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.

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.

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.

Pregnancy Outcomes at Kasungu Maternity Ward in Central Malawi—A Review of Maternity Ward Register

Health care services during pregnancy and childbirth and after delivery are important for the survival and wellbeing of both the mother and the infant. The pregnancy outcomes at Kasungu District Hospital Maternity Ward have not been documented. Additionally, MDHS does not capture data regarding, prematurity, APGAR scores, and causes of maternal deaths and causes of neonatal deaths. Using Kasungu District Hospital Maternity Ward register, we aimed to describe the pregnancy outcomes at Kasungu Maternity Ward. From March 2016 to February 2017, data were available for 10,842 deliveries. The calculated Perinatal Mortality Rate (PMR) was about 77/1000 births and the Maternal Mortality Ratio (MMR) was 318 deaths per 100,000 live births. The Spontaneous Vertex Delivery (SVD) rate was 86% and the caesarean section rate was 10%. 1734 (16%) of all deliveries were premature borne between 28 and 36 gestation weeks. 1182 (11%) deliveries had missing APGAR scores and 81 neonates were born with 5 min Apgar scores less than 7. Adverse pregnancy outcomes occur at Kasungu Hospital Maternity Ward. More effort and resources are needed to decrease their occurrence.

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.

Perinatal Mortality and Associated Risk Factors among Singleton Babies in Unguja Island, Zanzibar

Background: Perinatal mortality is a major public health problem, particularly in developing countries where three quarters of neonatal deaths happen in the first week of life. Therefore, it is crucial to understand factors associated with perinatal mortality in order to design strategies and interventions that will improve newborn outcomes. Methods: A prospective cohort study was carried out, whereby pregnant women with gestational age ≥ 28 weeks were enrolled. Interviews were conducted during antenatal booking using structured questionnaire. Follow-up visits were made within 48 hours after delivery and on seventh day post delivery. Results: A total of 959 pregnant women were enrolled;38 were lost to follow-up prior delivery. The remaining 921 participants, resulting in PMR of 45.5 per 1000 births. Over half of the deaths were stillbirths (SBR 29.6 per 1000 births) and early neonatal deaths (ENMR 16.8 per 1000 live births). Using Generalized Linear Model (GLM), risk factors associated with perinatal mortality included: maternal age ≥ 35 years (ARR 3.0, 95% CI: 1.0 to 9.0), nulliparous women (ARR 4.2, 95% CI: 1.6 to 11.1), assisted vaginal delivery (ARR 5.1, 95% CI: 1.4 to 19.0), home delivery (ARR 3.3, 95% CI: 1.6 to 6.6), previous newborn death (ARR 4.0, 95% CI: 1.5 to 10.1), pregnancy-induced hypertension (ARR 4.8, 95% CI: 2.4 to 9.4), herbal use during labour (ARR 2.4, 95% CI: 1.2 to 5.1) and newborn asphyxia (ARR 5.9, 95% CI: 1.3 to 26.5). Conclusions: Perinatal mortality was found to be high in Zanzibar. Healthcare providers should pay special attention to women with pregnancy-induced hypertension and nulliparous women throughout pregnancy and delivery. However, home delivery and use of herbs during labour should be discouraged.

Support Epidemiology and Prognosis of Premature Rupture of Membranes in Pikine National Hospital Center

