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Background Bartter syndrome (BS) is a rare autosomal recessive renal disease. There are relatively few reports on fetal Bartter syndrome, but it has been documented that the condition can increase the incidence of prematurity and hypovolemia. Umbilical vein thrombosis (UVT) is a rare obstetric complication that poses a serious threat to fetal safety, potentially leading to acute fetal distress and even intrauterine fetal death. Consequently, early identification and intervention of UVT are crucial. Case presentation We present a case of an emergency cesarean section prompted by ultrasound findings of intrahepatic segment of umbilical vein thrombosis and polyhydramnios. After birth, the newborn was admitted to the Department of Neonatology for observation and further treatment due to persistent, uncorrected hypokalemia. Genetic testing diagnosed the infant with Bartter syndrome type 4b. We hypothesize that the umbilical vein thrombosis and polyhydramnios in this case may be associated with fetal Bartter syndrome. Conclusion This case highlights a suspected instance of umbilical vein thrombosis and polyhydramnios potentially linked to fetal Bartter syndrome. Currently, the causes of umbilical vein thrombosis primarily focus on abnormalities in umbilical cord structure or mechanical injury to the cord, with few cases involving fetal genetic conditions. The purpose of this report is to enhance medical professionals' understanding of Bartter syndrome and to consider it as a possible cause of fetal umbilical vein thrombosis and polyhydramnios. Further research should explore the link between fetal Bartter syndrome, umbilical vein thrombosis, and polyhydramnios. Additionally, strengthening case collection and analysis will help accumulate experience, optimize management strategies, and improve maternal and fetal outcomes.

Background The Global Roadmap for Health Measurement and Accountability sees integrated systems for health information as key to obtaining seamless, sustainable, and secure information exchanges at all levels of health systems. The Global Strategy for Women’s, Children’s and Adolescent’s Health aims to achieve a continuum of quality of care with effective coverage of interventions. The WHO and World Bank recommend that countries focus on intervention coverage to monitor programs and progress for universal health coverage. Electronic health registries - eRegistries - represent integrated systems that secure a triple return on investments: First, effective single data collection for health workers to seamlessly follow individuals along the continuum of care and across disconnected cadres of care providers. Second, real-time public health surveillance and monitoring of intervention coverage, and third, feedback of information to individuals, care providers and the public for transparent accountability. This series on eRegistries presents frameworks and tools to facilitate the development and secure operation of eRegistries for maternal and child health. Methods In this first paper of the eRegistries Series we have used WHO frameworks and taxonomy to map how eRegistries can support commonly used electronic and mobile applications to alleviate health systems constraints in maternal and child health. A web-based survey of public health officials in 64 low- and middle-income countries, and a systematic search of literature from 2005–2015, aimed to assess country capacities by the current status, quality and use of data in reproductive health registries. Results eRegistries can offer support for the 12 most commonly used electronic and mobile applications for health. Countries are implementing health registries in various forms, the majority in transition from paper-based data collection to electronic systems, but very few have eRegistries that can act as an integrating backbone for health information. More mature country capacity reflected by published health registry based research is emerging in settings reaching regional or national scale, increasingly with electronic solutions. 66 scientific publications were identified based on 32 registry systems in 23 countries over a period of 10 years; this reflects a challenging experience and capacity gap for delivering sustainable high quality registries. Conclusions Registries are being developed and used in many high burden countries, but their potential benefits are far from realized as few countries have fully transitioned from paper-based health information to integrated electronic backbone systems. Free tools and frameworks exist to facilitate progress in health information for women and children.

Background The limited availability of maternal and child health data has limited progress in reducing mortality and morbidity among pregnant women and children. Global health agencies, leaders, and funders are prioritizing strategies that focus on acquiring high quality health data. Electronic maternal and child health registries (eRegistries) offer a systematic data collection and management approach that can serve as an entry point for preventive, curative and promotive health services. Due to the highly sensitive nature of reproductive health information, careful consideration must be accorded to privacy, access, and data security. In the third paper of the eRegistries Series, we report on the current landscape of ethical and legal governance for maternal and child health registries in developing countries. Methods This research utilizes findings from two web-based surveys, completed in 2015 that targeted public health officials and health care providers in 76 countries with high global maternal and child mortality burden. A sample of 298 public health officials from 64 countries and 490 health care providers from 59 countries completed the online survey. Based on formative research in the development of the eRegistries Governance Guidance Toolkit, the surveys were designed to investigate topics related to maternal and child health registries including ethical and legal issues. Results According to survey respondents, the prevailing legal landscape is characterized by inadequate data security safeguards and weak support for core privacy principles. Respondents from the majority of countries indicated that health information from medical records is typically protected by legislation although legislation dealing specifically or comprehensively with data privacy may not be in place. Health care provider trust in the privacy of health data at their own facilities is associated with the presence of security safeguards. Conclusion Addressing legal requirements and ensuring that privacy and data security of women’s and children’s health information is protected is an ethical responsibility that must not be ignored or postponed, particularly where the need is greatest. Not only are the potential harm and unintended consequences of inaction serious for individuals, but they could impact public trust in health registries leading to decreased participation and compromised data integrity.

