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Hydrops fetalis: a simple novel screen for the rapid identification of haemoglobin Bart's syndrome

George-Kodiseri E, Faridah K

Family Physician, 1991;3(1):25-27.

Haemoglobin Bart's hydrops fetalis syndrome is totally lethal. Globin chain electrophoresis on mylar backed cellulose acetate strips, by a method modified from Ueda and Schneider has been established to demonstrate total absence of alpha chains in this syndrome. This simple test can identify fetuses, stillbirths and newborns with homozygous Î±o-thalassaemia. In this region where DNA studies are limited, and prenatal diagnosis is unavailable, this test which describes the phenotypic expression of Hb Bart's syndrome will improve genetic counselling of women at risk of homozygous Î±o-thalassaemia.

Matched MeSH terms: Stillbirth
A review of perinatal mortality in Peninsular Malaysia from 1980 to 1989

Musa Mohd Nordin, Mohd Sham Kasim, Wong, Swee Lan

Malaysian Journal of Child Health, 1993;5(1):9-19.
MyJurnal

An analysis of perinatal statistics in Peninsular Malaysia from 1980 — 1989 was undertaken. The Perinatal Mortality Rate showed a 42% decrease over the 10 year period. The Perinatal Mortality Rate was higher among the Indian and Malay ethnic groups compared to the Chinese. This was largely contributed by the higher Stillbirth rate in the former 2 ethnic groups. The Indians have the highest rate of low birthweight babies. There is a decline in the rate of low birthweight babies born over the studied decade. The major causes of early neonatal mortality included problems asociated with prematurity, asphyxia neonatorum, septicaemia and congenital anomalies. Further epi-demiological research is required to identify other riskfactors which contribute to this ethnic biased perinatal mortality rates. Besides intensifying and upgrading current multifaceted approaches, interventional strategies need to be directed to the identified high risk groups. (Copied from article).

Matched MeSH terms: Stillbirth
Paediatric deaths in Kuala Lumpur

Kumar V, Jumali IB

Med Sci Law, 2006 Oct;46(4):301-9.
PMID: 17191633

The main aim of this study was to determine the causes and epidemiological aspects of paediatric death. Data was collected on 143 cases of paediatric death from a total of 2,895 autopsies performed in University Malaya Medical Centre (UMMC), Kuala Lumpur, over a five-year period from 2000 to 2004. There were 78 males and 65 females. The largest number of cases (32.9%) were stillborn. The highest proportion of cases (30.1%) were Chinese. The majority of cases of paediatric death were non-traumatic (74.8%) of which intrauterine death (IUD) was the most common (32.9%). Amongst the traumatic deaths (25.2%), accidental injury (23.8%) was observed in the majority of cases.

Matched MeSH terms: Stillbirth/epidemiology
Fulltext A review of determinant factors of stillbirths in Malaysia

Rosnah Sutan

Malaysian Journal of Community Health, 2008;14(2):68-77.
MyJurnal

Introduction : Stillbirth is one of the important adverse pregnancy outcomes that has been used as a health indicator for the measurement of the health status of a country especially for its obstetric care management. However, the aetiology of the occurrence of the stillbirth was commonly difficult to identify because of limitations in the classification system.
Methods : A review of existing, available information published up to January 2007 on stillbirths in Malaysia was used to obtain the basic background on the determinant factors of stillbirths. Results : Malaysia, which is a fast developing country, reported a stillbirth rate in the range of 4 to 5 per 1000 births. Almost 30- 40% were recorded as normally formed macerated stillbirths. This was based on a rapid reporting system of perinatal deaths using the modified version of the Wigglesworth’s pathophysiology classification. Those of extreme maternal age (less than 19 years and more than 35 years), those reside in rural areas, of the ‘Bumiputera’ and Indian ethnic groups were at higher risk of stillbirth. On detailed analysis it was seen that the risks of having a normally formed macerated stillbirth increased among those who had a preterm delivery and hypertension. Stillbirth rates were also higher in those with shorter gestational age and in those with parity between 2 and 5. No other factors related to stillbirth were found in this review.
Conclusion : This is a review based on existing published data which has a lot of limitation when it comes to analysing other important factors that might be related with the risk of the stillbirth. However, extreme maternal age and mothers from rural areas are the two factors that were persistently found in almost all literature. When these factors are combined with signs of pre term delivery, they indicate that close monitoring needs to be done.