Premature rupture of membranes (PROM) complicates 3% of preterm pregnancies and occurs in 60% to 80% of term pregnancies. However, its management remains largely controversial. The objective of this study was to establish the epidemiological profile, to study the management and the prognosis of Premature rupture of membranes (PROM) in our practice. Patients and methods: It was a prospective, descriptive and analytical study from May 1st 2016 to January 31st 2017 at the Pikine National Hospital Center. The target population consisted of all patients received at the hospital with premature rupture of membranes and who had given birth in the structure. The variables studied were: marital status, mode and reason for admission;risk factors;antecedents;prenatal care;the clinical and paraclinical examinations;support and immediate maternal and fetal neonatal complications. Results and comments: The mean maternal age was 27.34 years and the majority of women were aged between 18 and 39 years (94.4%). Fifty-one point three percent of patients were primiparous, large multiparous represented only 2.5%. The majority of patients (385 patients or 66.9%) had consulted in the first 12 hours following the onset of fluid flow. For 20.1% of them this flow was associated with uterine contractions. Hidden risk factors were dominated by the twin pregnancy. The blood count showed that 38.8% of patients had leukocytosis and CRP was positive in 18.3% of patients. An ampicillin-based antibiotics was established in 42.6% of cases, corticosteroid therapy in 5.2% and 1% in tocolysis. An expectation was adopted in 65.7% of cases, induction of labor in 7.3% and a cesarean section immediately in 27% of cases. In total, 65.7% of patients had vaginal delivery and 34.3% cesarean. The perinatal mortality rate was 3.6% or 22 newborns on 610. Two cases of endometritis were observed and one case of immediate postpartum hemorrhage. No maternal deaths were recorded. Conclusion: These results show that the prognosis of premature rupture of membranes remains favorable in our practice. To improve this prognosis, we recommend sensitization of patients during prenatal care regarding signs of danger, a systematic bacteriological sample from all pregnant at the end of their pregnancy and the health personnel to direct patients’ references to structures in case of PROM.

Emergency Neonatal Obstetric Cares at Cocody University Hospital: Overview of Instrumental Extraction

Objectives: The aim of this study was to show an overview of situation of instrumental extraction at the maternity of Cocody University Hospital by determining availability and assessing the maternal and fetal prognosis. Patients and method: it was a retrospective study with a descriptive purpose on 6 months from January 1 to June 31, 2015. It concerned all patients admitted in the expulsive phase of labor delivery room and with an indication of fetal instrumental extraction and the state of their newborns at birth. Results: We saved 2288 vaginal deliveries;including 28 instrumental deliveries on 104 indications of instrumental extraction is an implementation rate of 26.9% (16 by vacuum extractor and 12 forceps). Among patients with indication but without instrumental extraction (n = 76), there is 42.3% vaginal delivery (n = 44) and 30.8% of cesarean section (n = 32). 44 have given birth vaginally (42.3%) and 32 by caesarean section (30.8%). It’s young patient (28 years), nulliparous (42.3%). Average time between instrumental extraction indication and the delivery of the baby was 58 min in the case of instrumental extraction and 1 hour 41 minutes in the case of spontaneous delivery in anticipation of the c-section. Motherhood had 3 instrumental extractors (2 vacuum extractors and 1 forceps) recycled after each use. The Apgar score was good in 85.7% in children born by instrumental extraction and bad in 54.5% in children born vaginally without instrumental extraction. We found 20 stillborn in intra partum occurred only in children born vaginally without instrumental extraction. Twelve (12) cases of bleeding of the issue by uterine atony (27.3%) were recorded in patients pregnant without instrumental extraction. No maternal deaths were observed. Conclusion: The realization of instrumental extraction rate remains low at the maternity of the UH-C. In the event, the fetal prognosis was better.

Childbirth in the Adolescent Female at the General Hospital of Loandjili (Congo)

