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Stillbirth is defined as the birth of a viable baby without signs of life. They account for more than 2.5 million intrauterine deaths per year worldwide and are associated with a number of risk factors, the most important of which are maternal and placental factors. Autopsy provides information that may be of use in determining time since death, gestational age of the fetus, mode of death, cause of fetal demise, and the likelihood of recurrence. The format of the autopsy is guided by parental consent, but even when consent is limited, valuable information may be obtained by careful consideration of antemortem test results, imaging, and genetic testing. Where there is a delay between death and delivery, fetuses are affected by maceration, which may increase the technical complexity of the autopsy and impart a number of artefactual changes, which should not be misinterpreted as genuine pathology. The most common pathologies encountered at autopsy are placental abnormalities, changes related to maternal disorders, malformations, and central nervous system pathology. © Springer Nature Switzerland AG 2022. All rights reserved.
ABSTRACT
Intro: COVID-19 pandemic era makes quality of obstetric triage care including caesarean section in obstetric true emergency cases delayed. Maternal fetal triage index (MFTI) score is an instrument used to define true emergency in obstetric cases. Decision to delivery interval (DDI) is time interval from caesarean section decision to delivery within <30 minutes standard in emergency cases.This study was designed to evaluate the decision to delivery time interval and its effect on perinatal outcomes and the associated factors during category-1 emergency caesarean section deliveries. Method(s): A prospective observational descriptive study was conducted from 2020-2022 at Kariadi tertiary Hospital. A total of 40 clients who were undergone category-1 emergency caesarean section were included in this study. This is a indepht analysis pregnant women confirmed with COVID-19 infection and had true emergency cases based on MFTI score (stat-priority 1). Finding(s): Among 346 pregnant women with COVID-19, total 160 C-section cases with 40 eligible data were included in this study. Gestational age mostly in their second and third trimester. Maternal comorbidities were diabetes in pregnancy, HIV, pre eclampsia, SLE and thyroid disease. This study showed that DDI <30 minutes were found in 34 cases (85%), DDI 30-60 minutes as many as 6 (15%), and no (0%) DDI >60 minutes. Emergency cases with the shortest DDI were umbilical cord prolapse 3 (100%), fetal distress 14 (93%), placental abruption 5 (83%), impending uterine rupture 5 (83%), and antepartum hemorrhage 7 (70%). Perinatal outcome were Apgar score lower than 7 at 1 minutes (25%) and stillbirth (5%). Conclusion(s): Most of DDI in this study met the recommendation of <30 minutes, but some cases did not meet the standard. This can be caused by multifactorial factors such as advice from the doctor in charge, patient transfer distance, operating room preparation, and anesthetic preparation due to COVID-19.Copyright © 2023
ABSTRACT
The coronavirus disease 2019 (Covid-19), that was later declared pandemic by World Health Organization, had led to panic and fear worldwide. Like many outbreaks caused by viruses, in cheif reason for fear was the infectious agent's potential to be transmitted from pregnant women to their fetuses and newborns. In our study, the hospital records of 117 pregnant women who delivered stillbirths in our clinic between 01.01.2015 and 31.12.2020 were examined. The pregnancy characteristics and perinatal outcomes were examined by making retrospective analysis of the records. Considering six year of the study data, it was observed that the stillbirth rates increased in the pandemic period. One hundred seventeen stillbirth cases that occurred in the last six years were analyzed. The mean age of the pregnant women was 29.64+6 (18-44) and parity was 2.54+1.58 (1-8). Body mass index was calculated as 21.36+3.40 (16-27) average and smoking consumption rate was 9.40% (11/117). Maternal diabetes was detected in 8.54% of the patients (10/117) and pregnancies were complicated by maternal hypertension in 5.12% of the patients (6/117). The average birth weight was 1597+1038 (500-4700) gram. Sixty percent of the deliveries (n=71) were performed by vaginally. Fetal sex was 52.1% male (n=61). The number of deliveries in the past six years was 11780. Almost 1% of the deliveries occurred as stillbirths (117/11780). The unusual stillbirth ratio during the pandemic was 3.1 times higher than the average of pre-pandemic period (2.5vs0.80). In our study, we investigated stillbirth rates before and during the pandemic. Although vertical transmission of Covid-19 has not been reported, the adverse pregnancy and neonatal outcomes have been provided in many studies. Undoubtedly, in obstetrical practice stillbirth is one of the most destructive consequences for pregnant women. Considering the increase in stillbirth rates, we think that pregnant women with adverse perinatal outcomes should be routinely tested for Covid-19, especially during the outbreak.Copyright © 2021 Necati Ozpinar. All rights reserved.
