This study is about how parents cope with pregnancy and infant loss and the use of internet support sites. We understand that losing a pregnancy or baby can be an extremely stressful event, and are very sorry for your loss. We know it may be hard to think about filling out a research survey at this time, but we are trying to develop internet programs to help future parents. All of the information you provide is completely confidential.
Research Study - what helps and does not help newly bereaved families in the hospital?
Research Study - medical bad news delivery and the communications between patients and care providers about their diagnosis
Mothers’ perceptions of fetal movement are key to improving perinatal outcomes.
Two recent articles [check pub date] by ISA Board members Dr Frederik Frøen, Dr Babill Stray-Pedersen, Dr Ruth Fretts and Vicki Flenady, RN, and their colleagues, Alexander E.P. Heazell, Julie Victoria Holm Tveit, Per E. Børdahl, and Eli Saastad, point out that mothers’ perception of fetal movements is the oldest and most commonly used method to assess fetal well-being, a method to which almost all pregnant women adhere. The method seems to work--women who seek medical attention because of their perceptions of decreased fetal movements do indeed have a higher risk of stillbirth, fetal growth restriction, fetal distress, preterm birth, and other serious perinatal problems. Improved awareness of fetal movements has been associated with improved perinatal outcomes.
Unfortunately, the “holy grail”—a clear and proven “alarm limit” of fetal movements, below which the alarm must be sounded—has proven elusive: no proposed definitions of decreased fetal movements have ever been proven to be superior to mothers’ own perceptions in terms of identifying risk to the fetus. There is currently not enough research evidence on the optimal management of women who report decreased fetal movements. No randomized controlled trials have been performed. Given the lack of data, the research team advises that the use of specific limits developed for fetal movement counting should be discouraged. This does not mean fetal movement monitoring should not be used. Indeed, the strong associations between decreased fetal movement and adverse outcomes suggest several steps be taken when decreased fetal movement is perceived by the mother. These steps include confriming that movements are decreased through consultation and prviding guidance to the mother about how best to count movements if necessary. If maternal concern remains, the exclusion of both acute and chronic conditions associated with decreased fetal movements should be undertaken including a nonstress test and an ultrasound scan.
For more information, please see the full article at [source Semin Perinatol 32:243-246 and Semin Perinatol 32:307-311]
Trends in intrapartum fetal death in Ireland, 1979-2003
This 200x study, authored by Walsh, McMenamin, Foley, Daly, Robson, and Geary, was undertaken to analyze trends in intrapartum fetal death and rates of perinatal autopsy over a 25-year period in Dublin, Ireland. Results of this long-term study show that there was a significant decrease in the rate of intrapartum fetal death in the period studied. This primarily resulted from a reduction in deaths attributable to intrapartum hypoxia. The study also found that rates of perinatal autopsy had fallen significantly during the same period, a matter of concern for researchers in particular[SHL1] .
Walsh CA, McMenamin MB, Foley ME, Daly SF, Robson MS, Geary MP. “Trends in intrapartum fetal death, 1979-2003.” Am J Obstet Gynecol. 2008 Jan;198(1):47 e1-7.
Binge drinking in pregnancy and risk of fetal death
Drinking is considered binge drinking when there is an intake of five or more drinks on one occasion. A 200x study by Strandberg-Larsen, Nielsen, Grønbœk, Andersen, Olsen, and Andersen examined whether the frequency and timing of binge drinking episodes during the first 16 weeks of pregnancy increase the risk of fetal death. 89,201 women from 1996 to 2002 participated in this study, and results showed that while binge drinking three or more times during pregnancy is associated with an increased risk of stillbirth, neither the frequency nor the timing of binge drinking was associated with an increased risk of spontaneous abortion.
Strandberg-Larsen K, Nielsen NR, Gronbaek M, Andersen PK, Olsen J, Andersen AM. “Binge drinking in pregnancy and risk of fetal death.” Obstet Gynecol. 2008 Mar;111(3):602-9.
Study in Indonesia finds multiple-nutrient supplementation does better than iron and folic acid alone in reducing neonatal deaths
In developing countries, nutrient supplementation for pregnant women is generally restricted to provision of iron and folic acid. This 200x study led by Shankar compared the effect of maternal supplementation with multiple micronutrients to that of supplementation with iron and folic acid alone, on fetal loss and infant death. The study randomly assigned 262 midwives to distribute supplements to 31,290 pregnant women. Results showed that multiple micronutrients can reduce the incidence of early infant mortality and other adverse obstetric outcomes.
Supplementation with Multiple Micronutrients Intervention Trial (SUMMIT) Study Group, Shankar AH, Jahari AB, Sebayang SK, Aditiawarman, Apriatni M, Harefa B, Muadz H, Soesbandoro SD, Tjiong R, Fachry A, Shankar AV, Atmarita, Prihatini S, Sofia G. “Effect of maternal multiple micronutrient supplementation on fetal loss and infant death in Indonesia: a double-blind cluster-randomised trial.” Lancet. 2008 Jan 19;371(9608):215-27.
Viruses and other infections—a possible cause of some stillbirths?
The exact causes of almost half of all stillbirths are unknown. Recent evidence suggests that some viruses may be a contributing factor, either alone or in combination with other infections. This 200x article by Rawlinson, Hall, Jones, Jeffery, Arbuckle, Graf, Howard, and Morris describes some of the causes of stillbirth including clinical, epidemiological, viral and other infectious agents causes. It summarizes some of the recently-developed molecular techniques used to detect the presence of any infection in the placenta and/or stillborn baby. Finally, the article describes whether the actual infectious agent caused death or whether there may be other causes. Having a correct diagnosis is a great benefit to parents in their decision-making for future pregnancies.
Rawlinson WD, Hall B, Jones CA, Jeffery HE, Arbuckle SM, Graf N, et al. “Viruses and other infections in stillbirth: what is the evidence and what should we be doing?” Pathology. 2008 Feb;40(2):149-60.
New article/study regarding 'Seeing and holding stillborns immediately after birth"
Line Christoffersen (ISA Parent Committee member) from Norway, has co-authored an important article:
The article, published in the 4 September 2008 British Journal of Midwifery, Vol. 16, Iss. 9, can be found at http://www.intermid.co.uk/cgi-bin/go.pl/library/article.cgi?uid=30885;article=BJM_16_9_588_591
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