NSIDRC Journal Article Alert — June 25, 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.
Miscarriage/Stillbirth/Prenatal Issues
1. Sappenfield WM, Peck MG, Gilbert CS, Haynatzka VR, Bryant
T 3rd
Perinatal Periods of Risk: Analytic Preparation and Phase 1
Analytic Methods for Investigating Feto-Infant Mortality
Matern Child Health J. 2010 Jun 20. [Epub ahead of print]
Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA, Bill_Sappenfield@doh.state.fl.us.
The Perinatal Periods of Risk (PPOR) methods provide the necessary framework and tools for large urban communities to investigate feto-infant mortality problems. Adapted from the Periods of Risk model developed by Dr. Brian McCarthy, the six-stage PPOR approach includes epidemiologic methods to be used in conjunction with community planning processes. Stage 2 of the PPOR approach has three major analytic parts: Analytic Preparation, which involves acquiring, preparing, and assessing vital records files; Phase 1 Analysis, which identifies local opportunity gaps; and Phase 2 Analyses, which investigate the opportunity gaps to determine likely causes of feto-infant mortality and to suggest appropriate actions. This article describes the first two analytic parts of PPOR, including methods, innovative aspects, rationale, limitations, and a community example. In Analytic Preparation, study files are acquired and prepared and data quality is assessed. In Phase 1 Analysis, feto-infant mortality is estimated for four distinct perinatal risk periods defined by both birthweight and age at death. These mutually exclusive risk periods are labeled Maternal Health and Prematurity, Maternal Care, Newborn Care, and Infant Health to suggest primary areas of prevention. Disparities within the study community are identified by comparing geographic areas, subpopulations, and time periods. Excess mortality numbers and rates are estimated by comparing the study population to an optimal reference population. This excess mortality is described as the opportunity gap because it indicates where communities have the potential to make improvement.
2. Sappenfield WM, Peck MG, Gilbert CS, Haynatzka VR, Bryant
T 3rd
Perinatal Periods of Risk: Phase 2 Analytic Methods for Further
Investigating Feto-Infant Mortality
Matern Child Health J. 2010 Jun 18. [Epub ahead of print]
Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA, Bill_Sappenfield@doh.state.fl.us.
The perinatal periods of risk (PPOR) methods provide a framework and tools to guide large urban communities in investigating their feto-infant mortality problem. The PPOR methods have 11 defined steps divided into three analytic parts: (1) Analytic Preparation; (2) Phase 1 Analysis-identifying the opportunity gaps or populations and risk periods with largest excess mortality; and (3) Phase 2 Analyses-investigating these opportunity gaps. This article focuses on the Phase 2 analytic methods, which systematically investigate the opportunity gaps to discover which risk and preventive factors are likely to have the largest effect on improving a community's feto-infant mortality rate and to provide additional information to better direct community prevention planning. This article describes the last three PPOR epidemiologic steps for investigating identified opportunity gaps: identifying the mechanism for excess mortality; estimating the prevalence of risk and preventive factors; and estimating the impact of these factors. While the three steps provide a common strategy, the specific analytic details are tailored for each of the four perinatal risk periods. This article describes the importance, prerequisites, alternative approaches, and challenges of the Phase 2 methods. Community examples of the methods also are provided.
3. Lachvac L, Svajdler M, Valansky L, Nagy V, Benicky M, Frohlichova
L, Nyitrayova O
Juxtaglomerular cell tumor, causing fetal demise
Int Urol Nephrol. 2010 Jun 17. [Epub ahead of print]
Department of Urology, Faculty Hospital, Trieda SNP 1, 040 11, Kosice, Slovakia, lubomir.lachvac@upjs.sk.
AIMS: This case report describes juxtaglomerular cell tumor-a rare renin-producing tumor of the kidney, complicating pregnancy. CLINICAL CASE: A previously healthy 24-year-old primigravid woman developed hypertension in the 20th week of pregnancy, leading to a miscarriage in the 28th week. However, hypertension continued after the miscarriage. A more complete examination revealed a solid tumor in the lower pole of the right kidney. The patient underwent a partial right nephrectomy. A histological examination and electron microscopy confirmed the diagnosis of JGCT. The patient s blood pressure was normalized within 2 weeks. CONCLUSIONS: JGCT can lead to miscarriage if undiscovered during pregnancy. A kidney ultrasound should be performed on pregnant women with newly detected hypertension. No staining in early phase of contrast CT is the feature that differentiates JGCT from renal cell carcinoma. These tumors are benign, with only one reported exception, and nephron-sparing surgery is preferable.
4. Marsden JT, Rees DC
A retrospective analysis of outcome of pregnancy in patients
with acute porphyria
J Inherit Metab Dis. 2010 Jun 22. [Epub ahead of print]
Department of Clinical Biochemistry, King's College Hospital
NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK, joannemarsden1@nhs.net.
Abstract
A survey was posted to 27 women with acute porphyria about complications and outcome of pregnancy. Fifteen women returned the completed questionnaire and the pregnancies were characterised depending on the timing of diagnosis of porphyria. Four women were diagnosed with porphyria before the first pregnancy, five during a pregnancy and six after pregnancy. Five women were diagnosed with porphyria from family studies and the remaining ten were diagnosed when they presented with acute symptoms. There were a total of 33 pregnancies and 23 live births. Four women reported symptoms associated with porphyria during pregnancy. Two women received treatment with haem arginate during pregnancy with one of them having haem arginate therapy weekly with no adverse effect either to her or the baby. One woman had acute pain and skin symptoms during pregnancy but was not diagnosed until after delivery, and another reported acute symptoms during pregnancy. There were no differences, compared to the general population, between birth weight and miscarriage rate, and there were few obstetric complications with only one patient having pre-eclampsia at 37 weeks gestation. These results show that pregnancy is typically uncomplicated in acute porphyria, and that problems are more likely if the porphyria has not been diagnosed previously. We found that administration of haem arginate during pregnancy is safe and its continuous use during pregnancy has no detrimental effect on the outcome of pregnancy.
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Loss Resource Center
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