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Background. From 25 February 2020 to 30 June 2021, experienced perinatal pathologists examined 975 placentas, macroscopically and microscopically, of SARS-CoV-2- positive mothers enrolled in a national prospective study, adopting the Amsterdam Consensus Statement protocol. The main results included the absence of specific pathological findings for SARS- CoV-2 infections, even though a high proportion of placentas showed signs of inflammation, including chorioamnionitis, funisitis, villitis, chronic histiocytic intervillositis, and fibrin deposition. In this further analysis, we focused our attention on placental maturity in SARS-CoV-2 infection as, according to recent literature, this feature has scarcely been considered. Method(s): All the maternal and placental data were collected by an online database system. Placental maturation was evaluated in 975 placentas from SARS-CoV-2 positive pregnant women according to the onset of maternal infection. Gestational age (GA) at the time of infection included placentas less than 14 weeks up to 41, but pathological analyses were carried out at delivery, in the third trimester. Parenchymal maturation was classified as follows: consistent with GA, immature, dysmature (also known as delayed villous maturation), and hypermature (or accelerated villous maturation). Incidence of maternal diabetes was also calculated as may affect placental maturation. Result(s): Among 975 placentas, 29 cases were missing (data not inserted by pathologists). On the whole, placental maturation was consistent with GA in 686 cases, immature in 77, hypermature in 48, and dysmature in 135. According to the gestational age at which SARS-CoV-2 infection was diagnosed, the results were as follows: - < 14 weeks: 27 placentas consistent with GA, 2 immature, 4 hypermature, 5 dysmature - 14-27 weeks: 95 placentas consistent with GA, 10 immature, 6 hypermature, 22 dysmature - >=28 weeks: 559 placentas consistent with GA, 65 immature, 38 hypermature, 107 dysmature Incidence of maternal diabetes was quite low in any kind of placental maturation, as reported below: - Immature: 1 / 77 (1.3%) - Consistent with GA: 8/686 (1.2%) - Hypermature: 2/48 (4.2%) - Dysmature: 4/135 (3%) Conclusion(s): In our population, 260/975 cases (26.7%) presented abnormal placental maturation, and among them, about a half (135/260), showed dysmaturity. According to maternal GA at onset of infection, anomalous development was mainly diagnosed after 28 weeks. Incidence of maternal diabetes was very low and unlikely correlated with the histological findings. If SARS-CoV-2 infection plays a role in determining placental abnormal maturation, or instead, if this anomaly may be a permissive feature to the virus, has yet to be investigated.
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Background: Exclusive breastfeeding is recognized as the ideal feeding method for infants. Newborns receiving formula inhospital are at higher risk for early breastfeeding cessation. Among infants born in 2017, CDC Breastfeeding Report Card, 2020, reported the rate of breastfed infants receiving formula before two days of age as 15% in West Virginia (WV). We aimed to determine factors associated with in-hospital formula supplementation of breastfed newborns at a large community hospital in Southern WV. We hypothesized that disparities exist in supporting women to exclusively breastfeed. Methods: We retrospectively reviewed 500 randomly selected charts of infants born 09/01/2019-09/1/2020. Full-term infants with a recorded maternal decision to exclusively breastfeed were included. Exclusion criteria were prematurity, NICU admission, maternal diabetes, and infant hypoglycemia. Factors associated with formula supplementation were compared between mothers exclusively breastfeeding and those who were not at the time of discharge. Results: Of the reviewed charts, 70% of birth mothers desired to exclusively breastfeed. 211 infants met all inclusion criteria. 70% were delivered via vaginal delivery;52% were induced. Of the included newborns, 41% were supplemented with formula. 32% of mothers met with lactation consultants prior to formula supplementation. Top reasons for formula supplementation were mother request (45%) and newborn difficulty latching (22%). Median time of first supplementation was 20.0 hours (range:0.5-54). 12% of the supplementation occurred within 6 hours and 96.5% within 2 days of age. Rates of formula supplementation did not increase during the nurses' night shift or at nurses' shift change. Exclusive breastfeeding at discharge was associated with higher education level (p=0.002), tobacco abstinence (p=0.03), prior births (p=0.04), and increased maternal age (p=0.02);with every 1 year increase in maternal age, there was 7% decrease in supplementation. No statistically significant associations were present between exclusive breastfeeding at discharge meeting with a hospital lactation consultant, maternal race, marital status, induction need, or neonatal characteristics (p>0.05). When controlling for confounders of maternal age, marital status, tobacco use, and lactation consultation, Cesarean delivery (odd ratio: 2.0,1.03-4.2, 95% confidence interval), primiparity (2.6, 1.4-4.8), and not completing high school (12.5, 1.6-96.5) predicted formula supplementation. Exclusive breastfeeding discharge rates remained relatively steady over the 12 month study period, including during the COVID-19 pandemic. Conclusion: At our center, formula supplementation rate of 41% in the first two days of age appears higher than the state's rate using the CDC report card. Mother request and newborn difficulty latching are the top reasons for formula supplementation. Median age of supplementation was 20 hours. Lactation consultations were not universal and disparities existed for breastfeeding mothers supplementing with formula. Addressing maternal disparities is essential to enhance newborn health equity. Our study's findings will be used to develop prenatal and postnatal interventions to maximize hospital breastfeeding support and minimize formula supplementation.
