Epidemiological Aspects of Stillbirth and Neonatal Deaths in the Delivery Room at the Libreville Mother-Child University Hospital from 2019 to 2022

Introduction: Stillbirths are estimated at 2 million each year, of which more than 40% occur during labour. Our objective was to study the epidemiological aspects of stillbirth and neonatal deaths in the delivery room in our health facility. Patients and methods: Prospective, descriptive and analytical study, conducted at the Jeanne Ebori Foundation Mother-Child University Hospital over 4 years (January 2019-December 2022). All neonatal deaths in the delivery room or foetal death in utero, were included. Results: Among the 18,346 deliveries performed, 512 newborns were declared dead in the delivery room (27.9‰ live births), divided into in utero foetal death (19.0‰) and immediate neonatal death (8.9‰). The mean age was 34.3 weeks of amenorrhea. The rate of preterm birth was 60.4%. The sex ratio was 1.1. The average weight was 2186.6. The main causes were vascular (46.1%), foetal (20.2%), adnexal (17.1%) and asphyxia per partum (16.6%). Foetal causes were more likely to result in IUFD than other causes (OR = 6.4 [2.4 - 15.7], p < 0.001). After birth, partum asphyxia was more likely to lead to death before 15 minutes of life than other causes (OR = 11 [6.1 - 18.9], p Conclusion: The causes of stillbirth and early neonatal mortality are dominated by maternal vascular pathologies. However, the proportion of childbirth-related causes remains worrying. Better monitoring of pregnancy and labour will minimize this prevalence in our hospital.

The Fetal Outcome and Fetal Wastage Pattern among Different Types of Obstetric Fistula at the National Obstetric Fistula Centre, Abakaliki, Nigeria

BACKGROUND: Obstetric Fistula is a major public health problem in developing world. It is associated with a high fetal wastage rate. The objective of this study was to evaluate different types of obstetric fistula and their fetal wastage rate. METHOD: A retrospective population study was done at the National Obstetric Fistula Centre, Abakaliki between 1st January-31st December, 2016. The calculated minimum sample size was 3, however, the total number of 203 patients were studied. The case notes of all the women who had obstetric fistula repairs over the period were analyzed. RESULTS: The mean age from this study was 38 ± 12.1 years. The fetal wastage rate from this study was 82.76% while the live birth was 17.24%. Seventy percent of the stillbirth were delivered via SVD, while 11% of stillbirth were delivered through EmCS. Twelve different types of fistula were identified in this study using anatomical classifications. Large extensive fistula, urethral loss and multiple fistula had the highest fetal wastage of 100% respectively. This was followed by mid-vaginal fistula (95.7%), Juxtaurethral fistula 94.4%, Juxtacervical fistula 88.5%, Intracervical fistula 85.71%, Ureteric fistula 85.71%, Vesicouterine 84.21%, Vault fistula 62.5%. Rectovaginal fistula had the least fetal wastage of 15.79% and the highest live birth of 84.2%. CONCLUSION: The findings showed a high fetal wastage rate amongst women with obstetric fistula. There was high fetal wastage across different types of obstetric fistula. Rectovaginal fistula had the best outcome in terms of live births.

Green synthesis of silver nanoparticles using aqueous extract of saffron(Crocus sativus L.) wastages and its antibacterial activity against six bacteria

Objective: To synthesis silver nanoparticles(Ag NPs) by using extract of saffron(Crocus sativus L.) wastages and to test their antibacterial activity against six bacteria.Methods: In this paper, the synthesis of Ag NPs using aqueous extract of saffron wastage as a green method without any chemical stabilizer and reducer is demonstrated. The synthesized Ag NPs were determined by UV–vis spectrum, high resolution transmission electron microscopy, X-ray diffraction, and Fourier transmission infrared spectroscopy analysis.Results: UV–vis spectrum showed a peak at 450 nm due to excitation of surface plasmon vibrations. Fourier transmission infrared spectroscopy showed that nanoparticles were capped with plant secondary metabolites. X-ray diffraction analysis also demonstrated that the size range of the synthesized nanoparticles was 12–20 nm. Transmission electron microscope image illustrated Ag NPs with spherical shape and an average size of15 nm. The result of antibacterial activities showed that the biosynthesized Ag NPs had an inhibiting activity against Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumonia, Shigella flexneri and Bacillus subtilis.Conclusions: The biosynthesized Ag NPs showed significant antibacterial effect against Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumonia, Shigella flexneri and Bacillus subtilis, so, it can be used in biomedical applications.