Objective: To contribute to the knowledge of the characteristics of teenage birth. Patients and Methods: Retrospective, descriptive and comparative studies, from February 1st 2014 to April 31st 2015, carried out in the Obstetrics and Gynecology Department General Hospital of Loandjili. Included were births of less than 18 years of age at the end of a pregnancy of at least 22 weeks of amenorrhea on the one hand, and adults aged 18 and over, who had given birth at the same end of the pregnancy immediately after the teenager. Thus two populations consisted of 170 cases each. The parameters studied were: Sociodemographic, clinical and prognostic characteristics. Results: During this period, 4190 patients had given birth to 4341 births. Among them, 170 teenage girls are 4%. The average age of teenagers in our study was 16.2 years with a 17-year-age, versus 28.2 years for adults. The average parity was 1.19. While in adults, multiparity was represented at 45.89% with an average parity of 3.19. The average number of prenatal consultations (ANC) was 2.89 for adolescent girls and 31.2% had not been performed. By cons in adults, it was 4.23. These ANCs were started in teenage girls with an average of 22 weeks at the first ANC, while adults started on average at 18 weeks. The average delivery time was 38 weeks of amenorrhea for both populations. Thirty-four cases of premature newborns from adolescent mothers were observed, compared with 14 in adult mothers (p 0.05). The delivery mode was low in 66% of adolescent girls versus 75% of adults. Indications for caesarean section in adolescents were represented by complications of arterial hypertension (38.59%), followed by mechanical dystocia. While in adults, cervical dystocia and scar uteri were the most represented. During this study period, no maternal deaths were recorded among adolescent girls. Characteristics of the newborn: the condition of the newborn at birth was good according to the rating of Apgar among teenagers in 91%, and in adults in 96.5% and, with a birth weight at teenage girls normal in 74% versus 88% in adults. Low birth weight and prematurity were reported with a statistically significant difference in adolescent girls.

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.

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.

Impact of Fibromyalgia on Female Infertility

Fibromyalgia is a chronic, widespread musculoskeletal pain and polyalgic syndrome, evolving for more than three months. Research on its consequences on fertility is therefore relevant to explore. The aim of this study is to highlight the relationship between fibromyalgia and some women’s diseases that induced infertility. The results showed that fibromyalgia is more common in 92.9% of patients wishing to procreate and 64.8% of patients with gynecological disorders. 70.7% of patients with menstrual disorder have fibromyalgia and 76.5% of fibromyalgia patients have myomas. Among ovarian pathologies, 76.5% of women with ovarian dystrophy have fibromyalgia. Fibromyalgia is also very prevalent in women with miscarriage (55.9%) and stillbirth history (90.1%). For all studied situations, a highly significant difference was observed (p < 0.000). All these data suggest that fibromyalgia is related to different situations that can induce infertility in women.

Clinical Management Guidelines for Intrahepatic Cholestasis of Pregnancy

Intrahepatic cholestasis of pregnancy(ICP)is a significant gestational complication in late pregnancy,potentially leading to severe perinatal complications such as intrauterine fetal demise and preterm birth.The Obstetrics Group of the Gynecology and Obstetrics Branch and the Perinatal Medicine Branch of the Chinese Medical Association organized a panel of domestic experts to deliberate and propose recommendations based on domestic and international guidelines,recent evidence-based medical evidence about key clinical issues including risk factors,clinical manifestations,perinatal outcomes,diagnosis,severity grading,maternal and fetal monitoring,treatment methods,timing,and methods of pregnancy termination,and postpartum follow-up for ICP,with the aim to guide its clinical diagnosis,treatment,and management.

Starch supplementation improves the reproductive performance of sows in different glucose tolerance status

This study was to evaluate the effects of glucose tolerance status,maternal starch supplementation and soybean substitution in diets on the performance of dams and their offspring.Eighty-eight pregnant sows(Landrace x Large White)were selected from an initial total of 120 sows,based on blood glucose test values,and assigned to 4 experimental treatments in a 2×2 factorial design.The factors were glucose tolerance status(glucose intolerant[GIT]vs.normal glucose tolerant[NGT])or dietary treatments(corn starch diet[CS]vs.soybean substitution diet[SSI]).A higher area under the curve(AUC)for post-meal glucose was observed(P<0.05)in the GIT group than in the NGT group on d 109 of gestation.The CS group had a lower value of homeostasis model assessment-insulin resistance than the SS group(P<0.05)on d 109 of gestation.Corn starch supplementation for sows decreased the stillbirth rate(P<0.05),regardless of the sows’glucose tolerance status.The villus height of the jejunum and the villus height to crypt depth ratio of the ileum were greater in normal birth weight piglets from the CS group than from the SS group(P<0.01),and so was the activity of sucrase in the jejunum and ileum(P<0.01).Compared with the SS group,the CS group showed a reduction in pre-weaning mortality rate,an increase in the number of high-birth-weight piglets,and a decrease in the number of low-birth-weight piglets(P<0.05)under GIT status.In conclusion,sows fed CS decreased stillbirth rate and improved insulin resistance,as well as improving the intestinal morphology and digestive enzyme activities of their progeny,regardless of glucose tolerance status.Additionally,the CS group improved birth weight distribution and decreased pre-weaning mortality rate of piglets under GIT status.

