Chromosomal disorders:estimating baseline birth prevalence and pregnancy outcomes worldwide

Chromosomal disorders, of which Down syndrome is the most common, can cause multi-domain disability. In addition, compared to the general population, there is a higher frequency of death before the age of five. In many settings, large gaps in data availability have hampered policy-making, programme priorities and resource allocation for these important conditions. We have developed methods, which overcome this lack of data and allow estimation of the burden of affected pregnancies and their outcomes in different settings worldwide. For example, the methods include a simple equation relating the percentage of mothers 35 and over to Down syndrome birth prevalence. The results obtained provide a starting point for consideration of services that can be implemented for the care and prevention of these disorders

An evaluation of classification systems for stillbirth

<p>Abstract</p> <p>Background</p> <p>Audit and classification of stillbirths is an essential part of clinical practice and a crucial step towards stillbirth prevention. Due to the limitations of the ICD system and lack of an international approach to an acceptable solution, numerous disparate classification systems have emerged. We assessed the performance of six contemporary systems to inform the development of an internationally accepted approach.</p> <p>Methods</p> <p>We evaluated the following systems: Amended Aberdeen, Extended Wigglesworth; PSANZ-PDC, ReCoDe, Tulip and CODAC. Nine teams from 7 countries applied the classification systems to cohorts of stillbirths from their regions using 857 stillbirth cases. The main outcome measures were: the ability to retain the important information about the death using the <it>InfoKeep </it>rating; the ease of use according to the <it>Ease </it>rating (both measures used a five-point scale with a score <2 considered unsatisfactory); inter-observer agreement and the proportion of unexplained stillbirths. A randomly selected subset of 100 stillbirths was used to assess inter-observer agreement.</p> <p>Results</p> <p><it>InfoKeep </it>scores were significantly different across the classifications (<it>p </it>≤ 0.01) due to low scores for Wigglesworth and Aberdeen. CODAC received the highest mean (SD) score of 3.40 (0.73) followed by PSANZ-PDC, ReCoDe and Tulip [2.77 (1.00), 2.36 (1.21), 1.92 (1.24) respectively]. Wigglesworth and Aberdeen resulted in a high proportion of unexplained stillbirths and CODAC and Tulip the lowest. While <it>Ease </it>scores were different (<it>p </it>≤ 0.01), all systems received satisfactory scores; CODAC received the highest score. Aberdeen and Wigglesworth showed poor agreement with kappas of 0.35 and 0.25 respectively. Tulip performed best with a kappa of 0.74. The remainder had good to fair agreement.</p> <p>Conclusion</p> <p>The Extended Wigglesworth and Amended Aberdeen systems cannot be recommended for classification of stillbirths. Overall, CODAC performed best with PSANZ-PDC and ReCoDe performing well. Tulip was shown to have the best agreement and a low proportion of unexplained stillbirths. The virtues of these systems need to be considered in the development of an international solution to classification of stillbirths. Further studies are required on the performance of classification systems in the context of developing countries. Suboptimal agreement highlights the importance of instituting measures to ensure consistency for any classification system.</p

Temporal changes in key maternal and fetal factors affecting birth outcomes: A 32-year population-based study in an industrial city