Incidence of Pitting Corrosion Wastage on the Hull Girder Ultimate Strength

The paper focuses on the assessment of the hull girder ultimate strength,combined with random pitting corrosion wastage,by the incremental-iterative method.After a brief review about the state of art,the local ultimate strength of pitted platings under uniaxial compression is preliminarily outlined and subsequently a closed-form design formula is endorsed in the Rule incremental-iterative method,to account for pitting corrosion wastage in the hull girder ultimate strength check.The ISSC bulk carrier is assumed as reference ship in a benchmark study,devoted to test the effectiveness of the incremental-iterative method,by a comparative analysis with a set of FE simulations,performed by Ansys Mechanical APDL.Four reference cases,with different locations of pitting corrosion wastage,are investigated focusing on nine combinations of pitting and corrosion intensity degrees.Finally,a comparative analysis between the hull girder ultimate strength,combined with pitting corrosion wastage,and the relevant values,complying with the Rule net scantling approach,is performed.Based on current results,the modified incremental-iterative method allows efficiently assessing the hull girder ultimate strength,combined with pitting corrosion wastage,so revealing useful both in the design process of new vessels and in the structural health monitoring of aged ships.

Clustering of Pregnancy Wastages among Young HIV-Positive Women in a High HIV Prevalence District in India

Context: This paper examined the clustering of pregnancy wastage among HIV-infected pregnant women, particularly focusing on the outcomes of abortions and stillbirths, from a large sample of HIV-positive women to bridge the existing information gap. Methods: Data from a cross-sectional survey conducted among currently married HIV positive women aged 15-29 years in Bagalkot district, Karnataka, India were used. Further to assess the clustering of pregnancy wastage, the binomial distribution was used. Results: The study shows that 2% of the women account for 32% of the total pregnancy wastages and 7% of all the interviewed HIV positive women account for 62% of the total pregnancy wastages. The study further shows that a higher percent observed (29.6%) than expected (15.5%) who had experienced 2 pregnancy wastages suggesting 14.1% more women experienced 2 pregnancy wastages than expected. Again, a positive deviant of 19.2 among women with at least 3 pregnancy wastage also suggests a higher observed than expected pregnancy wastages, and suggests clustering of pregnancy wastages among HIV-positive women. After adjusting for the socio-economic characteristics, the variance of the observed and expected has reduced only marginally. Conclusions: Clustering of pregnancy wastages among HIV positive women suggests for an increased attention on reproductive health of this marginalized group. The findings will be useful for the interventions working with WLHA in India, particularly the knowledge of clustering would help policy makers and program implementers to focus on high risk women who are likely to experience multiple pregnancy losses.

Comparing material wastage levels between conventional in-situ and prefabrication construction in Hong Kong

Generation of construction wastes constitutes a major impact to the environment. Studies have been directed toward reducing wastes of the various construction processes. However, contractors in Hong Kong are rather conservative and lack motivation to develop new technology for waste minimization. This paper examines the benefits of using prefabrication in reducing material wastage levels for some traditional in-situ trades such as concreting, rebar fixing, bricklaying, drywall, plastering, screeding and tiling in Hong Kong. By measuring thirty construction projects, it is been found that waste levels of all major construction trades can be effectively reduced. This is particularly significant in the trade of plastering where 100% saving can be achieved after adopting prefabrication. The standardized design of the building can also be useful in the adoption of prefabrication for private housing projects.

Study on Recycling Garments Wastage as an Alternative Sizing Material

This paper deals with garments wastage, which could proficiently assess alternative sizing materials than conventional sizing materials. In this research, the synthesized Carboxymethyl Cellulose (CMC) was originated from garments wastages and after that, synthesized CMC and exported CMC were added in sizing recipe for newly sized yarn and conventionally sized yarn respectively. Yarn count, strength, CSP, desizing efficiency and dye absorbency have been evaluated and a comparison has been made among the samples. Less count variation was found in newly sized yarn and a desirable amount of strength & CSP were also acquired in newly sized yarn but it was slightly less than the conventional one. After desizing and dye absorbency test, it has shown a favorable character for further steps like dyeing, printing, etc. These findings convey that synthesized CMC prepared from garments wastage in this study are good candidates for alternative sizing agents.

