No correlation was observed with fetal gender, gestational age, medical and family history. Cardio-genetic pathologies might be a potentially underexplored etiological factor in unexplained IUFD and should be considered further in fetal post-mortem examinations. Concern is often raised by maternity providers and families when pregnant and recently bereaved women are approached to participate in stillbirth research. Our aim was to assess factors influencing recruitment in the New Zealand Multicentre Case-Control Stillbirth Study and to gain insight into how women felt about their participation.
Eligible women were contacted through their maternity providers from seven New Zealand health regions between and Pregnant controls were randomly selected and matched for region and gestation. Participants were interviewed by a research midwife and given a free-post feedback form asking their views about participation. Feedback was evaluated using thematic analysis. A total of eligible cases and eligible controls were recruited. Non-participants consisted of: Reasons for women declining: no reason provided , Written feedback was provided by participants Identification of recruitment barriers and our reassuring participant feedback may assist researchers and participants in future stillbirth research.
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Recent studies have demonstrated an increased risk of late pregnancy stillbirth while sleeping in the supine position. In this position the gravid uterus completely obstructs the inferior vena cava. While this occurs in the majority of women, only a small number experience supine hypotension syndrome.
The aim of this study is to investigate the role of collateral venous drainage in late pregnancy in various positions. After obtaining ethics approval, 10 healthy pregnant women at 35—38 weeks gestation, without supine hypotension syndrome, underwent Magnetic Resonance MR scanning in supine and left lateral decubitus positions.
MR images T2 Weighted were evaluated to measure the calibre and blood flow of the major vessels inferior vena cava, azygos vein and abdominal aorta and cardiac output.
Early Pregnancy Scans
Preliminary results have shown that cardiac output remained relatively unchanged in both positions. The blood flow and diameter of the IVC dramatically decreased in the supine position, however, the diameter of the azygos vein was doubled in size. This MRI study demonstrates for the first time that healthy pregnant women without symptomatic supine hypotension maintain cardiac output when lying flat by collateral venous drainage including the azygos venous system.
Variations in the collateral system may affect venous return to the heart, reducing cardiac output and uteroplacental perfusion. This may, in part, explain the effects of maternal position on risk of stillbirth in late pregnancy. Non-clinically conventional measures of sleep physiology may be required to detect subtle changes associated with maternal position change. Descriptions of maternal sleep behaviour in late pregnancy, such as duration of each sleep position and frequency of position change, are also important in the context of TASS.
Sleep position was synchronised with the flattening index, an estimate of inspiratory flow limitation. The physiological effects of position were assessed by repeated measures in continuous five minute epochs. Conventional measures of obstructive sleep apnoea OSA severity, the apnoea-hypopnoea index AHI and oxygen desaturation index ODI , were also assessed by sleep position. Data are presented as median IQR. These healthy women in late pregnancy had no clinically-defined OSA in any position, but instead demonstrated marked inspiratory flow limitation when sleeping supine.
This flow limitation may contribute to the observed reduction in the time spent supine by increasing arousals from sleep, and thus may have a protective function. The significant variation in stillbirth rates between and within High Income Countries suggests that more could be done to reduce stillbirth rates. One approach is to identify modifiable risk factors.
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Two case-control studies from New Zealand and Australia have described an association between going to sleep position and the risk of late stillbirth. In total cases women with a non-anomalous singleton late stillbirth and controls women with ongoing pregnancies participated. In multivariable analysis supine going to sleep position the night before stillbirth was thought to have occurred had a greater than 2-fold increased risk of late stillbirth adjusted Odds Ratio aOR 2.
In addition, sleep duration less than 5. No interaction was detected between the effect of supine going to sleep position and a small for gestational age infant, maternal body mass index or gestation. The population attributable risk for supine going to sleep position was 3. This UK study confirms findings from New Zealand and Australian studies that going to sleep position is associated with late stillbirth.
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We should now consider the best way to change practice via a public health campaign. The death of an infant at any stage in a pregnancy is profoundly traumatic both for the parents and the healthcare professionals involved. Most of the research pertaining to healthcare professionals in this area has focused on the effects of antenatal stillbirth or perinatal death, without investigating the specific impact of unexpected IPD.
Our study aims to provide an in-depth qualitative exploration of the attitudes and responses that Irish Obstetricians have following direct involvement with an intrapartum fetal death. Following ethical approval this qualitative study was conducted in a tertiary university maternity teaching hospital in the Republic of Ireland.
Ten obstetricians composed of five consultants and five obstetricians in training were purposively recruited. Semi-structured interviews were conducted in a time and location that suited the participant. The data were analysed using interpretative phenomenology as it explores and understand how individuals make sense of major life experiences. Direct involvement with an intrapartum death had a profound and negative impact on obstetricians. Devastation, shock, sadness, fear and guilt were some of the emotions experienced by doctors in the aftermath of an IPD. Analysis of the data revealed two superordinate themes; the doctor as a person, and supporting each other.
