NSIDRC Journal Article Alert — October 15, 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.
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Miscarriage/Stillbirth/Prenatal Issues
1. Lund M, Nielsen HS, Hviid TV, Steffensen R, Nyboe Andersen A, Christiansen
OB
Hereditary thrombophilia and recurrent pregnancy loss: a retrospective
cohort study of pregnancy outcome and obstetric complications
Hum Reprod. 2010 Oct 11. [Epub ahead of print]
The Fertility Clinic 4071, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen 2100, Denmark.
BACKGROUND The association among hereditary thrombophilia, recurrent pregnancy loss (RPL) and obstetric complications is yet uncertain. The objective of the study was to assess the prognostic value of the factor V Leiden (FVL) and prothrombin (PT) mutations for the subsequent chance of live birth for women with RPL. METHODS Pregnancy outcome was recorded in a retrospective cohort of 363 women with a minimum of three consecutive pregnancy losses (early miscarriage, late miscarriage or stillbirth/neonatal death) who were not treated with anticoagulation therapy. RESULTS Of the 363 women, 29 were FVL-mutation carriers and 6 were PT-mutation carriers. The unadjusted live birth rate was 45.7% in FVL/PT carriers versus 63.4% in FVL/PT non-carriers, P = 0.04. The adjusted odds ratio for live birth in FVL/PT carriers was 0.48 (95% CI = 0.23-1.01), P = 0.05. Among the obstetric complications, only excessive bleeding was found to be associated with FVL/PT mutations. CONCLUSIONS In the unadjusted analysis, FVL and PT mutations have a negative prognostic impact on the live birth rate in women with RPL; however, when adjusting for significant covariates, the results no longer reach statistical significance. Strong conclusions on the association between obstetric complications and hereditary thrombophilia cannot be drawn from this study. Whether anticoagulation therapy would improve the prognosis in women with RPL and FVL/PT mutations remains to be documented in large randomized controlled trials.
2. Carlo WA, McClure EM, Chomba E, Chakraborty H, Hartwell T, Harris
H, Lincetto O, Wright LL
Newborn Care Training of Midwives and Neonatal and Perinatal Mortality
Rates in a Developing Country
Pediatrics. 2010 Oct 11. [Epub ahead of print]
Division of Neonatology, Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama;
Objective: This study was designed to test the hypothesis that 2 training programs would reduce incrementally 7-day neonatal mortality rates for low-risk institutional deliveries. Methods: Using a train-the-trainer model, certified research midwives sequentially trained the midwives who performed deliveries in low-risk, first-level, urban, community health clinics in 2 cities in Zambia in the protocol and data collection, in the World Health Organization Essential Newborn Care (ENC) course (universal precautions and cleanliness, routine neonatal care, resuscitation, thermoregulation, breastfeeding, kangaroo care, care of small infants, and common illnesses), and in the American Academy of Pediatrics Neonatal Resuscitation Program (in-depth basic resuscitation). Data were collected during 3 periods, after implementation of each training course. Results: A total of 71 689 neonates were enrolled in the 3 study periods. All-cause, 7-day neonatal mortality rates decreased from 11.5 deaths per 1000 live births to 6.8 deaths per 1000 live births after ENC training (relative risk: 0.59 [95% confidence interval: 0.48-0.77]; P < .001), because of decreases in rates of deaths attributable to birth asphyxia and infection. Perinatal mortality rates but not stillbirth rates decreased. The 7-day neonatal mortality rate was decreased further after Neonatal Resuscitation Program training, after correction for loss to follow-up monitoring. Conclusions: ENC training for midwives reduced 7-day neonatal mortality rates in low-risk clinics. Additional in-depth basic training in neonatal resuscitation may reduce mortality rates further.
3. Tirado-González I, Muñoz-Fernández R, Blanco O, Leno-Durán E, Abadía-Molina
AC, Olivares EG
Reduced proportion of decidual DC-SIGN+ cells in human spontaneous
abortion
Placenta. 2010 Oct 8. [Epub ahead of print]
Instituto de Biopatología y Medicina Regenerativa, Centro de Investigación Biomédica, Universidad de Granada, 18100 Armilla, Granada, Spain.
