Perinatal risk factors for the occurrence of singleton apparently stillborn infants / 中国当代儿科杂志

OBJECTIVES@#To identify the perinatal risk factors for the occurrence of singleton apparently stillborn infants.@*METHODS@#This was a case-control study. A total of 154 singleton neonates with gestational age ≥28 weeks and Apgar score of 0-1 who were subsequently successfully resuscitated in the Obstetrics and Gynecology Hospital of Fudan University from January 2006 to December 2015 were enrolled as the case group (apparently stillborn group). A total of 616 singleton infants born from January 2006 to December 2015 (1-minute Apgar score >1) were randomly selected in a 1:4 ratio as the control group. Univariate analysis and multivariate logistic regression were used to analyze the perinatal risk factors for the occurrence of apparently stillborn infants.@*RESULTS@#The gestational age and birth weight in the apparently stillborn group were significantly lower than those in the control group (P<0.05). The incidences of fetal hydrops, cord prolapse, grade III meconium-stained amniotic fluid, placental abruption, breech presentation, severe pre-eclampsia, maternal general anesthesia at delivery, abnormal antenatal fetal heart monitoring and decreased fetal movement were significantly higher in the apparently stillborn group than those in the control group (P<0.05). The multivariate logistic analysis showed that the mother had general anesthesia at delivery (OR=34.520), decreased antenatal fetal movement (OR=28.168),placental abruption (OR=15.641), grade III meconium-stained amniotic fluid (OR=6.365), abnormal antenatal fetal heart monitoring (OR=5.739), and breech presentation (OR=2.614) were risk factors for the occurrence of apparently stillborn infants (P<0.05), while higher gestational age was a protective factor (OR=0.686, P<0.05).@*CONCLUSIONS@#Attention needs to be paid to mothers with abnormal prenatal fetal heart monitoring, decreased fetal movement, preterm labor, placental abruption, breech presentation, grade III meconium-stained amniotic fluid, and general anesthesia. Preparations for resuscitation should be done to rescue apparently stillborn infants.

One year observational study of stillbirths in a referral hospital of Saurashtra region

Background: Stillbirths constitute a major part of perinatal death, and India ranks first in absolute number of stillbirths. The causes of stillbirth differ in different parts of the world and are affected by fetomaternal factors and type of antenatal and intrapartum care. The objective of this study was to evaluate the stillbirth rate as well as the aetiology and risk factors for stillbirths in our institute.Methods: All stillbirths delivered at or above 28 weeks of gestation or weighing more than 1000 gms in P. D. U. Medical College and Hospital, Rajkot during study period of 1 year were enrolled in the study. The stillbirth rate of the institute was studied. Socio-demographic, maternal and fetal factors of stillbirth cases were analysed.Results: Stillbirth rate of our institute was 41.63 per 1000 births. 70% cases belonged to rural region and 48% cases were referred to our hospital from other institutes. Stillbirth was found more in multigravida women with 67.2% cases. 57.01% stillborn babies were males, 34.71% of stillborns had extremely low birth weight and were pre-term. 54.78% stillborns were macerated. In 24.8% cases, aetiology of stillbirth was unknown. Antepartum haemorrhage contributed 19% cases, asphyxia -16.8% cases and pre-eclampsia-12.1% cases of stillbirth in our study.Conclusions: Proper screening and antenatal and intrapartum supervision and timely referral to the tertiary care centre can play an important role in decreasing the rate of stillbirths.

