Maternal and fetal characteristics and causes of stillbirth in a tertiary care hospital of Nepal: secondary analysis of registry-based surveillance data.

OBJECTIVES: Stillbirth is one of the vital indicators of quality care. This study aimed to determine maternal-fetal characteristics and causes of stillbirth in Nepal. DESIGN: Secondary analysis of single-centred registry-based surveillance data. SETTING: The study was conducted at the Department of Obstetrics and Gynecology, Chitwan Medical College Teaching Hospital, a tertiary care hospital located in Bharatpur, Nepal. PARTICIPANTS: All deliveries of intrauterine fetal death, at or beyond 22 weeks' period of gestation and/or birth weight of 500 g or more, conducted between 16 July 2017 and 15 July 2019 were included in the study. MAIN OUTCOME MEASURES: The primary outcome measure of this study was stillbirth, and the secondary outcome measures were maternal and fetal characteristics and cause of stillbirth. RESULTS: Out of 5282 institutional deliveries conducted over 2 years, 79 (1.5%) were stillbirths, which gives the stillbirth rate of 15 per 1000 births. Of them, the majority (75; 94.9%) were vaginal delivery and only four (5.1%) were caesarean section (p<0.0001). The proportion of the macerated type of stillbirth was more than that of the fresh type (58.2% vs 41.8%; p=0.13). Only half of the mothers who experienced stillbirth had received antenatal care. While the cause of fetal death was unknown in one-third of cases (31.6%; 25/79), among likely causes, the most common was maternal hypertension (29.1%), followed by intrauterine infection (8.9%) and fetal malpresentation (7.6%). Four out of 79 stillbirths (5%) had a birth defect. CONCLUSION: High rate of stillbirths in Nepal could be due to the lack of quality antenatal care. The country's health systems should be strengthened so that pregnancy-related risks such as maternal hypertension and infections are identified early on. Upgrading mothers' hygiene and health awareness is equally crucial in reducing fetal deaths in low-resource settings

Association between Lactobacillus species and bacterial vaginosis-related bacteria, and bacterial vaginosis scores in pregnant Japanese women

<p>Abstract</p> <p>Background</p> <p>Bacterial vaginosis (BV), the etiology of which is still uncertain, increases the risk of preterm birth. Recent PCR-based studies suggested that BV is associated with complex vaginal bacterial communities, including many newly recognized bacterial species in non-pregnant women.</p> <p>Methods</p> <p>To examine whether these bacteria are also involved in BV in pregnant Japanese women, vaginal fluid samples were taken from 132 women, classified as normal (n = 98), intermediate (n = 21), or BV (n = 13) using the Nugent gram stain criteria, and studied. DNA extracted from these samples was analyzed for bacterial sequences of any <it>Lactobacillus</it>, four <it>Lactobacillus </it>species, and four BV-related bacteria by PCR with primers for 16S ribosomal DNA including a universal <it>Lactobacillus </it>primer, <it>Lactobacillus </it>species-specific primers for <it>L. crispatus</it>, <it>L. jensenii</it>, <it>L. gasseri</it>, and <it>L. iners</it>, and BV-related bacterium-specific primers for BVAB2, <it>Megasphaera</it>, <it>Leptotrichia</it>, and <it>Eggerthella</it>-like bacterium.</p> <p>Results</p> <p>The prevalences of <it>L. crispatus</it>, <it>L. jensenii</it>, and <it>L. gasseri </it>were significantly higher, while those of BVAB2, <it>Megasphaera</it>, <it>Leptotrichia</it>, and <it>Eggerthella</it>-like bacterium were significantly lower in the normal group than in the BV group. Unlike other <it>Lactobacillus </it>species, the prevalence of <it>L. iners </it>did not differ between the three groups and women with <it>L. iners </it>were significantly more likely to have BVAB2, <it>Megasphaera, Leptotrichia</it>, and <it>Eggerthella</it>-like bacterium. Linear regression analysis revealed associations of BVAB2 and <it>Megasphaera </it>with Nugent score, and multivariate regression analyses suggested a close relationship between <it>Eggerthella</it>-like bacterium and BV.</p> <p>Conclusion</p> <p>The BV-related bacteria, including BVAB2, <it>Megasphaera</it>, <it>Leptotrichia</it>, and <it>Eggerthella</it>-like bacterium, are common in the vagina of pregnant Japanese women with BV. The presence of <it>L. iners </it>may be correlated with vaginal colonization by these BV-related bacteria.</p