Matched MeSH terms: Stillbirth
Fulltext Psychosocial impact of mothers with perinatal loss and its contributing factors: an insight

Sutan R, Amin RM, Ariffin KB, Teng TZ, Kamal MF, Rusli RZ

J Zhejiang Univ Sci B, 2010 Mar;11(3):209-17.
PMID: 20205307 DOI: 10.1631/jzus.B0900245

To evaluate the psychosocial impact among mothers with perinatal loss and its contributing factors.

Matched MeSH terms: Stillbirth/epidemiology*; Stillbirth/psychology*
Fulltext The risk factors for unexplained antepartum stillbirths in Scotland, 1994 to 2003

Sutan R, Campbell D, Prescott GJ, Smith WC

J Perinatol, 2010 May;30(5):311-8.
PMID: 19829298 DOI: 10.1038/jp.2009.158

To determine the factors contributing to unexplained antepartum stillbirth in Scotland.

Matched MeSH terms: Stillbirth/epidemiology*
Fulminant type 1 diabetes associated with pregnancy: a report of 2 cases from Malaysia

Tan F, Loh WK

Diabetes Res Clin Pract, 2010 Nov;90(2):e30-2.
PMID: 20832134 DOI: 10.1016/j.diabres.2010.08.009

Two previously healthy Malaysian women presented abruptly with severe diabetic ketoacidosis during pregnancy and immediate postpartum period. Their clinical courses, biochemical and immunological profiles were consistent with fulminant type 1 diabetes first described in the Japanese. Fulminant type 1 diabetes may not be as rare as currently reported outside Japan.

Matched MeSH terms: Stillbirth
Low perinatal autopsy rate in Malaysia: time for a change

Tan GC, Hayati AR, Khong TY

Pediatr Dev Pathol, 2010 Sep-Oct;13(5):362-8.
PMID: 20367214 DOI: 10.2350/09-03-0623-OA.1

Our objectives were to determine the perinatal autopsy rate in a tertiary hospital in Malaysia and to quantify the value of the perinatal autopsy. All stillbirths, miscarriages, therapeutic abortions, and neonatal deaths between January 1, 2004, and August 31, 2009, were identified from the archives. The autopsy findings were compared with the clinical diagnoses. The autopsy reports were also reviewed to determine if it would be possible to improve the quality of the autopsies. There were 807 perinatal deaths, of which 36 (4.5%) included an autopsy. There were ethnic differences in the rate of autopsy, with the lowest rate among the Malays. The autopsy provided the diagnosis, changed the clinical diagnosis, or revealed additional findings in 58.3% of cases. Ancillary testing, such as microbiology, chromosomal analysis, and biochemistry, could improve the quality of the autopsy. This study provides further data on the perinatal autopsy rate from an emerging and developing country. It reaffirms the value of the perinatal autopsy. Attempts must be made to improve on the low autopsy rate while recognizing that the performance of autopsies can be enhanced through the use of ancillary testing.

Matched MeSH terms: Stillbirth/ethnology
Fulltext Perinatal postmortem: factors influencing uptake and subsequent outcomes in an Asian population

Valayatham V, Hiu J

Med J Malaysia, 2012 Feb;67(1):87-90.
PMID: 22582555 MyJurnal

To assess uptake of perinatal postmortems (PM) among mothers experiencing perinatal deaths. Subjective assessment of factors influencing uptake was studied. Analysis of perinatal PM outcomes and its impact on cause analyses of intrauterine fetal demise was made.

Matched MeSH terms: Stillbirth*
Fulltext Psychosocial impact of perinatal loss among Muslim women

Sutan R, Miskam HM

BMC Womens Health, 2012;12:15.
PMID: 22708998 DOI: 10.1186/1472-6874-12-15

Women of reproductive age are vulnerable to psychosocial problems, but these have remained largely unexplored in Muslim women in developing countries. The aim of this study was to explore and describe psychosocial impact and social support following perinatal loss among Muslim women.