<p>Abstract</p> <p>Background</p> <p>The link between maternal factors and birth outcomes is well established. Substantial changes in society and medical care over time have influenced women's reproductive choices and health, subsequently affecting birth outcomes. The objective of this study was to describe temporal changes in key maternal and fetal factors affecting birth outcomes in Newcastle upon Tyne over three decades, 1961–1992.</p> <p>Methods</p> <p>For these descriptive analyses we used data from a population-based birth record database constructed for the historical cohort <b>Pa</b>rticulate <b>M</b>atter and <b>P</b>erinatal <b>E</b>vents <b>R</b>esearch (PAMPER) study. The PAMPER database was created using details from paper-based hospital delivery and neonatal records for all births during 1961–1992 to mothers resident in Newcastle (out of a total of 109,086 singleton births, 97,809 hospital births with relevant information). In addition to hospital records, we used other sources for data collection on births not included in the delivery and neonatal records, for death and stillbirth registrations and for validation.</p> <p>Results</p> <p>The average family size decreased mainly due to a decline in the proportion of families with 3 or more children. The distribution of mean maternal ages in all and in primiparous women was lowest in the mid 1970s, corresponding to a peak in the proportion of teenage mothers. The proportion of older mothers declined until the late 1970s (from 16.5% to 3.4%) followed by a steady increase. Mean birthweight in all and term babies gradually increased from the mid 1970s. The increase in the percentage of preterm birth paralleled a two-fold increase in the percentage of caesarean section among preterm births during the last two decades. The gap between the most affluent and the most deprived groups of the population widened over the three decades.</p> <p>Conclusion</p> <p>Key maternal and fetal factors affecting birth outcomes, such as maternal age, parity, socioeconomic status, birthweight and gestational age, changed substantially during the 32-year period, from 1961 to 1992. The availability of accurate gestational age is extremely important for correct interpretation of trends in birthweight.</p

Incentivando o vínculo mãe-filho em situação de prematuridade: as intervenções de enfermagem no Hospital das Clínicas de Ribeirão Preto

This study aims at describing nursing actions performed in the high-risk neonatal units at a university hospital of the University of São Paulo at Ribeirão Preto so as to favor mother-child attachment in prematurity situations. The nurse accompanies parents in their first visit, giving them support as well as information concerning the equipment surrounding the newborn and encouraging skin-to-skin contact, touching and talking. Parents' access to and staying with high-risk newborns is permanently allowed. A visiting program by grandparents and siblings of pre-term newborns was implemented, even when under intensive care, which encourages family contact. Parents participate in a support group with other parents who experienced the situation of having their pre-term children in serious conditions and hospitalized. We consider that our experience has favored the establishment of mother-child and family attachment, observing greater interaction between the family and the newborn, particular involving the mother. Greater interest in learning about care as well as satisfaction concerning the assistance received have also been expressed by families.El objetivo de este estudio es describir las acciones de enfermería realizadas en las unidades neonatales de riesgo de un hospital-escuela de la ciudad de Ribeirão Preto - USP, en el sentido de favorecer el vinculo y apego madre-hijo en situación de prematuridad. La enfermera acompaña los padres en la primera visita, procurando apoyarlos e informar sobre los equipos que cercan al recién-nacido, incentivando el contacto piel a piel, el toque y habla. El acceso y permanencia de los padres junto a los bebes de riesgo son permitidos. Implantamos un programa de visitas de los abuelos y hermanos del prematuro, aunque estén en cuidado intensivo, con el objetivo de incentivar el contacto familiar. Los padres participan en un grupo de apoyo, conjuntamente con otros padres que pasan por la experiencia de tener sus hijos prematuros en estado grave y hospitalizados. Consideramos que nuestra experiencia favoreció el establecimiento del vinculo y apego madre-hijo y familia, resultando en una mayor interacción de la familia con el bebe, en especial, de la madre, y mayor interés en el aprendizaje de sus cuidados, además de la satisfacción manifestada por la atención recibida.O objetivo deste estudo é descrever as ações da enfermagem realizadas nas unidades neonatais de risco de um hospital-escola de Ribeirão Preto-USP, no sentido de favorecer o vínculo e apego mãe-filho em situação de prematuridade. A enfermeira acompanha os pais na primeira visita, procurando apoiá-los e informando-os sobre os equipamentos que cercam o recém-nascido, incentivando o contato pele-a-pele, o toque e a fala. O acesso e permanência dos pais junto aos bebês de risco são liberados.Foi implantado programa de visitas dos avós e irmãos do prematuro aos bebês, mesmo quando em cuidado intensivo, incentivando o contato familiar. Os pais participam de um grupo de apoio, juntamente com outros pais que passam pela experiência de terem seus filhos prematuros em estado grave e hospitalizados. Consideramos que a nossa experiência tem favorecido o estabelecimento do vínculo e apego mãe-filho e família, observando-se maior interação da família com o bebê, em especial da mãe, e maior interesse no aprendizado de seus cuidados, além da satisfação manifestada pela assistência recebida