Inclusion of wheat aleurone in gestation diets improves postprandial satiety,stress status and stillbirth rate of sows

This study investigated the effects of different amounts of wheat aleurone(WA)(0,15%,30%)inclusion in gestation diets on the reproductive performance,postprandial satiety,stress status and stereotypic be-haviors of sows.A total of 84 Landrace×Yorkshire sows(parity 4.87±1.32)at breeding were randomly allotted to one of the three isoenergetic and isonitrogenous dietary treatments based on parity and body weight.The results showed that,compared with the control(0),sows fed the WA diet had a higher serum concentration of peptide YY(PYY)(P<0.05)and glucagon like peptide-1(GLP-1)(P<0.05)and a lower concentration of saliva cortisol(P<0.01).Importantly,compared with the control group,only the 15%WA group had a higher concentration of the total antioxidant capacity(T-AOC)(P<0.05),lower pro-portions of sitting(P=0.05)and stillbirth rates(P<0.01).Accordingly,the production cost per piglet born alive($6.9 vs.$7.6)or per piglet born healthy($7.4 vs.$7.9)declined in the 15%WA group versus the control group.Overall,15%WA inclusion in gestation diets contributed to enhancing postprandial satiety,alleviating stress status and decreasing stillbirth rate of sows.This study provides a reference for the application of WA as a partial substitute for conventional feed ingredients to improve sows'repro-ductive performance.

Preventing Stillbirth:A Review of Screening and Prevention Strategies

Stillbirth is a devastating pregnancy complication that still affects many women,particularly from low and middle-income countries.It is often labeled as“unexplained”and therefore unpreventable,despite the knowledge that placental dysfunction has been identified as a leading cause of antepartum stillbirth.Currently,screening for pregnancies at high-risk for placental dysfunction relies on checklists of maternal risk factors and serial measurement of symphyseal-fundal height to identify small for gestational age fetuses.More recently,the first-trimester combined screening algorithm developed by the Fetal Medicine Foundation has emerged as a better tool to predict and prevent early-onset placental dysfunction and its main outcomes of preterm preeclampsia,fetal growth restriction and stillbirth by the appropriate use of Aspirin therapy,serial growth scans and induction of labour from 40 weeks for women identified at high-risk by such screening.There is currently no equivalent to predict and prevent late-onset placental dysfunction,although algorithms combining an ultrasound-based estimation of fetal weight,assessment of maternal and fetal Doppler indices,and maternal serum biomarkers show promise as emerging new screening tools to optimize pregnancy monitoring and timing of delivery to prevent stillbirth.In this review we discuss the strategies to predict and prevent stillbirths based on firsttrimester screening as well as fetal growth and wellbeing assessment in the second and third trimesters.

Second and Third Trimester Fetal Death in the Setting of COVID-19: A California 2020 Case Series

Maternal severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection in the second and third trimesters of pregnancy may impact fetal development via vertical transmission,complications of coronavirus disease 2019(COVID-19),or placental injury.However,potential associations between prenatal SARS-CoV-2 infection and fetal loss are not well understood.This case series of thirteen second and third trimester fetal losses reported by local public health departments to California’s state public health surveillance included maternal clinical and demographic characteristics as well as placental pathology,fetal autopsy reports,and coroner report.There was no evidence that maternal COVID-19 disease severity,placental injury,or SARS-CoV-2 vertical transmission contributed to pregnancy loss.However,this case series is a limited sample;more research is needed to identify factors of prenatal SARS-CoV-2 that may contribute to fetal death in the second and third trimesters.