rigshospitalet, DK-2100 Copenhagen, Denmark. rh08636@rh.dk
Women pregnant with a male fetus often generate cellular and humoral immune responses against male-specific minor histocompatibility (HY) antigens-however, the importance of these responses for pregnancy outcome is unclear. Epidemiologic studies have shown that the birth of a boy compared with a girl prior to a series of miscarriages significantly reduces the chance of a subsequent live birth and pregnancies with boys have an increased risk of placental abruption. This paper aims to review the current knowledge about the impact of anti-HY immunity on pregnancy outcome in terms of miscarriage and placental abruption. Our knowledge primarily comes from studies of the impact on pregnancy outcome of HLA class II alleles known to restrict CD4 T cell mediated anti-HY responses among 358 secondary recurrent miscarriage (SRM) patients and 203 of their children born prior to the miscarriages and investigation of these HLA alleles in 8 patients with recurrent severe placental abruptions. The chance of a subsequent live birth in SRM patients with firstborn boys compared to firstborn girls was significantly lower in women with HY-restricting HLA class II alleles [OR: 0.17 (0.1-0.4), p=0.0001]. Most patients with recurrent placental abruptions had firstborn boys and significantly more of these patients carried HLA haplotypes with HY-restricting class II alleles compared with controls (p=0.009). These findings are strongly indicative of aberrant maternal immune reactions against fetal HY antigens playing a role in recurrent miscarriage and placental abruption. We propose pathogenetic pathways for these conditions that in our view best explain the findings. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.
10. Bhattacharya S, Townend J, Bhattacharya S
Recurrent miscarriage: Are three miscarriages one too many?
Analysis of a Scottish population-based database of 151,021
pregnancies
Eur J Obstet Gynecol Reprod Biol. 2010 May;150(1):24-7. Epub
2010 Mar 5
Obstetric Epidemiology, Dugald Baird Centre for Research on Women's Health, Aberdeen Maternity Hospital, Aberdeen AB25 2ZD, United Kingdom. sohinee.bhattacharya@abdn.ac.uk
OBJECTIVE: To assess the risk of further miscarriage or preterm delivery in women with a history of miscarriages in previous pregnancies, adjusting for maternal age and smoking. STUDY DESIGN: Retrospective cohort study using all women with first pregnancies recorded between 1950 and 2000 in the Aberdeen Maternity and Neonatal Databank.Exposure was one or more spontaneous miscarriages, while outcomes assessed were further miscarriage or preterm delivery. RESULTS: There were 143,595 pregnancies with none, 6,577 with one, 700 with two, 115 with three and 24 with four consecutive previous miscarriages. The odds of miscarriage were greater in pregnancies following one previous miscarriage than none {adj.O.R. 1.94 (95% C.I. 1.80, 2.09)}. The risk of miscarriage following two miscarriages was greater than in pregnancies following one {adj.O.R. 1.56 (95% C.I. 1.28, 1.90)}. However, there was no further significant increase in odds of miscarriage for pregnancies following three {adj.O.R. 1.37 (95% C.I. 0.86, 2.17)} previous consecutive miscarriages. Odds of spontaneous preterm delivery were greater following one miscarriage than none {adj.O.R. 1.52 (95% C.I. 1.36, 1.69)} but no further increases in risk were seen. CONCLUSION: After adjusting for age and smoking, the risk of a further miscarriage increased sequentially in women who had one and two miscarriages. Three miscarriages did not increase the odds any further. One miscarriage was associated with an increased chance of spontaneous preterm delivery, but two or three miscarriages did not increase the odds any further. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.
11. Landres IV, Milki AA, Lathi RB
Karyotype of miscarriages in relation to maternal weight
Hum Reprod. 2010 May;25(5):1123-6. Epub 2010 Feb 26
Department of Obstetrics and Gynecology, Stanford Hospital and Clinics, Stanford, CA, USA. innaland@gmail.com
BACKGROUND: Obesity has been identified as a risk factor for spontaneous miscarriage although the mechanism is unclear. The purpose of this study is to better understand the effect of obesity on early pregnancy success by examining the cytogenetic results of miscarriages in women with normal and elevated body mass index (BMI). METHODS: We conducted a retrospective case-control study in an academic infertility practice. Medical records of women ages <40 years with first trimester missed abortion (n = 204), who underwent dilatation and curettage between 1999 and 2008, were reviewed for demographics, BMI, diagnosis of polycystic ovary syndrome (PCOS) and karyotype analysis. chi(2) and Student's t-test analysis were used for statistical analysis, with P < 0.05 considered significant. RESULTS: A total of 204 miscarriages were included, from women with a mean age of 34.5 years. The overall rate of aneuploidy was 59%. Women with BMI > or = 25 kg/m(2) had a significant increase in euploid miscarriages compared with women with lower BMI (P = 0.04), despite a similar mean age (34.4 years for both). CONCLUSIONS: We found a significant increase in normal embryonic karyotypes in the miscarriages of overweight and obese women (BMI > or = 25). These results suggest that the excess risk of miscarriages in the overweight and obese population is independent of embryonic aneuploidy. Further studies are needed to assess the impact of lifestyle modification, insulin resistance and PCOS on pregnancy outcomes in the overweight and obese population.