Tongue development in stillborns autopsied at different gestational ages / Desenvolvimento da língua em natimortos autopsiados em diferentes idades gestacionais

Abstract Objectives: This study aimed to analyze, through the morphometric method, the perimeter and length of the tongue, the collagen fibers, and the perimeter of blood vessels at different gestational ages and fetal weights. Material and methods: Tongues (n = 55) of stillborns autopsied at 23-40 weeks of gestational age were macroscopically analyzed, and their length and perimeter were measured. Fifty-five tongue fragments were collected through a longitudinal section in the region that accompanies the median lingual sulcus and histologically processed. Slides were stained with picrosirius and immunolabeled with CD31 antibody. Quantification was performed on collagen fibers under polarized light, and on the perimeter of vessels with the CD31. Results: A positive and significant correlation of gestational age with tongue perimeter and length was found. There was a positive and significant correlation between collagen fibers and gestational age, as well as between gestational age and the perimeter of blood vessels. Between collagen fibers and fetal weight, a positive and significant increase was observed. Regarding the correlation between the perimeter of blood vessels and the fetal weight, an increase was observed. Conclusion: As gestational age advances, there is an increase in tongue perimeter and length, in the percentage of collagen fibers, and in vascular perimeter, demonstrating that tongue formation is directly related to tongue growth and development.

Resumo Objetivo: Analisar, por meio do método morfométrico, o perímetro e o comprimento da língua, as fibras de colágeno, o perímetro dos vasos sanguíneos, em idades gestacionais e de acordo com o peso fetal. Materiais e métodos: Línguas (n = 55) de natimortos autopsiados com 23-40 semanas de idade gestacional foram analisadas macroscopicamente, medidas em comprimento e perímetro; 55 fragmentos das línguas foram coletados por meio de uma secção longitudinal na região que acompanha o sulco lingual médio e processados histologicamente. As lâminas foram coloridas com picrosirius e imunomarcadas com o anticorpo CD31. A quantificação foi feita em fibras de colágeno examinadas com microscópio de luz polarizada e o perímetro dos vasos com o CD31. Resultados: Foi encontrada uma correlação positiva e significativa da idade gestacional com o perímetro e o comprimento da língua. Houve uma correlação positiva e significativa entre as fibras de colágeno e a idade gestacional; bem como entre a idade gestacional e o perímetro dos vasos sanguíneos; e houve um aumento positivo e significativo entre as fibras de colágeno e o peso fetal. No que diz respeito à correlação entre o perímetro dos vasos sanguíneos e o peso fetal, houve um aumento. Conclusão: Conforme a idade gestacional avança, há um aumento no perímetro e no comprimento da língua, um aumento no percentual de fibras de colágeno e um aumento no perímetro vascular, demonstra que a formação da língua está diretamente relacionada ao crescimento e ao desenvolvimento da língua.

Identificación de las causas de muerte fetal en una institución hospitalaria de atención materna de Cartagena, Colombia, 2012-2014 / Identification of the causes of foetal demise in a maternal care institution in Cartagena, Colombia, 2012-2014

Objetivo: determinar las causas de las muertes fetales registradas en una institución pública de referencia en Cartagena, Colombia, durante los años 2012-2014. Materiales y métodos: serie de casos. Se incluyeron los óbitos fetales que fueron sometidos a autopsia en la Clínica Maternidad Rafael Calvo de Cartagena, institución pública de segundo nivel de complejidad, que atiende a pacientes afiliadas al régimen subsidiado por el Estado. Se realizó muestreo consecutivo. Se evaluaron la edad gestacional, el sexo y la causa clínica de la muerte mediante el sistema ReCoDe que permite clasificar la muerte fetal mediante nueve categorías. Los resultados se presentan mediante estadística descriptiva. Resultados: se evaluaron 458 fetos con reporte de autopsia. Se estableció la causa de la muerte de manera probable o posible en 440 casos (97 %). Las principales condiciones asociadas a la muerte fetal fueron la insuficiencia placentaria (44,7 %), seguidas de las alteraciones relacionadas con el líquido amniótico (18,6 %), la causa materna (12,8 %), y las causas fetales (12 %). El 2,8 % de los casos fueron clasificados como inexplicados. Conclusiones: el sistema de clasificación ReCoDe permitió la adecuada clasificación de la causa de muerte en el 97 % de los óbitos fetales sometidos a autopsia.