The doctor as person was characterised by two subordinate themes; emotional impact and frustration. Supporting each other was also characterised by two subordinate themes; the good and the bad and what might work. The impact of intrapartum death on Obstetric doctors is profound and long lasting and doctors are the second victims of these events. This needs greater acknowledgement and acceptance.
The development of timely and effective emotional support interventions for all obstetricians is of crucial importance. It is well documented that sensitive emotional care from health professionals has a significant impact upon life-long memories formed by parents at the time of the loss of their baby. Less is known about how confident health professionals feel providing this emotional care and if sufficient training is available to support them. This study aimed to ascertain self-rated confidence and training needs of health professionals providing support to parents who have experienced a loss from a multiple pregnancy.
An online survey, consisting of open and closed questions, was sent by email via professional organisations and clinical networks to fetal medicine and neonatal health professionals between March and June Responses were anonymous. Although confidence in providing practical support to parents who had experienced a loss from a multiple pregnancy was high , Respondents with less time in their current role reported lower confidence in providing emotional support.
Self-rated confidence in providing emotional support to parents following a loss from a multiple pregnancy was low. Less than half of respondents had received training on this important aspect of clinical care and the majority of respondents felt more training and further guidelines were needed.
BioMed Research International
Health professionals routinely report the impact of work-related stress on job satisfaction, personal health, and relationships. Health care leaders experience high levels of burn-out and turn-over as a result. Obstetrics is expected to be a positive place to work where poor outcomes are rare, which increases the burden on health professionals in this area when tragedies occur. Perinatal loss has been cited as a primary cause of obstetrics professionals leaving the specialty. Health professionals have also reported feeling inadequately trained to care for families experiencing perinatal death.
This lack of knowledge and confidence can magnify the stress on these individuals. Health professional retreats were designed to support the self-care, educational, and team-building needs of these caregivers. Each retreat is conducted off-site and unique to the attendees.
Self-care modules may include yoga, Reiki, massage, aromatherapy, and more. Parent panels are included in every retreat as is time for brainstorming and team-building activities. The health professional retreats have been extremely well-received. Event evaluations indicate high levels of rejuvenation, team-building, gratitude, and knowledge.
The parent panels are consistently the most popular modules offered. In follow-up surveys, attendees report increased comfort with their role during perinatal loss, decreased personal and work-related stress, increased confidence in their knowledge, and a desire to attend additional offerings.
Health professional retreats can be an effective strategy to decrease work-related stress, burn-out, and turn-over in obstetrics.
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In addition, they serve to improve care provided to families experiencing perinatal death. High-income countries differ substantially in reported survival rates of infants born near the limit of viability.
We compared the proportion of births classified as antepartum stillbirths, intrapartum stillbirths and live births. All of these differences narrowed with increasing gestational age and nearly disappeared by 26 weeks. Our findings show wide international differences in the classification of births and deaths for fetuses and infants born near the limit of viability. This makes international comparisons of stillbirth rates and neonatal death rates problematic at very early gestations. This study is based on publicly available, de-identified, aggregated datasets exempt from ethics review.
It has been less used to simultaneously examine perinatal outcome of childbirth, which is one of the lesser known advantages of the classification. The aim of this study is to suggest a method of using the RTGCS to assess perinatal mortality and morbidity. Data were retrospectively collected from contemporaneously written annual reports of a tertiary teaching maternity hospital in Dublin, Ireland.
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The rates reported include congenital anomalies. The overall perinatal mortality rate during that time period ranged from 5. As recommended by the World Health Organisation and as increasing numbers of countries worldwide implement the RTGCS to compare induction and rates of mode of delivery, it is important to remember that other perinatal outcomes can, and should, be analysed using the same system.
This will allow focussed interventions on prospective groups of women to take place depending on local results. An important goal of prenatal care is a timely detection of fetal growth restriction, and prevention of fetal asphyxia or perinatal mortality and morbidity by fetal monitoring and timely birth. We assessed the underlying risk factors for perinatal mortality in term born SGA infants.
We performed a population based nationwide cohort study in the Netherlands of , term born infants from January to January Logistic regression analyses were performed. Also audit results were investigated for detailed care information. We studied SGA infants who died in the perinatal period. Risk factors were: gestational age between At Gestational age between These risk factors concern the complete term population starting at Therefore, it is of utmost importance to develop accurate diagnostic tests to screen for SGA before 36 weeks gestation to prevent perinatal.
It allows for the parents to spend time with their baby and close family and friends before their final goodbye. The use of a Cuddle cot donated by Feileacain again as a result of fundraising from bereaved parents allows for the baby to remain with the parents for as long as they wish.
The Flower room was later established in order to provide a cool environment for baby prior to Postmortem or burial in accordance to the wishes of the parents.