Matched MeSH terms: Stillbirth/psychology*
Fulltext Trend of stillbirths and neonatal deaths in University Kebangsaan Malaysia Medical Centre (UKMMC) from 2004-2010

Haslina Hassan, Rosnah Sutan, Nursazila Asikin Mohd Azmi, Shuhaila Ahmad, Rohana Jaafar

Int J Public Health Res, 2013;3(1):241-248.
MyJurnal

The aim of the Fourth Millennium Developmental Goal is to reduce mortality among children less than 5 years by two thirds between 1990 and 2015. Efforts are more focus on improving children's health. The aim of this study was to describe the trend of stillbirth and neonatal deaths in University Kebangsaan Malaysia Medical Centre from 2004 to 2010. A retrospective cross-sectional study was conducted using hospital data on perinatal mortality and monthly census delivery statistics. There were 45,277 deliveries with 526 stillbirths and neonatal deaths. More than half of the stillborn cases were classified as normally formed macerated stillbirth and prematurity was common in neonatal deaths. The trend of SB and NND was found fluctuating in this study. However, by using proportionate test comparing rate, there was a transient significant decline of stillbirth but not neonatal deaths rates between 2004 and 2006. On the other hand, the neonatal deaths rate showed significant increment from 2006 to 2008. When both mortality rates were compared using proportionate test, from the start of the study, year 2004 with end of the study, year 2010, there was no significant decline noted. Trends of stillbirth and neonatal death rates in University Kebangsaan Malaysia Medical Centre within 7 years study period did not show the expected outcome as in Millennium Developmental Goal of two thirds reduction.

Matched MeSH terms: Stillbirth
Fulltext Risk factors of gestational diabetes mellitus in the refugee population in Gaza Strip: a case-control study

AlKasseh AS, Zaki NM, Aljeesh YI, Soon LK

East Mediterr Health J, 2014 Jan 09;19 Suppl 3:S12-8.
PMID: 24995734

To determine the risk factors of gestational diabetes mellitus in refugee populations in the Gaza Strip, a retrospective case-control study was performed between March and June 2011 in the United Nations Relief and Works Agency (UNRWA) primary health care clinics. Data were collected on maternal sociodemographics and the prevalence of diagnosed GDM according to World Health Organization criteria from clinics where postnatal Palestinian refugee women had been diagnosed with GDM during previous pregnancies, and non-GDM women were used as controls. Sociodemographic characteristics, pre-pregnancy body-mass index (BMI), obstetrics history and family history of diabetes were used as study variables. In total, 189 incident cases of GDM were identified. The most significant risk factors for GDM were: history of miscarriage more than once; overweight before pregnancy; history of stillbirth; history of caesarean birth; and positive family history of diabetes mellitus.

Matched MeSH terms: Stillbirth
α-thalassemia-associated hydrops fetalis: A rare cause of thyrotoxic cardiomyopathy

Tumian NR, Wong M, Wong CL

J Obstet Gynaecol Res, 2015 Jun;41(6):967-70.
PMID: 25510540 DOI: 10.1111/jog.12648

α°-thalassemia is a well-known cause of hydrops fetalis in South-East Asia and can be detected in utero. We report a very rare case of thyrotoxic cardiomyopathy associated with hyperplacentosis secondary to α°-thalassemia-associated hydrops fetalis. A 22-year-old primigravida with microcytic anemia presented at 27 weeks' gestation with pre-eclampsia, hyperthyroidism and cardiac failure. Serum β-human chorionic gonadotrophin was markedly elevated and abdominal ultrasound revealed severe hydropic features and enlarged placenta. Serum β-human chorionic gonadotrophin, cardiac function and thyroid function tests normalized after she delivered a macerated stillbirth. Histopathology of the placenta showed hyperplacentosis. Blood DNA analysis revealed that both patient and husband have the α°-thalassemia trait. This case illustrates a very atypical presentation of α°-thalassemia-associated hydrops fetalis and the importance of early prenatal diagnosis of α-thalassemia in women of relevant ethnic origin with microcytic anemia so that appropriate genetic counseling can be provided to reduce maternal morbidity and the incidence of hydrops fetalis.

Matched MeSH terms: Stillbirth
Fulltext Ending preventable newborn deaths in a generation

Akseer N, Lawn JE, Keenan W, Konstantopoulos A, Cooper P, Ismail Z, et al.