Objective: To determine the causes of foetal demise documented in a public referral institution in Cartagena, Colombia between 2012-2014. Materials and methods: Case series including foetal demises taken to autopsy at the Rafael Calvo Maternal Clinic in Cartagena, a level II public institution that sees patients affiliated to the State subsidised healthcare regime. A consecutive sampling was used. Gestational age, sex and the clinical cause of death were analysed using the ReCoDe system in which 9 categories are used to classify foetal demise. Descriptive statistics are used to present the results. Results: Overall, 458 foetuses with an autopsy report were assessed. Possible or probable cause of death was established in 440 cases (97 %). The main conditions associated with foetal death were placental insufficiency (44.7 %), followed by amniotic fluid abnormalities (18.6 %), maternal causes (12.8 %), and foetal causes (12 %). Of all the cases, 2.8 % were classified as unexplained. Conclusions: The ReCoDe classification system was useful for classifying the cause of death in 97 % of foetal demises taken to autopsy.

Una aproximación desde la física a las consecuencias patológicas de la longitud excesiva del cordón umbilical / A physics approach to the consequences of excess umbilical cord length

Introducción: el cordón umbilical es una estructura incomprendida a pesar de transportar todo lo que un feto necesita para crecer y subsistir. Cada una de sus características es relevante, y la principal es la longitud, la cual, cuando está alterada, se relaciona con pobre pronóstico neurológico y muerte fetal. Materiales y métodos: con base en la revisión de principios físicos, se proponen fórmulas que podrían explicar la importancia de la longitud del cordón por sus repercusiones hemodinámicas. Resultados: se analizó la circulación fetal desde el corazón hasta la red capilar vellositaria en el plato placentario y, por medio de fórmulas físicas, se plantea la importancia de la longitud del cordón en la perfusión fetal. Conclusiones: las complicaciones clínicas conocidas para la excesiva longitud del cordón umbilical fueron analizadas desde el punto de vista de la física, dejando listas las fórmulas para ser alimentadas con datos reales provenientes de doppler fetales y mediciones del cordón umbilical.

Introduction: Despite its role of transporting all the things that a foetus needs to grow and survive, the umbilical cord is still poorly understood. All of its characteristics are relevant, and paramount among them is its length. When abnormal, length is associated with poor neurological prognosis and foetal demise. Materials and methods: Based on a review of physics principles, formulae were proposed in an attempt to explain the importance of umbilical cord length on the basis of its haemodynamic repercussions. Results: Foetal circulation was analysed from the heart to the placental villous capillaries and physics formulae were used to describe the importance of umbilical cord length in foetal perfusion. Conclusions: Clinical complications known to be associated with excess umbilical cord length were analysed from the physics perspective, and formulae were established for use with real data derived from foetal Doppler scans and umbilical cord measurements.

Birth Weight and Future Life-span in Finnish Triplets.

Aims: Interest in the distribution of birth weight arises because of the association between birth weight and the future health of the child. A common statistical result is that the birth weight distribution differs slightly from the Gaussian distribution. Methods: A standard attempt has been done to split the distribution into two components, a predominant Gaussian distribution and an unspecified “residual” distribution. Results: We considered birth weight data among triplets born in Finland in 1905-1959 and compare the birth weight among stillborn and live-born triplets. The stillbirth rates are 119.1 per 1000 births for males, 124.6 for females and 121.8 for all. The sex differences are not significant. The still birth rate for the period 1905-1930 was 119.5 and for the period 1931-1959, 124.2. We identified a strong association between birth weight of the triplets and their survival. The weight distribution for male triplets is described well by the Gaussian curve, while for females a slight deviation from the Gaussian distribution is discernible.

Docimasia hepática y ausencia de cuidados mínimos: serie de casos / Docimasia liver and lack of minimal care: case series

Para definir si un lactante nació vivo o muerto, se ha practicado por algún tiempo la prueba de sumersión del pulmón en agua, pero diversas condiciones la alteran y además ella no tiene en cuenta los otros criterios de nacido vivo definidos por la Organización Mundial de la Salud (OMS) como los latidos del corazón, los movimientos espontáneos o las pulsaciones del cordón umbilical; por lo tanto, se requiere de pruebas adicionales. Presentamos tres casos de fetos abandonados con hallazgo histológico de hepatocitos claros. Este hallazgo en hígados de recién nacidos puede contribuir a establecer la vitalidad en el momento del nacimiento...