Causes and Effects of Stillbirths on Days Open and Cow Herd Survival in Holstein Friesian Cows

The aim of this retrospective study was to investigate the causes and the effects of stillbirth on the number of days open and cow herd survival in subsequent lactation of Holstein Friesian cows. A total of 1371 calvings from research dairy farm were used. Stillbirth in calves was defined as the death of a fetus before or during calving at full term (≥270 days of gestation) or within 24 hours after calving. During the period from January 2006 to December 2017 a percent of 95.04% of the calvings were with live calves, and 4.96% of the calvings were stillbirths. The major causes of stillbirth identified were: calving difficulty, parity of the cows, and sex of the calves at calving. A five point scale was used to assess calving difficulties, and numbers 1, 2 and 3 were considered unassisted calvings and number 4 and 5 as assisted. The twin calvings were not taken into account. Days open were measured as days from first calving to conception, and cow herd survival from first calving to culling or death. Trend test and multivariate data analysis were used. The findings revealed that primiparous cows were at higher risk of having stillbirths compared with multiparous cows. Cows that were at calving male calves were at higher risk of having stillbirths compared with cows that had female calves at calving. Also, cows with assisted calving were at higher risk of having stillbirths compared with cows with unassisted calvings. Cows with stillbirths had a increase mean of days open with 32 days. Cow herd survival was better in the cows with live calves at calving compared with the cows that had stillbirth at calvings.

104例产前死胎原因的临床分析与探讨

目的:分析产前死胎原因的临床资料,以增加对死胎原因的认识。方法:收集2018年1月至2022年12月在南京大学医学院附属鼓楼医院终止妊娠的产前死胎病例,分析其临床资料的分布特征及死胎原因分布,采用美国死胎协作网络(SCRN)开发的标准进行死因归类,并分为死因明确组和死因不明组,比较分析两组人群的不同特征。结果:研究期间共有产前死胎210例,符合纳入标准者共104例。其中有尸检结果的为33例(31.7%),39例(37.5%)有遗传学结果,具有胎盘病理学检查的有75例(72.1%)。经SCRN标准归类分级后,死因归入很可能有关者55例(52.9%),可能有关者33例(31.7%),可能无关者13例(12.5%),还有3例(2.9%)不能归因,即死因明确组占84.6%(88例),死因不明组占15.4%(16例)。死因明确组与死因不明组相比,前者胎盘病理学检查率显著增高(78.4%)。死因分类中,胎盘病理性改变占比最多,占26.9%(28例),其次是妊娠合并症占比25.0%(26例),有15.4%的死胎原因仍是不明原因。结论:胎盘病理学检查对明确死胎原因有重要意义,采用SCRN的死胎病因分类分级法具有可行性,胎盘病理性改变在死胎原因分类中占比较高,建议每一例死胎胎盘都要进行病理学检查。

西藏青稞机械化收获减损浅谈

随着西藏青稞机械化收获率的提高,机收过程中损失率也在逐渐增加。如何提高机械化收获作业质量,减少机收损失成为了研究热点。通过分析西藏青稞机械化收获过程中造成损失的原因,探讨了机械化收获减损技术方法,以期为青稞机械化收获减损提供参考,有效降低机收损失率。

成都東壹图书馆暖通系统分析

本项目为成都東壹图书馆,建筑的整体形态像一朵漂浮在公园上空的云,整体项目美学感官良好。首先,空调系统经计算确定图书馆负荷,空调系统采用2台模块式风冷涡旋热泵机组,机组冷水进出水温度为12℃/7℃,热水进出水温度为40/45℃。空调冷热水系统均采用负荷侧变流量的闭式两管制一级泵异程式系统。冷水供回水温度为7/12℃,热水供回水温度为45/40℃。选用自带水力模块的风冷涡旋热泵机组,空调水系统由水力模块中的膨胀罐定压,水力模块主要包含水泵、过滤器、膨胀罐、安全阀、压力表、放气阀、流量开关、流量调节阀、补水阀等。在气流组织方面,1F图书馆大空间区域采用单风道一次回风定风量全空气系统,可调新、回风比,在过渡季节可实现全新风运行。气流组织形式为上送上回。2F图书馆大空间区域采用单风道二次回风定风量全空气系统,利用二次回风提高送风温度。采用可调新、回风比,在过渡季节可实现全新风运行。结合室内布置的座位等均匀布置送风口。为保证现场舒适性空调效果良好,在风口的设计和选型上做了进一步的对比,通过现场实测风口过滤网孔隙的大小,选择了更优的3mm孔径的过滤网。在排烟系统的设计上,基于图书馆本身的结构形式和幕墙效果,故优先考虑自然排烟电动排烟窗的形式。