12. Toth B, Jeschke U, Rogenhofer N, Scholz C, Würfel W, Thaler
CJ, Makrigiannakis A
Recurrent miscarriage: current concepts in diagnosis and treatment
J Reprod Immunol. 2010 May;85(1):25-32. Epub 2010 Feb 24
Department of Gynecological Endocrinology and Fertility Disorders, Ruprecht-Karl University Heidelberg, Vossstr 9, 69115 Heidelberg, Germany. bettina.toth@med.uni-heidelberg.de
Although recurrent miscarriage (RM) affects only 1-3% of couples, it has a major influence on the wellbeing and psychosocial status of patients. Therefore, research into improved diagnosis and development of new treatment strategies is essential. In this review, we summarize current concepts on diagnosis and treatment in RM, drawing upon research reports and international guidelines to provide insights into the pathophysiology of pregnancy disrupted by repeated miscarriage. Anatomical malformations, infectious diseases, endocrine disorders, autoimmune defects as well as acquired and inherited thrombophilia are established risk factors in RM. In addition, our recent findings indicate an impact on miscarriage incidence of glycoproteins such as glycodelin, and nuclear hormone receptors such as the peroxisome proliferator-activated receptors (PPARs). Significantly reduced glycodelin expression is associated with miscarriage, whereas up-regulation of PPARs appears to compensate for either the activated immune response or the disturbed cytotrophoblast differentiation in RM patients. There is also evidence that circulating placental microparticles are increased in a subgroup of RM patients, indicating an acquired procoagulant state even outside pregnancy. Treatment strategies like aspirin and low molecular weight heparin (LMWH) are standard medications in RM, although only a few placebo-controlled trials have proven their benefit in respect to live birth rate. There is emerging evidence that new treatment options, including drugs like TNFalpha inhibitors and granulocyte colony-stimulating factor (G-CSF) might be beneficial in some cases of RM. However, larger clinical trials must be completed to further prove or disprove benefits of these drugs in the treatment of RM patients. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.
13. Wisborg K, Ingerslev HJ, Henriksen TB
IVF and stillbirth: a prospective follow-up study
Hum Reprod. 2010 May;25(5):1312-6. Epub 2010 Feb 23
Department of Paediatrics, Perinatal Epidemiology Research Unit, Aarhus University Hospital, Brendstrugaardsvej 100, Skejby, DK-8200 Aarhus, Denmark.
BACKGROUND: Previous studies have indicated that the risk of stillbirth is increased in singleton pregnancies achieved after assisted reproduction technology (ART). However, no previous study fully accounted for factors with potential influence on the risk of stillbirth. Further, whether fertility treatment, the possible reproductive pathology of the infertile couples or other characteristics related to being subfertile may explain a possible association with stillbirth remains unclear. This study compares the risk of stillbirth in women pregnant after fertility treatment (IVF/ICSI and non-IVF ART) and subfertile women with that in fertile women. METHODS: We used prospectively collected data from the Aarhus Birth Cohort, Denmark and included information about 20 166 singleton pregnancies (1989-2006). Outcome measure was stillbirth. RESULTS: The risk of stillbirth in women who conceived after IVF/ICSI was 16.2 per thousand ( per thousand) and in women who conceived after non-IVF ART 2.3 per thousand. In fertile and subfertile women, the risk of stillbirth was 3.7 per thousand and 5.4 per thousand, respectively. Compared with fertile women, women who conceived after IVF/ICSI had more than four times the risk of stillbirth [odds ratio (OR): 4.44, 95% confidence interval (CI): 2.38-8.28], and adjustments for maternal age, BMI, education, smoking habits and alcohol and coffee intake during pregnancy had only minor impact on the findings (OR: 4.08; 95% CI: 2.11-7.93). The risk of stillbirth in women who conceived after non-IVF ART and in women who conceived spontaneously with a waiting time to pregnancy of a year or more was not significantly different from the risk in women with a shorter time to pregnancy. CONCLUSIONS: Compared with fertile women, women who conceived by IVF/ICSI had an increased risk of stillbirth that was not explained by confounding. Our results indicate that the increased risk of stillbirth seen after fertility treatment is a result of the fertility treatment or unknown factors pertaining to couples who undergo IVF/ICSI.