In the case of infant death, a coroner routinely performs lung submersion in water to establish if a child had been liveborn or stillborn. However, this test fails to provide absolute proof because the lungs may have been affected by diverse conditions. Furthermore, it does not allow for liveborn criteria defined by WHO such as heartbeat, spontaneous movements, or umbilical cord pulse. Therefore, additional tests are needed. We present three cases of abandoned newborn with a histological finding of clear hepatocytes. This finding in fetal livers can help establish vitality at the time of birth...

Detection of Torque teno sus virus 1 and 2 in tissues from stillborn piglets delivered by sows via natural farrowing

We detected Torque teno sus virus 1 and 2 (TTSuV1 and TTSuV2) in tissue samples from 18 stillborn piglets using nested polymerase chain reaction. The detection rates of TTSuV1 and TTSuV2 were 78% and 50%, respectively, with 83% of the stillborn piglets positive for TTSuV1 or TTSuV2. TTSuV1 was detected highest in the liver (72%) followed by heart (56%), spleen (38%) and tonsils (38%) while TTSuV2 was detected highest in the tonsils (38%) followed by liver (33%), spleen (25%), and heart (17%). These results indicate that TTSuVs are commonly present but not equally distributed among the tissues of stillborn piglets.

Perfil de natimortalidade de acordo com ordem de nascimento, peso e sexo de leitões / Stillbirth pattern according to birth order, birth weight, and gender of piglets

Foram acompanhados 575 partos para avaliar a influência da ordem de nascimento, do sexo e do peso dos leitões na ocorrência de natimortos. Dos 7061 leitões, 90,2 por cento, 6,0 por cento e 3,8 por cento nasceram vivos, natimortos ou mumificados, respectivamente. O percentual de partos com natimortos foi 44,5 por cento. Partos com dois ou mais natimortos foram responsáveis por 63,1 por cento das perdas por natimortalidade, embora tenham sido responsáveis por 17,2 por cento das leitegadas. O percentual de natimortos aumentou com a ordem de nascimento; a maior taxa de natimortos, 21,7 por cento, ocorreu a partir da 14ª ordem. A taxa de natimortalidade foi de 3,6 por cento e 10,1 por cento nos leitões de primeira a nona e de 10ª a 13ª ordem, respectivamente. Em leitões com até 500g a taxa de natimortos foi de 52,1 por cento, mais alta que a de leitões mais pesados. Em leitões com 501 a 1200g foi de 10,1 por cento, maior que entre os com mais de 1200g (4,0 por cento). Não houve efeito de sexo dos leitões na ocorrência de natimortos, que foi de 6,2 por cento e 5,8 por cento para machos e fêmeas, respectivamente. A natimortalidade é maior entre os leitões com baixo peso ou com ordem de nascimento elevada.

To examine the influence of birth order, gender, and birth weight of piglets on stillbirth, records of 575 farrowings were analyzed. Out of 7,061 piglets, 90.2 percent, 6.0 percent, and 3.8 percent were born alive, stillborns and mummified, respectively. The percentage of farrowings with stillborns was 44.5 percent. Farrowings with two or more stillborns accounted for 63.1 percent of losses, although they produced 17.2 percent of the litters. Stillbirth rate increased with the increase of the birth order. Piglets born from the 14th order onward had the highest stillbirth rate (21.7 percent). Piglets born from the 1st to the 9th and from the 10th to the 13th order had stillbirth rates of 3.6 percent and 10.1 percent, respectively. For piglets weighting up to 500g, the stillbirth rate was 52.1 percent, which was higher than that recorded for heavier piglets. Piglets weighting from 501 to 1,200g had a stillbirth rate of 10.1 percent, which was higher than that observed for piglets weighing more than 1,200g (4.0 percent). There was no effect of gender of piglets on stillbirth occurrence, which reachead 6.2 percent and 5.8 percent for males and females, respectively. The stillbirth occurrence was higher for low weight piglets or higher birth order.