妊娠晚期死胎临床特点分析及管理措施探讨

目的分析妊娠晚期死胎的临床特点和相关危险因素,并提出针对性的预防措施。方法根据围产儿死亡报表,通过查阅本院电子病历系统收集并整理87例妊娠晚期死胎患者的临床资料,包括基本信息、孕周、死胎原因等,进行统计分析。结果2014~2022年,本院妊娠晚期死胎发生率为1.805%(87/48189),78.2%的死胎发生在院前阶段,62.1%的患者感知有胎动减少或消失,约46.0%的患者存在妊娠期合并症或并发症,胎儿生长受限的比例达25.3%。死胎的可能病因顺位依次为脐带因素、母体因素、胎儿因素、胎盘早剥,另有14例死胎原因不明。5类病因在年龄、产次、孕前体质量指数及孕周方面均差异无统计学意义(P0.05)。结论加强孕期宣教和管理,提高孕妇认知,嘱其在出现胎动变化和异常症状时及早就诊,同时积极治疗妊娠合并症及并发症,可能有助于减少死胎的发生。

Analysis of Stillbirth in Different Types of Sows

Statistical analysis was conducted on sow stillbirth traits of three mating types with 1686 litters including Erhualian, Large White and F1. The number of stillborn piglets per litter (NSB) in Erhualian, Large White and F1 averaged 0.87, 0.32, 0.72, and the percentage born alive (PBA) averaged 95.1%, 97.1% , 95.7% , respectively. The Erhualian pig with a higher litter size also had a higher stillbirth rate. The results of the variance analysis indicated that the mating type, parity, farrowing year X farrowing season interaction and the total number born had highly significant effects on both NSB and PBA in sows (P < 0.001). Farrowing season had highly significant effects on NSB (P<0.01), and significant effects on PBA (P< 0.05). Farrowing year had no significant effects on NSB (P >0.05), and highly significant effects on PBA (P < 0.01). From parity 1 to parity 10, the least square means for NSB progressively increased with increasing parity, the least square means for PBA progressively decreased with increasing parity. The sows farrowed in winter had the highest NSB and the lowest PBA, the sows farrowed in autumn had the lowest NSB and the highest PBA. The least square means for NSB markedly increased with an increase in the total number born, indicating that the positive phenotypic correlation existed between them. The least square means for PBA markedly decreased with an increase in the total number born, indicating that the negative phenotypic correlation existed between them. The estimating results of the paternal half sib indicated that the heritabilities for NSB and PBA were 0.111 and 0.123, the genetic correlation, phenotypic correlation and environmental correlation between them were -0.985, -0.947 and -0.942, respectively.

Understanding Jordanian Mothers’ Experience after Stillbirth: A Qualitative Study Protocol

Background: Low and middle income countries have the highest rates of stillbirths in the world. In Jordan, stillbirth and how it impacts on mothers who experience it is under-researched. The stories of mothers who have had a stillbirth need to be told and the silence associated with stillbirth needs to be broken. The aim of this study is to explore and understand the meanings attributed by mothers’ to their experience of stillbirth in Jordan. Methods: The study will employ phenomenological qualitative research design. Semi-structured interview will be conducted with the mothers’ who will be recruited from three governmental hospitals in the north, middle and south of Jordan. Data will be transcribed, managed and analysed using interpretative, phenomenological analysis. The Jordanian Ministry of Health and Jordan University Ethics Committee approved the study on Nov. 2019, FEB 2020, respectively. Discussion: The findings of this study will make an original contribution to our knowledge about how stillbirth is experienced by mothers in Jordan. This finding will be useful to health care providers to improve the quality of health care provided to those mothers by adopting individualized and holistic care approach to meet the needs of each mother. Moreover, it will inform public health authorities and policy makers regarding the need for more awareness of stillbirth and a better bereavement care strategy for mothers in hospitals.