14. Bader E, Alhaj AM, Hussan AA, Adam I
Malaria and stillbirth in Omdurman Maternity Hospital, Sudan
Int J Gynaecol Obstet. 2010 May;109(2):144-6. Epub 2010 Jan
22
Faculty of Medicine, University of Khartoum, Khartoum, Sudan.
OBJECTIVE: The study was conducted in the labor ward of Omdurman Maternity Hospital, Sudan, from November 2007 to February 2008 to investigate the prevalence and risks factors for stillbirth. METHODS: A case-control study. Cases were women who delivered stillbirths; 2 consecutive women who delivered a live-born singleton neonate at term (37-42 weeks) per case were used as controls. Sociodemographic, clinical (including malaria infections), and obstetric histories were gathered using standard questionnaires. Maternal body mass index and hemoglobin levels were measured. Maternal, placental, and cord blood smears were investigated for malaria parasites. RESULTS: Among 4760 singleton deliveries, there were 103 stillbirths, yielding a stillbirth rate of 22 per 1000 deliveries. Over half (52.4%) of these stillbirths were macerated stillbirths. Maternal sociodemographic characteristics were not associated with stillbirth, while a history of maternal malaria in the index pregnancy was the main risk factor for stillbirth (odds ratio, 3.0; 95% confidence interval, 1.0-8.9; P=0.04). CONCLUSION: Measures to prevent malaria infection should help to prevent stillbirth in this part of Sudan. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.
15. Gilbert NL, Casapía M, Joseph SA, Ryan JA, Gyorkos TW
Inadequate prenatal care and the risk of stillbirth in the
Peruvian Amazon
Int J Gynaecol Obstet. 2010 May;109(2):155-6. Epub 2010 Jan
20
Département de médecine sociale et préventive, Université de Montréal, QC, Canada.
16. Murphy F, Philpin S
Early miscarriage as 'matter out of place': an ethnographic
study of nursing practice in a hospital gynaecological unit
Int J Nurs Stud. 2010 May;47(5):534-41. Epub 2009 Nov 22
School of Health Science, Swansea University, United Kingdom. f.murphy@swan.ac.uk
BACKGROUND: Early miscarriage has been conceptualised as loss and bereavement where nurses are urged to provide sympathetic, psychological care for women. However, the reality of women's experience is also about blood, 'dirt' and failure which are under explored in the literature. OBJECTIVE: To explore the management and care of women having an early miscarriage within a hospital setting. DESIGN: A qualitative, ethnographic study. SETTING: A gynaecological unit consisting of an early pregnancy clinic and two gynaecological wards in a general hospital in an urban area of Wales, United Kingdom. PARTICIPANTS: The first group was a purposive, volunteer sample of eight women who had experienced an early miscarriage and were admitted to hospital for active management of their miscarriage. The second was a purposive, volunteer sample of 16 hospital health professionals actively involved in the care of women having an early miscarriage. This included 10 nurses, three doctors and three ultrasonographers. METHODS: Three main methods were employed. Firstly, 20 months participant observation working alongside gynaecological nurses in a gynaecological unit. Secondly, documentary analysis of key documents such as nursing care plans. Finally, in-depth interviews with women who had experienced early miscarriage and hospital health professionals involved in their care. RESULTS: Three key categories emerged; 'first signs and confirmation', 'losing the baby' and 'the aftermath'. 'First signs' relates to the women's experiences when first realising that their pregnancy is under threat. 'Losing the baby' further explores women's accounts of their experience and the 'aftermath' relates to the long term impact of miscarriage on them and their lives. This paper focuses on the women's experiences of the physical manifestations of miscarriage in 'losing the baby'. Drawing on anthropological literature and the concepts of dirt and pollution, it is argued that miscarriage for both women and health professionals can be considered as ambiguous and that miscarriage and the early passage of the foetus can be seen as 'matter out of place'. CONCLUSION: This exploration of how women were managed in a hospital setting reinforced the notion of the ambiguous nature of miscarriage and supports the position that miscarriage may be considered as atypical bereavement. Furthermore, an analysis is offered of the significance of the vaginal blood loss as polluting and gives insights into how nurses manage this ambiguity. Copyright 2009 Elsevier Ltd. All rights reserved.
Prepared by the
National Sudden and Unexpected Infant/Child Death and Pregnancy
Loss Resource Center
Georgetown University
2115 Wisconsin Avenue, N.W., Suite 601
Washington, DC 20007
(866) 866-7437 toll free
(202) 687-7466 local
(202) 784-9777 fax
info@sidscenter.org
http://www.sidscenter.org