Sífilis congênita, gêmeos natimortos e retenção placentária culminando em histerectomia: relato de caso / Congenital syphilis, stillborn twins and placental retention culminating in hysterectomy: case report

Introdução: a sífilis congênita é uma das mais incabíveis causas de morbidez e mortalidade perinatal, o que revela uma assistência pré-natal ineficaz. A infecção intra-uterina pelo Treponema pallidum pode resultar em natimorto, morte neonatal, prematuro e/ou lesões sifilíticas que conduzem adesordens como surdez, prejuízo neurológico e deformidades ósseas. É infecção congênita que persiste em destaque, mesmo com a penicilina G benzatina reduzindo em quase 98% a transmissão materno-fetal quando a mãe é tratada adequadamente. Objetivo: neste trabalho apresenta-se o caso de uma gestação gemelar que teve como desfecho a morte intra-útero dos fetos, a retenção placentária e o choque hipovolêmico, culminando em histerectomia, ocorrido na maternidade do Hospital Escola Luiz Gioseffi Jannuzzi, em Valença, Rio de Janeiro. Relato do caso: relata-se a história de uma paciente de 33 anos, de classe socioeconômica baixa, multípara, admitida no serviço em trabalho de parto prematuro, com ambos os fetos mortos intra-útero. O parto foi transpélvico, com retenção placentária e choque hipovolêmico. Efetuado o pronto-atendimento, foi realizada a histerectomia e a estabilização do quadro. O VDRL, por razão da internação, revelou positividade, com início do tratamento. A paciente permaneceu internada oito dias. Conclusão: fica evidente que a sífilis é uma moléstia com graves conseqüências para as gestantes e seus conceptos, visto que 80% das mães infectadas sem tratamento, transmitem a doença para os fetos e um grande número destes morre antes de alcançar dois anos de idade.

Introduction: congenital syphilis is one of the most inappropriate morbidity causes and perinatal mortality, revealing ineffective prenatal care. Theintra-uterine infection for the Treponema pallidum can result in stillborn, neonatal death, premature and/or syphilitic lesions that lead to disorders as deafness, neurological damage and bone deformities. It is congenital infection that persists in prominence, although penicillin benzathine G prevents in almost 98% the maternal-fetal transmission, when the mother is treated correctly. Objective: this work presents the case of a twins` gestation that ended up with the death intra-uterus of fetuses, placental retention and shock due to loss of blood, culminating in hysterectomy, witch happened at theMaternity of Hospital School Luiz Gioseffi Jannuzzi, in Valença, Rio de Janeiro. Case report: the case of a 33 year-old patient who belonged to alow socioeconomic class, with several previous childbirths is related, she was admitted in the service in premature birth work, with both fetuses deadintra-uterus. The childbirth was transpelvic, with placental retention and shock due to loss of blood. With ready-attendance done, hysterectomy andthe stabilization of the case. VDRL, in cases of internment, revealed to be positive, in the beginning of the treatment. The patient stayed eight days in the hospital. Conclusion: it is evident that syphilis is a disease with serious consequences to pregnant women and their children, since, 80% of infectedmothers without treatment, they transmit the disease to the fetuses and several of them die before reaching two years old.

