Care following stillbirth in high-resource settings:latest evidence, guidelines, and best practice points

Third-trimester stillbirth affects approximately 2.6 million women worldwide each year. Although most stillbirths (98%) occur in low- and middle-income countries, most of the research on the impact of stillbirth and bereavement care has come from high-income countries. The impact of stillbirth ranges from stigma to disenfranchised grief, broken relationships, clinical depression, chronic pain, substance use, increased use of health services, employment difficulties, and debt. Appropriate bereavement care following a stillbirth is essential to minimise the negative socio-economic impact on parents and their families. This article presents the best practice points in stillbirth bereavement care, including taking an individualised and flexible approach. The latest published research, guidelines, and best practice points from high-income countries will be used and will highlight the gaps in the research which urgently need to be addressed. Research and investment in appropriate, respectful aftercare is needed to minimise the negative impact for parents

Mothers working to prevent early stillbirth study (MiNESS 20–28):a case–control study protocol

Introduction: In the UK, 1600 babies die every year before, during or immediately after birth at 20–28 weeks’ gestation. This bereavement has a similar impact on parental physical and psychological well-being to late stillbirth (>28 weeks’ gestation). Improved understanding of potentially modifiable risk factors for late stillbirth (including supine going-to-sleep position) has influenced international clinical practice. Information is now urgently required to similarly inform clinical practice and aid decision-making by expectant mothers/parents, addressing inequalities in pregnancy loss between 20 and 28 weeks. Methods and analysis: This study focuses on what portion of risk of pregnancy loss 20–28 weeks’ gestation is associated with exposures amenable to public health campaigns/antenatal care adaptation. A case–control study of non-anomalous singleton baby loss (via miscarriage, stillbirth or early neonatal death) 20+0 to 27+6 (n=316) and randomly selected control pregnancies (2:1 ratio; n=632) at group-matched gestations will be conducted. Data is collected via participant recall (researcher-administered questionnaire) and extraction from contemporaneous medical records. Unadjusted/confounder-adjusted ORs will be calculated. Exposures associated with early stillbirth at OR≥1.5 will be detectable (p0.80) assuming exposure prevalence of 30%–60%. Ethics and dissemination: NHS research ethical approval has been obtained from the London—Seasonal research ethics committee (23/LO/0622). The results will be presented at international conferences and published in peer-reviewed open-access journals. Information from this study will enable development of antenatal care and education for healthcare professionals and pregnant people to reduce risk of early stillbirth. Trial registration number: NCT06005272

Exploring the Anti-Hypoxaemia Effect of Hydromethylthionine : A Prospective Study of Phase 3 Clinical Trial Participants

Funding Information: This work was funded by TauRx Therapeutics Ltd., Singapore.Peer reviewedPublisher PD

Temperature Dependence of the Electroclinic Effect in the Twist-Bend Nematic Phase

Funding Information: This research was funded by the Croatian Science Foundation (Grant No. IP-2019-04-7978); by the Agence Nationale pour la Recherche ANR (France) through Grant BESTNEMATICS, No. ANR-15-CE24-0012; by the French-Croatian bilateral program COGITO; by the Université de Picardie Jules Verne, Amiens, France. Publisher Copyright: © 2023 by the authors.Peer reviewedPublisher PD

Investigating Dunedin whistlers using volcanic lightning

Whistlers detected at Dunedin, New Zealand are an anomaly: there is little lightning around Dunedin's conjugate point yet whistlers appear in relatively large numbers. These surplus whistlers have consequently inspired investigations into their origins. Dunedin's lightning-sparse conjugate point lies in the Aleutian Islands, a region populated with active volcanoes. Their presence has allowed us to perform a novel analysis: the correlation of whistlers to volcanic lightning. We report on our investigation, which successfully yielded the first observations of "volcanic whistlers." It was found that the single July 2008 Mount Okmok eruption had an impressive effect on the number of whistlers at Dunedin. The eruptions at Mount Redoubt in 2009 also caused a sporadic flow of whistlers in Dunedin

Inequalities and stillbirth in the UK: a meta-narrative review

Objective To review what is known about the relationship between stillbirth and inequalities from different disciplinary perspectives to inform stillbirth prevention strategies. Design Systematic review using the meta-narrative method. Setting Studies undertaken in the UK. Data sources Scoping phase: experts in field, exploratory electronic searches and handsearching. Systematic searches phase: Nine databases with no geographical or date restrictions. Non-English language studies were excluded. Study selection Any investigation of stillbirth and inequalities with a UK component. Data extraction and synthesis Three authors extracted data and assessed study quality. Data were summarised, tabulated and presented graphically before synthesis of the unfolding storyline by research tradition; and then of the commonalities, differences and interplays between narratives into resultant summary meta-themes. Results Fifty-four sources from nine distinctive research traditions were included. The evidence of associations between social inequalities and stillbirth spanned 70 years. Across research traditions, there was recurrent evidence of the social gradient remaining constant or increasing, fuelling repeated calls for action (meta-theme 1: something must be done). There was less evidence of an effective response to these calls. Data pertaining to socioeconomic, area and ethnic disparities were routinely collected, but not consistently recorded, monitored or reported in relation to stillbirth (meta-theme 2: problems of precision). Many studies stressed the interplay of socioeconomic status, deprivation or ethnicity with aggregated factors including heritable, structural, environmental and lifestyle factors (meta-theme 3: moving from associations towards intersectionality and intervention(s)). No intervention studies were identified. Conclusion Research investigating inequalities and stillbirth in the UK is underdeveloped. This is despite repeated evidence of an association between stillbirth risk and poverty, and stillbirth risk, poverty and ethnicity. A specific research forum is required to lead the development of research and policy in this area, which can harness the multiple relevant research perspectives and address the intersections between different policy areas. PROSPERO registration number CRD42017079228