Incidence and maternal-fetal risk factors of stillbirth. A population-based historical cohort and a nested casecontrol study.

Background: For parents, stillbirth is a tragic experience; thus, identifying the associated risk factors can be beneficial in order to prevent this event. This study aimed to investigate the incidence and risk factors associated with stillbirth. Methods: In this historical cohort study, a total of 18,129 birth records were investigated. The outcome variable was having or not having stillbirth. For each case of stillbirth, three live birth infants on the same day and same hospital were selected as controls, which were matched for gestational age. The data were collected using a researcher-made checklist. Finally, data were analyzed using STATA, 13.0 with Cox proportional hazards regression model at the significance level of 0.05. Results: The cumulative incidence of stillbirth was 9.48 per 1,000 live births. Based on multivariate Cox regression model, five risk factors for stillbirth were identified, including male gender, fetal diseases, gestational hypertension, gestational diabetes, and maternal hypothyroidism, (all hazard ratios > 1 and p<0.05), and - for the first time in Iran - maternal hypothyroidism, oligohydramnios, and polyhydramnios were shown as risk factors for stillbirth, which were not evaluated in any previous study. Conclusion: The findings of this study suggest that some maternal and fetal risk factors can be recognized as predictors of stillbirth, which might help to detect and prevent high-risk parents at early stages in order to avoid adverse health consequences in the mother and her neonate.

Evaluation of rFVIIa (NovoSeven) in Glanzmann patients with thromboelastogram.

Glanzmann thrombasthenia (GT) is a rare platelet function disorder characterized by a defect in fibrinogen binding to platelet membrane glycoprotein (GP) IIb/IIIa. Recombinant FVIIa (rFVIIa) is a haemostatic agent approved for the treatment of haemophilia patients with inhibitors, patients with acquired haemophilia and in EU also for treatment of factor VII (FVII)-deficient patients and GT patients with antibodies to GPIIb-IIIa. The present study was conducted to evaluate the use of the whole blood test system, rotational thrombelastometry (ROTEM), in measuring the overall haemostasis potential of rFVIIa in 28 GT patients treated with rFVIIa. The correlation of administered rFVIIa and time to start fibrin formation and clot dynamic/stability was assessed and correlation to the clinical response was elucidated. Assessments were performed on predose blood samples spiked with four different concentrations of rFVIIa and whole blood samples taken at 10 and 120 min following dosing. ROTEM parameters clotting time (CT), clot formation time (CFT) and maximum clot firmness (MCF) were measured. Both ex vivo and in vivo data showed beneficial effects on CT in the presence of rFVIIa, but no effect of added rFVIIa was seen on CFT and MCF. In conclusion, the use of thrombelastography at least in the modified form of ROTEM seems to be of limited use in predicting an adequate dose of rFVIIa in GT patients. A good clinical haemostatic response was recorded in spite of the limited changes in the ROTEM pattern supporting the conclusion that ROTEM should not be the method of choice for monitoring rFVIIa therapy in Glanzmann patients.