Stillbirth at a Nigerian Tertiary Hospital

Background: Despite improvements in antenatal and intrapartum care, stillbirth still remains an important, largely understudied and pregnant problem in obstetrics. Most of the stillbirths occur in the developing world and the majority of stillbirths are preventable. Objective: To determine the stillbirth rate, the identifiable risk factors and sociodemographic factors associated with stillbirths. Materials and Methods: This was a retrospective review of all deliveries conducted at UATH over a five-year period spanning from the January 2012 to December 2016. In this study, stillbirths were considered as foetal death at or after 28 weeks of gestation or a birth weight of 1000 g or more. The folders of cases that met the definition of stillbirth within the study period were retrieved and analyzed for sociodemographic factors, type of stillbirth, fetomaternal determinants of stillbirths and presumptive/identifiable risk factors for the stillbirth. Results: There were a total of 5714 deliveries within the period under review, of which 288 resulted in stillbirths giving an institutional stillbirth rate of 50.4/1000 deliveries. Out of the 288 stillbirths, 136 (47.2%) were fresh stillbirths while 152 (52.8%) were macerated. Macerated stillbirth (152, 52.8%) was slightly predominant, with obstructed labour 94 (32.6%) being responsible for most of the stillbirths. Most of the stillbirths were preterm (183, 63.5%). There were 6 congenitally malformed stillbirth foetuses and no autopsy was carried out on any of the 288 stillborn. However, majority of the parturients who had stillbirth were unemployed (137, 47.6%) and uneducated (110, 38.2%). Conclusion: The stillbirth rate within the study period appears. Complications of labour seem to be the leading risk factor for stillbirth in this study. Low socioeconomic status underscores the need to reduce factors related to social, educational, occupational and healthy inequalities in the developing world.

Verbal Autopsy of Stillbirths and Neonatal Deaths in a Rural Area of Burkina Faso

Introduction: In developing countries, many neonatal deaths still occur at home and the causes of these deaths are not ascertained. Objective: To identify the causes of stillbirths and neonatal deaths that occur at home and the factors that have contributed to these deaths. Materials and Method: We have used the method of verbal autopsy to investigate the stillbirths and neonatal deaths in nine villages in the health area of Namsiguia, health district of Ouahigouya, Burkina Faso, during the period January 1, 2007 to December 8, 2012. Results: Over these six years, we have recorded 19 stillbirths and 36 neonatal deaths among 1507 live births, demonstrating a neonatal mortality rate of 28.8 per1000 and a rate of stillbirths of 12.6 per 1000. The average age of newborns at death was 5.6 days and the sex-ratio was 1.6. The major cause of stillbirths was antenatal hypoxia and birth asphyxia (42.1%). The direct causes of neonatal deaths were neonatal sepsis (41.7%), preterm birth (19.4%) and hypoxia and birth asphyxia (11.1%). There were 42.1% deliveries and 58.3% neonatal deaths, which occurred at home. We have noted 89.5% fresh stillbirths. Death occurred more often during the early neonatal period (55.5%). Factors significantly associated with neonatal death were, lack of school education of mothers (OR = 4), precocious marriage of the mother (OR = 8), poor follow-up of pregnancies (OR = 3), birth at home (OR = 4), low socioeconomic level (OR = 6), and low geographical access to the health facility (OR = 4). Conclusions: Strengthening of the health infrastructure and improving their accessibility, reinforcement of the staff for high quality care, and communication for a change in behavior in rural communities, will contribute toward reducing neonatal mortality in the area of health of Namsiguia.