Int J Gynaecol Obstet, 2015 Oct;131 Suppl 1:S43-8.
PMID: 26433505 DOI: 10.1016/j.ijgo.2015.03.017

The end of the Millennium Development Goal (MDG) era was marked in 2015, and while maternal and child mortality have been halved, MGD 4 and MDG 5 are off-track at the global level. Reductions in neonatal death rates (age <1 month) lag behind those for post-neonates (age 1-59 months), and stillbirth rates (omitted from the MDGs) have been virtually unchanged. Hence, almost half of under-five deaths are newborns, yet about 80% of these are preventable using cost-effective interventions. The Every Newborn Action Plan has been endorsed by the World Health Assembly and ratified by many stakeholders and donors to reduce neonatal deaths and stillbirths to 10 per 1000 births by 2035. The plan provides an evidence-based framework for scaling up of essential interventions across the continuum of care with the potential to prevent the deaths of approximately three million newborns, mothers, and stillbirths every year. Two million stillbirths and newborns could be saved by care at birth and care of small and sick newborns, giving a triple return on investment at this key time. Commitment, investment, and intentional leadership from global and national stakeholders, including all healthcare professionals, can make these ambitious goals attainable.

Matched MeSH terms: Stillbirth
Fulltext A dilemma in management of intrauterine death in mother with major placenta previa

Rima Anggrena, D., Yulianty, A., Nor Azlin, M.I.

Journal of Surgical Academia, 2017;7(2):43-45.
MyJurnal

Placenta previa is a condition when the placental tissue extends over the internal cervical os. It is associated with
maternal and fetal morbidity and mortality. With intrauterine death, the mode of delivery will be more difficult to
decide. Here, we report a case of 30 years old G3P2 with placenta previa major diagnosed with intrauterine death at
29 weeks gestation who was managed conservatively and delivered vaginally with minimal complication. A good
patient selection and thorough counseling, patient with placenta previa major and intrauterine death still can be safely
delivered vaginally.

Matched MeSH terms: Stillbirth
Fulltext Parvovirus Infection and Congenital Leukemia: Is it a causal or casual?

Dasrilsyah RA, Ahmad S, Tan GC, Lim PS

International Medical Journal Malaysia, 2017;16(1):123-126.
MyJurnal

Congenital leukemia is an extremely rare disease but frequently fatal. We report a case of intrauterine death (IUD) secondary to congenital erythroid leukaemia associated with maternal Parvovirus B19 infection. Further research is needed to ascertain the association between maternal Parvovirus B19 infection and congenital leukemia.

Matched MeSH terms: Stillbirth
Importance of Adopting BMI Classifications Using Public Health Action Points to Delineate Obstetric Risk Factors Resulting in Worsening Obstetric Outcomes Among Asian Population

Ganeshan M, Bujang MA, Soelar SA, Karalasingam SD, Suharjono H, Jeganathan R

J Obstet Gynaecol India, 2018 Jun;68(3):173-178.
PMID: 29895995 DOI: 10.1007/s13224-017-1000-9

Aims: The aim of this study is to compare obstetric outcomes between overweight and class 1 obesity among pregnant women in their first pregnancy based on WHO's BMI cut-offs and the potential public health action points identified by WHO expert consultations specific for high-risk population such as Asians.
Methods: This is a retrospective cohort review of data obtained from the Malaysian National Obstetrics and Gynaecology Registry between the year 2010 and year 2012. All women in their first pregnancy with a booking BMI in their first trimester were included in this study. The association between BMI classifications as defined by the WHO cut-offs and the potential public health action points identified by WHO expert consultations towards adverse obstetric outcomes was compared.
Results: A total of 88,837 pregnant women were included in this study. We noted that the risk of adverse obstetric outcomes was significantly higher using the public health action points identified by WHO expert consultations even among the overweight group as the risk of stillbirths was (OR 1.2; 95% CI 1.0,1.4), shoulder dystocia (OR 1.9; 95% CI 1.2,2.9), foetal macrosomia (OR 1.8; 95% CI 1.6,2.0), caesarean section (OR 1.9; 95% CI 1.8,2.0) and assisted conception (OR 1.9; 95% CI 1.6,2.1).
Conclusion: A specifically lower BMI references based on the potential public health action points for BMI classifications were a more sensitive predictor of adverse obstetric outcomes, and we recommend the use of these references in pregnancy especially among Asian population.

Matched MeSH terms: Stillbirth
Fulltext Leptospirosis seropositivity and its serovars among cattle in Northeastern Malaysia

Daud A, Fuzi NMHM, Arshad MM, Kamarudin S, Mohammad WMZW, Amran F, et al.

