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Completing a Medical Certificate of Cause of Death
Published in Jason Payne-James, Suzy Lishman, The Medical Examiner Service, 2023
Suzy Lishman, Jason Payne-James
The standard MCCD should not be used for recording the deaths of stillborn children or deaths within the first 28 days of life. There is a separate Certificate of Still-birth and Neonatal Death Certificate for these deaths (see Figure 6.1c and d). Stillbirths are infants born after 24 weeks gestation that did not show any sign of life after being born. Any child that has breathed after birth is regarded as a live birth, irrespective of the gestation.
Assessment of fetal well-being: Fetal heart rate monitoring and the fetal biophysical profile
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Yinka Oyelese, Martin Chavez, Anthony M. Vintzileos
Johnson and coworkers (44) managed 307 consecutive post-term pregnancies with twice-weekly BPPs and suggested that if the biophysical score was reassuring, waiting for spontaneous onset of labor was advisable, resulting in good perinatal outcomes with a much lower cesarean section rate (15% vs. 42% for induction patients). The same authors also reported on the use of the fetal BPP in managing 238 diabetic pregnancies who had a total number of 1028 profiles performed (69). In patients with an abnormal score, there was a high rate of intensive care nursery admissions and cesarean section rate (50%). Of the fetuses with normal BPP scores, 57.4% entered spontaneous labor, 31.3% were induced, and the remaining 11.3% were delivered by elective repeat or primary cesarean section. Stillbirths were prevented and 87% of the patients delivered at or near term with minimal maternal or neonatal morbidity. Abnormal BPP scoring was associated with a significantly higher rate of operative intervention and neonatal morbidity. According to the authors, the fetal BPP allows for a safe expectant management in the diabetic pregnancy.
Pregnancy loss defined
Published in Janetta Bensouilah, Pregnancy Loss, 2021
According to the International Stillbirth Alliance, 4.5 million stillbirths occur each year worldwide, with the rate in developed countries estimated to be one in 100–200 pregnancies.8 There is no agreed international definition of stillbirth of a baby. The WHO defines it as the death of a baby after 22 weeks of pregnancy, or when the baby weighs at least 500 grams. In the UK it is considered to be the death of a baby after 24 weeks, in Sweden after 28 weeks, in Norway after 16 weeks, and in the USA and Australia after 20 weeks.8 Intrauterine death refers to the situation where a baby dies in the womb but is not spontaneously miscarried. Medical induction of labour brings about delivery, which is then termed a stillbirth. Multifetal pregnancies are more at risk of intrauterine death than singletons, and the higher the number of fetuses, the greater the risk. A baby of any gestational age who is born demonstrating signs of life, such as breathing, a heartbeat or pulsation of the umbilical cord, is regarded as alive and acquires the same legal status as other humans and is owed a duty of care.6 Babies who are born at the cusp of viability present enormous difficulties and dilemmas, and a high level of understanding, support and sensitivity is required for all involved.
Risk of fetal malformation, spontaneous abortion, and adverse pregnancy outcomes after gestational terbinafine exposure: a systematic review
Published in Journal of Dermatological Treatment, 2022
Philipp Foessleitner, Alex Farr, Julia Deinsberger
The follow-up cohort study by Andersson et al. (14) involving a total of 1,650,649 pregnancies evaluated the risk of preterm birth and stillbirth in women exposed to terbinafine during pregnancy compared to unexposed controls, who were matched in a ratio of 1:10. Topical and systemic terbinafine exposures were described separately (Table 3). Preterm birth occurred in 304 (6.2%) topically exposed vs. 3239 (6.6%) unexposed (relative risk ratio [RR] 0.94; CI 95%, 0.84–1.05) women and in 37 (6.2%) systemically exposed vs. 344 (5.7%) unexposed (RR 1.08; CI 95%, 0.77–1.49) women. Therefore, no significant increase in preterm births was detected after topical or systemic terbinafine use during pregnancy. This study revealed similar outcomes for stillbirth. Stillbirth occurred in 18 (0.3%) topically exposed vs. 186 (0.3%) unexposed women (RR 0.95; CI 95%, 0.59–1.55) and in 4 (0.4%) systemically exposed vs. 31 (0.3%) unexposed (RR 1.46; CI 95%, 0.52–4.14) women.
Classifying stillbirths in a tertiary care hospital of India: International Classification of Disease-perinatal Mortality (ICD-PM) versus cause of death-associated condition (CODAC) system
Published in Journal of Obstetrics and Gynaecology, 2021
Bharti Sharma, Sujata Siwatch, Nandita Kakkar, Vanita Suri, Ankit Raina, Neelam Aggarwal
There are inherent challenges in identifying and ascertaining the cause of stillbirth as there is always an overlap between actual cause, associated condition and risk factors. Another major challenge is to obtain the complete history i.e., Information of maternal, foetal and placental conditions. Extensive postnatal evaluation (perinatal autopsy, placental examination, genetic testing) may not be feasible in a country like India. To make an international comparison, LMICs also need to follow an accurate and consistent system of classification. A classification system needs to identify the most appropriate clinical cause of death and needs to be simple and reproducible. In a recent Delphi study, 17 characteristics for a classification system were reported; some emphasise the risk factors which are suitable for epidemiology and health care planning, while a few represent probable clinical cause of death. Out of these, a global system must have at least five characteristics: (1) easy to use and produce data; (2) clear guidelines; (3) able to work with all levels (HMIC &LMIC); 4) ensures causes of death categories to be relevant in all settings; 5) produce data for preventive strategies (Wojcieszek et al. 2016). India has adopted CODAC (Cause of death and Associated conditions, the system which finds out the most appropriate cause of death along with associated conditions and promises to be good for LMIC where limited information is available (or whatever information is gathered by verbal autopsy) (Frøen et al. 2009). In our institute, CODAC classification system is being followed since 2014.
Stillbirth and risk factors: an evaluation of Irish and UK websites
Published in Journal of Communication in Healthcare, 2021
Tamara Escañuela Sánchez, Sarah Meaney, Keelin O’Donoghue
A codebook was developed to assign coding values to the different categories of interest (see Supplementary Table 2). Availing of a codebook allows the process of the data coding to be systematic and replicable [35]. The categories included in the codebook were; name and link of website, date websites were accessed, main topic of website (General vs. Specialized), website provider, target audience, hosting country, presence of advertisement, and accreditation from official organizations. In addition, the website content pertaining to basic information about stillbirth was searched for and recorded, including prevalence rates, procedures (e.g. legal procedures after stillbirth, post-mortem examination, etc.), medical or psychological consequences (including; bereavement process, physical changes, health-related associated issues, etc.), and support for parents. Information relating to modifiable risk factors for stillbirth was also included and recorded, specifically that relating to risk factors with a behavioural component (smoking, alcohol and drug use, medicine intake, sleep position, attendance to antenatal care, and weight management). Information about other types of risk factors for stillbirth (e.g.: fetal growth restriction, high blood pressure, placental insufficiency, etc.) was recorded in a general variable, since the focus of this study were modifiable risk factors. Data were considered as absent when no information explicitly linked to stillbirth was found. Information about other types of pregnancy loss, or when risk factors were mentioned without reference to stillbirth, was not included.