Co-infection by porcine circovirus type 2 and porcine parvovirus in aborted fetuses and stillborn piglets in southern Brazil

Porcine circovirus types 1 and 2 (PCV1, PCV2) and porcine parvovirus (PPV) are widespread in pig populations around the world. Nevertheless, only PCV2 has been associated with different clinical syndromes, thus representing a major problem to the pig industry. The association of cases of swine abortions and stillborns with PCV1 and PCV2 and PPV was studied retrospectively (2005-2007). Additional pathogens were also investigated in lesioned fetuses. The studied litters included stillborn piglets and several mummified fetuses of varied sizes. Ventricular dilatation, myocardial pale areas, and mesocolic edema were the gross lesions. Escherichia coli was detected as co-infecting with PCV2 the cases in which mesocolic edema was seen. Microscopic lesions included non-suppurative myocarditis, myocardial necrosis and fibrosis, mineralization foci and intranuclear inclusion bodies in cardiomyocytes, and interstitial mononuclear pneumonia. Samples from 7 (5.78 per cent) of 121 aborted fetuses and stillborn piglets had lesions consistent with a viral cause and showed both positive anti-PCV2 immunostaining as well as PCV2-PCR. In samples from 3 (2.47 per cent) of these 7 fetuses, co-infection with PPV was confirmed by Nested-PCR. Both viruses were detected in fetuses at different stages of gestation. Viral antigens of PCV2 were detected by immunohistochemistry mainly in macrophages and myocytes. PCV1 individually was not detected in any of these affected fetuses, but it was associated with PCV2 and/or PPV in some of them. These findings indicate that PCV2 alone or in association with PPV should be kept in mind when investigating causes of infectious abortion in pigs in Brazil.

Estudou-se retrospectivamente (2005-2007) a associação de casos de abortos e natimortos suínos com infecções por circovírus suíno (PCV) tipos 1 e 2 e parvovírus suíno (PPV). Outros agentes patogênicos foram pesquisados em amostras de fetos com lesões. O estudo incluiu natimortos e fetos mumificados de tamanhos variados. Dilatação ventricular, áreas pálidas miocárdicas e edema de mesocólon foram as lesões macroscópicas observadas. Escherichia coli co-infectou com PCV2 as amostras dos casos com edema de mesocólon. Lesões microscópicas incluíram miocardite não supurativa, necrose e fibrose miocárdicas, focos de mineralização e corpúsculos de inclusão em cardiomiócitos e pneumonia intersticial mononuclear. Entre os 121 fetos suínos abortados ou natimortos analisados, sete (5,78 por cento) tinham lesões compatíveis com origem viral e foram positivos pelas técnicas de imunoistoquímica e PCR para PCV2. Além disso, três (2.47 por cento) desses sete casos também foram confirmados como co-infectados com PPV através da PCR. Antígenos de PCV2 foram observados principalmente em macrógafos e no interior de miócitos dos fetos suínos abortados e natimortos. PCV2 e PPV foram detectados em diferentes estágios de gestação. PCV1 não foi associado isoladamente com feto ou natimorto afetado, mas estava presente em associação com PCV2 e/ou PPV em alguns desses produtos. Esses achados indicam que a infecção por PCV2, isoladamente ou em associação com PPV, deve ser considerada no diagnóstico de aborto infeccioso suíno no Brasil.

A Cytogenetic Study of 130 Couples with Recurrent Spontaneous Abortion / 대한임상병리학회지

BACKGROUND: Chromosomal aberration of a couple can lead to recurrent miscarriage and it has been accounted for 2-10% of recurrent spontaneous abortions in the Caucasian population. The purpose of this study is to evaluate the frequency of chromosomal abnormalities in couples having fetal losses. We also attempted to define the relationship of those chromosome rearrangements with the presence or absence of stillborn fetus or malformed live child. METHODS: A total of 130 couples with two or more spontaneous abortions were studied. Chromosome studies were performed on metaphases using standard peripheral lymphocyte culture technique. RESULTS: Ten (7.7%) chromosomal abnormalities were detected, 7 (5.4%) in women and 3 (2.3%) in men. The chance of finding chromosomal abnormality in couples with stillborn fetus or malformed live child was higher than in couples with spontaneous abortions but no other adverse event, but the difference was not statistically significant. CONCLUSIONS: Cytogenetic analysis was indicated in couples with recurrent spontaneous abortions. The chance of chromosomal abnormality in couples with stillborn fetus or malformed live child was higher.