Vet World, 2018 Jun;11(6):840-844.
PMID: 30034179 DOI: 10.14202/vetworld.2018.840-844

Background: Leptospirosis is a zoonotic disease that infects human and livestock which causes economic losses to the farmers. It has been reported as one of the causes of reproductive failure in cattle and other ruminants, determining abortions, stillbirth, weak newborns, and decrease in their growth rate and milk production.
Aim: The objectives of this study were to determine the leptospirosis seroprevalence and to identify the predominant infecting serovars among cattle.
Materials and Methods: A cross-sectional study involving 420 cattle from six randomly selected districts in Kelantan was conducted. A serological test using the microscopic agglutination test was conducted in the Institute of Medical Research with a cutoff titer for seropositivity of ≥1:100.
Results: The overall prevalence of leptospirosis seropositivity among cattle in this study was 81.7% (95% confidence interval: 63.5, 80.1). The most common reaction obtained with the sera tested was from the serovar Sarawak with 78.8%.
Conclusion: A high seroprevalence of leptospiral antibodies was found among cattle in Northeastern Malaysia. These findings urge that more studies are required to determine the reasons for the high seroprevalence among the cattle along with its transmission and pathogenicity of the local serovar Sarawak.

Matched MeSH terms: Stillbirth
Fulltext Outcome of pregnancy in chromosomally normal foetus with increased nuchal translucency

Ranjit, S., Carol, P., Kellie, C., Pauline, M., Renuka, S.

International Medical Journal Malaysia, 2018;17(1):55-62.
MyJurnal

Objective: The aim of this study is to evaluate the outcome of pregnancy in prenatal and postnatal period of pregnancy complicated with thick nuchal translucency but normal karyotype. Methods: This is a retrospective study of 119 singleton pregnancies with increased NT (NT > 2.5mm) but a normal karyotype over a 3 year period. The records of ultrasound at 18-20 and 25-26 weeks’, antenatal and postnatal details were reviewed. The developmental and health outcomes of the surviving children were obtained through telephone conversation with the family. Adverse outcome such as miscarriages, termination of pregnancy, intrauterine death, structural anomalies and neurodevelopment delay were analysed. Results: Out of 119 foetuses with increased NT but normal karyotype, 11.8% of pregnancies ended with miscarriages, termination of pregnancy and intrauterine death. 89.9% foetuses were structurally normal. 12.9% presented with structural anomalies in the second-trimester ultrasound scan. 81.8% showed major malformations, out of which 44% consisted of heart defects. 1% of foetuses were syndromic and 1.9% had developmental delay. 96.8% of foetuses with NT equal to or greater than the 95th percentile (3.4mm) and 80% with NT equal to or greater than the 99 percentile (5.5mm) had a normal outcome. 50% of foetuses with thickened nuchal fold had a poor outcome. Postnatal follow-up was established for all infants and toddlers, and abnormalities were observed in 5.6% of them. Chances of having a live and healthy infant decreases with increased NT, corresponding to 80% for NT equal to or greater than 5.5mm. Conclusion: We have provided data that may help in the counselling of parents and increasing their confidence on a favourable pregnancy outcome. In cases with increased nuchal translucency but normal karyotype, the chances of normal pregnancy success rate is 89.9%. Parents can be reassured that thickened nuchal translucency with a normal karyotype and normal targeted ultrasound between 20-22 weeks gestation, the risk of adverse perinatal outcome and postnatal developmental delay is not increased in comparison with that of the general population. This seems to be the case for all degrees of increased nuchal translucency.

Matched MeSH terms: Stillbirth
Fulltext Biochemical derangement in twin pregnancy: complete hydatidiform mole and viable foetus

Munirah, M., Khalidah, M.B., Dian Nasriana, N., Hanita, O.

Medicine & Health, 2018;13(2):180-187.
MyJurnal

Case of co-existence of twin pregnancy of complete hydatidiform molar with viable intrauterine pregnancy is extremely rare with low incidence of 1 case for 20,000 – 100,000. It is associated with high risk of spontaneous abortion, preterm delivery, intrauterine death, bleeding, pre-eclampsia, and persistence trophoblastic disease (PTD). It may associate with biochemical derangement that may induce symptomatic manifestation to the mother. There are few cases reported in Asia population with significant clinical dilemma and management to the maternal and foetus. Here, we report a case of a young woman with previous bad obstetric history who presented with antepartum per-vaginal bleeding and was noted to have a twin pregnancy with complete hydatidiform molar and viable foetus. It was complicated with markedly elevated human chorionic gonadotropin (hCG) and hyperthyroidism. Postpartumly, her hCG level was persistently high and her condition progressed into gestational trophoblastic neoplasm.

Matched MeSH terms: Stillbirth

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