Recent studies showed that some functions of decidual dendritic cells appear to be essential for pregnancy. In humans, decidual dendritic cells are identifiable by their expression of DC-SIGN. We compared the subpopulations of human decidual DC-SIGN+ cells from first-trimester normal pregnancies and spontaneous abortions by flow cytometry. In normal decidua, DC-SIGN+ cells expressed antigens associated with immature myeloid dendritic cells. In samples from spontaneous abortions, we detected decidual DC-SIGN+ cells with an antigen phenotype equivalent to that of DC-SIGN+ cells from normal pregnancies, but at a significantly lower proportion (P < 0.01). Our results support the hypothesis that dendritic cells play a role in normal or pathological human pregnancy outcomes.
4. Bond MJ, Heidelbaugh JJ, Robertson A, Alio PA, Parker WJ
Improving research, policy and practice to promote paternal involvement
in pregnancy outcomes: the roles of obstetricians-gynecologists
Curr Opin Obstet Gynecol. 2010 Oct 7. [Epub ahead of print]
Joint Center for Political and Economic Studies, Health Policy Institute, Washington, District of Columbia, USA.
PURPOSE OF REVIEW: To review current research, policy, and practice on paternal involvement in pregnancy outcomes and suggest recommendations to improve paternal involvement in pregnancy and childbirth.
RECENT FINDINGS: Although much has been written about fathers' influence on child health and development, little is known about the expectant father's role in pregnancy and childbirth. Recent studies have demonstrated the importance of paternal involvement during pregnancy, but more research is needed to identify specific contributions expectant fathers make and their impact on reducing infant mortality and associated risk factors during pregnancy and childbirth.
SUMMARY: Obstetricians-gynecologists can play a greater role in promoting research, policy and practice to improve paternal involvement in pregnancy and childbirth.
5. Jauniaux E, Van Oppenraaij RH, Burton GJ
Obstetric outcome after early placental complications
Curr Opin Obstet Gynecol. 2010 Oct 7. [Epub ahead of print]
Academic Department of Obstetrics and Gynaecology, UCL Institute for Women's Health, University College London (UCL), London, UK bDivision of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, The Netherlands cCentre for Trophoblast Research, University of Cambridge, Cambridge, UK.
PURPOSE OF REVIEW: To evaluate the impact of early pregnancy complications involving placentation and early placental development on adverse obstetric outcome in ongoing and subsequent pregnancies.
RECENT FINDINGS: We found an increased risk of adverse outcome (odds ratio >2.0) in ongoing pregnancies of preterm delivery (PTD), very preterm delivery (VPTD), placental abruption, small for gestational age (SGA), low birth weight (LBW) and very LBW (VLBW) after a threatened miscarriage episode; pregnancy-induced hypertension, preeclampsia, placental abruption, PTD, SGA and low 5-min Apgar score following the detection of an intrauterine haematoma; and VPTD, VLBW and perinatal death after a vanishing twin phenomenon. In subsequent pregnancies, the risk of perinatal death was increased (odds ratio >2.0) after a single miscarriage, the risk of VPTD after two or more miscarriages, the risk of placenta previa, premature preterm rupture of membranes, PTD, VPTD and LBW after recurrent miscarriage and the risk of VPTD after two or more terminations of pregnancy.
SUMMARY: Our analysis of the literature review indicates a link between early pregnancy complications involving the placenta and subsequent adverse obstetric and perinatal outcomes. Some of these associations are based on limited or small uncontrolled studies. Larger population-based prospective controlled studies have recently been published confirming most of these findings. This suggests that the early detection of these risk factors could improve the screening of women at high risk of specific obstetric complications in ongoing and subsequent pregnancies.
Prepared by the
National Sudden and Unexpected Infant/Child Death and Pregnancy
Loss Resource Center
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