死胎病耻感量表的汉化及信效度检验

目的 汉化死胎病耻感量表并检验其信效度。方法 通过文化调试、专家咨询、预调查,形成中文版量表,并采用便利抽样法对349例经历围产期丧失的产妇进行问卷调查,检验量表的信效度。结果 中文版量表共20个条目,探索性因子分析提取4个公因子,累计方差贡献率为68.46%;验证性因子分析模型拟合度χ^(2)/df为1.611,RMSEA为0.053,GFI为0.895;量表总的Cronbach’s α系数为0.920,折半信度为0.820,重测信度为0.809;量表水平的平均内容效度指数为0.975,条目水平的内容效度指数为0.833~1.000;效标效度关联系数为-0.379。结论 中文版死胎病耻感量表具有良好的信效度,可作为衡量围产期丧失母亲病耻感的测评工具。

1994年至2020年我国孕产妇死胎发生率的Meta分析

目的系统评价并描述我国1994年1月至2022年5月间孕产妇死胎率(Stillbirth rate)及不同地区孕产妇中死胎率的总体估计,为进一步降低死胎发生率采取因地制宜的围产期管理策略提供支持和依据。方法计算机检索4大主流高质量英文数据库(即PubMed、Cochrane library、Web of Science、EMBASE)及4大中文核心数据库(中国知网,中国生物医学文献数据库、维普及万方数据库),搜集建库至2022年4月30日发表的有关我国孕产妇人群死胎(包含死产)率的队列及横断面研究,采用STATA 16.0软件进行Meta分析。结果共纳入200篇文献,合计纳入研究的总样本量22455289例。Meta分析结果显示,我国死胎发生率为6‰[95%CI(6‰,7‰)]。亚组分析显示,不同地区孕产妇死胎率之间存在差异(χ^(2)=392.00,P<0.001)。西部地区孕产妇人群死胎率最高为9‰[95%CI(8‰,9‰)]。其次是中部地区为8‰[95%CI(6‰,9‰)],最后是东部和东北地区为6‰[95%CI(6‰,6‰),(5‰,7‰)]。前10 a(1994年至2005年)、后10 a(2006年至2016年)及最近3 a(2017年至2020年)我国孕产妇死胎率之间存在差异(χ^(2)=302.00,P<0.001)。1994年至2005年的死胎率为8‰[95%CI(7‰,8‰)],高于2006年至2016年的死胎率,为6‰[95%CI(5‰,6‰)],最近3 a(2017年至2020年)的死胎率最低,为5‰[95%CI(4‰,6‰)]。结论1994年至2020年间我国孕产妇死胎率为6‰,西部地区死胎率较高为9‰。1994年至2020年间前后10 a及最近3 a的死胎率呈下降趋势。

大气污染物与部分不良妊娠结局的关系

随着中国经济的迅速发展和城市化进程的持续加速,大气污染问题日益凸显,对人类健康产生了极大的影响。最近几年来,国内外的研究工作大量涌现,研究结果显示,在妊娠期间接触大气污染物和不良妊娠结果之间存在一定的相关性,大气污染对孕妇和胎儿健康的影响随之受到更多的重视。本文主要就大气污染物对部分不良妊娠结局的影响及其可能的生物学机作一简要综述。

米非司酮联合宫颈球囊在孕晚期瘢痕子宫死胎引产中的应用

目的:探究米非司酮联合宫颈球囊在孕晚期瘢痕子宫死胎引产中的应用。方法:回顾性选取我院收治的瘢痕子宫妊娠晚期胎死宫内且符合纳入标准需要引产患者40例作为研究对象,按照随机数字表法分为球囊组20例及联合组20例,分别给予宫颈Cook球囊及宫颈Cook球囊联合米非司酮治疗。分析米非司酮干预的临床效果。观察患者宫颈Bishop评分、阴道分娩率、剖宫取胎率、平均总产程、平均产后出血量(产后2小时内)及引产并发症(子宫破裂、感染等)等的变化。结果:联合组临床效果95.00%,相较于球囊组的临床效果65.00%明显升高(P<0.05)。取出球囊后,宫颈Bishop评分相较于引产前明显升高(P<0.05),且联合组宫颈Bishop评分显著高于球囊组(P<0.05)。与球囊组相对比,联合组孕产妇阴道分娩率明显升高(P<0.05),剖宫取胎率明显降低(P<0.05)。相较于球囊组,联合组孕产妇平均总产程显著缩短(P<0.05),平均产后出血量显著减少(P<0.05)。联合组引产并发症发生率5%,相较于球囊组引产并发症发生率30.00%显著降低(P<0.05)。结论:米非司酮联合宫颈球囊在孕晚期瘢痕子宫死胎引产中能够起到较好效果,能够有效降低剖宫产取胎率,增加阴道分娩率,安全性较高。