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Introduction: Following a change in national diabetic guidance [1,2], local audit performed in 2019 identified areas of improvement which were incorporated into a revised care pathway for elective caesarean section (ELCS) in 2020. Shortly after introduction, the COVID-19 pandemic led to telephone (rather than face-to-face) pre-assessment. We performed a re-audit in 2021 to assess the impact of the new pathway and pre-assessment changes. Methods: Following local audit registration, retrospective notes review of all diabetic mothers having ELCS (22/11/21–24/12/21) was performed and results compared to the previous audit (2019) and national recommendations [1,2]. Results: Notes were available for all 10 women having ELCS in 2021 and compared to 10 women in 2019. In 2021 all women had gestational diabetes (GDM) and treatment included diet control (3), metformin alone (5), or insulin and metformin (2). In 2019, eight women had GDM and two were type-1 diabetics, with treatment including diet control (3), metformin alone (2), insulin alone (1) and dual insulin and metformin (4). The revised care pathway advised variable rate insulin infusion for all diabetics with blood glucose >7 mmol/L. In 2021, no women required a VRII, compared to two in 2019 due to type one diabetes and blood glucose over 9 mmol/L. In both audits, all women were admitted on the day of surgery and had ELCS under spinal anaesthesia. A comparison of the audit results in 2019 and 2021 is shown (Table). (Table Presented) Discussion: Despite a revised care pathway, guideline compliance for perioperative management of diabetic women having ELCS did not improve, although no woman had a documented blood glucose >7 mmol/L. Compliance was poor in all areas of perioperative management. We now plan to relaunch the pathway in all perioperative clinical areas to improve awareness. This re-audit highlights the importance of reviewing clinical practice to assess the impact of the pandemic on service improvements in perioperative obstetric care.
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INTRODUCTION: The effect of SARS-CoV-2 severity or the trimester of infection in pregnant mothers, placentas, and infants is not fully understood. METHODS: A retrospective, observational cohort study in Chapel Hill, NC of 115 mothers with SARS-CoV-2 and singleton pregnancies from December 1, 2019 to May 31, 2021 via chart review to document the infants' weight, length, head circumference, survival, congenital abnormalities, hearing loss, maternal complications, and placental pathology classified by the Amsterdam criteria. RESULTS: Of the 115 mothers, 85.2% were asymptomatic (n = 37) or had mild (n = 61) symptoms, 13.0% had moderate (n = 9) or severe (n = 6) COVID-19, and 1.74% (n = 2) did not have symptoms recorded. Moderate and severe maternal infections were associated with increased C-section, premature delivery, infant NICU admission, and were more likely to occur in Type 1 (p = 0.0055) and Type 2 (p = 0.0285) diabetic mothers. Only one infant (0.870%) became infected with SARS-CoV-2, which was not via the placenta. Most placentas (n = 63, 54.8%) did not show specific histologic findings; however, a subset showed mild maternal vascular malperfusion (n = 26, 22.6%) and/or mild microscopic ascending intrauterine infection (n = 28, 24.3%). The infants had no identifiable congenital abnormalities, and all infants and mothers survived. DISCUSSION: Most mothers and their infants had a routine clinical course; however, moderate and severe COVID-19 maternal infections were associated with pregnancy complications and premature delivery. Mothers with pre-existing, non-gestational diabetes were at greatest risk of developing moderate or severe COVID-19. The placental injury patterns of maternal vascular malperfusion and/or microscopic ascending intrauterine infection were not associated with maternal COVID-19 severity.