Background Electronic health registries – eRegistries - can systematically collect relevant information at the point of care for reproductive, maternal, newborn and child health (RMNCH). However, a suite of process and outcome indicators is needed for RMNCH to monitor care and to ensure comparability between settings. Here we report on the assessment of current global indicators and the development of a suite of indicators for the WHO Essential Interventions for use at various levels of health care systems nationally and globally. Methods Currently available indicators from both household and facility surveys were collated through publicly available global databases and respective survey instruments. We then developed a suite of potential indicators and associated data points for the 45 WHO Essential Interventions spanning preconception to newborn care. Four types of performance indicators were identified (where applicable): process (i.e. coverage) and outcome (i.e. impact) indicators for both screening and treatment/prevention. Indicators were evaluated by an international expert panel against the eRegistries indicator evaluation criteria and further refined based on feedback by the eRegistries technical team. Results Of the 45 WHO Essential Interventions, only 16 were addressed in any of the household survey data available. A set of 216 potential indicators was developed. These indicators were generally evaluated favourably by the panel, but difficulties in data ascertainment, including for outcome measures of cause-specific morbidity and mortality, were frequently reported as barriers to the feasibility of indicators. Indicators were refined based on feedback, culminating in the final list of 193 total unique indicators: 93 for preconception and antenatal care; 53 for childbirth and postpartum care; and 47 for newborn and small and ill baby care. Conclusions Large gaps exist in the availability of information currently collected to support the implementation of the WHO Essential Interventions . The development of this suite of indicators can be used to support the implementation of eRegistries and other data platforms, to ensure that data are utilised to support evidence-based practice, facilitate measurement and accountability, and improve maternal and child health outcomes.

Background 2.7 million babies were stillborn in 2015 worldwide; behind these statistics lie the experiences of bereaved parents. The first Lancet series on stillbirth in 2011 described stillbirth as one of the “most shamefully neglected” areas of public health, recommended improving interaction between families and frontline caregivers and made a plea for increased investment in relevant research. Methods A systematic review of qualitative, quantitative and mixed-method studies researching parents and healthcare professionals experiences of care after stillbirth in high-income westernised countries (Europe, North America, Australia and South Africa) was conducted. The review was designed to inform research, training and improve care for parents who experience stillbirth. Results Four thousand four hundred eighty eight abstracts were identified; 52 studies were eligible for inclusion. Synthesis and quantitative aggregation (meta-summary) was used to extract findings and calculate frequency effect sizes (FES%) for each theme (shown in italics), a measure of the prevalence of that finding in the included studies. Researchers’ areas of interest may influence reporting of findings in the literature and result in higher FES sizes, such as; support memory making (53 %) and fathers have different needs (18 %). Other parental findings were more unexpected; Parents want increased public awareness (20 %) and for stillbirth care to be prioritised (5 %). Parental findings highlighted lessons for staff; prepare parents for vaginal birth (23 %), discuss concerns (13 %), give options & time (20 %), privacy not abandonment (30 %), tailored post-mortem discussions (20 %) and post-natal information (30 %). Parental and staff findings were often related; behaviours and actions of staff have a memorable impact on parents (53 %) whilst staff described emotional, knowledge and system-based barriers to providing effective care (100 %). Parents reported distress being caused by midwives hiding behind ‘doing’ and ritualising guidelines whilst staff described distancing themselves from parents and focusing on tasks as coping strategies. Parents and staff both identified the need for improved training (parents 25 % & staff 57 %); continuity of care (parents 15 % & staff 36 %); supportive systems & structures (parents 50 %); and c lear care pathways (parents 5 %). Conclusions Parents’ and healthcare workers’ experiences of stillbirth can inform training, improve the provision of care and highlight areas for future research.

Background Stillbirth, defined as the death of a fetus at or after 22 weeks of gestation, remains a neglected public health issue, with approximately 2 million stillbirths occurring annually. Pakistan ranks among the top three countries with the highest number of stillbirths, yet progress in reducing stillbirth rates remains slower than regional and global averages. Despite the substantial burden, there is a lack of evidence on the prevalence, geographic variation, and predictors of stillbirths in Pakistan, particularly from marginalized settings. Methods We conducted a longitudinal cohort study in 12 selected public and private birthing facilities located in Karachi, Sindh, Pakistan between February 9, 2021, and January 1, 2022. We enrolled pregnant women visiting the selected birthing sites during antenatal care visits and those directly visiting for deliveries. We used the World Health Organization (WHO) standard definition of stillbirth occurring at a gestational age of ≥22 weeks. We analyzed stillbirth rates across birthing sites, geographic location, and gestational age, and used firth logistic regression to identify risk factors for stillbirths. Results Of the pregnant women enrolled ( n  = 21,523), 63.5% (13,668/21,523) with a gestational age ≥ 22 weeks delivered their babies at the study birthing facilities. The overall weighted stillbirth rate was 12.0 per 1,000 births across all sites. The prevalence varied substantially across sites, geographic location, gestational age, and facility type (public or private). Multivariable logistic regression showed a significant association between polio-endemic super high-risk union councils (AHR: 3.53; CI: 1.84–6.75), preterm delivery (AHR: 3.97; CI: 1.42–11.16), unvaccinated for Tetanus Toxoid (TT) vaccine during pregnancy (AHR: 5.29; CI: 2.61–10.74), and having received <8 ANC visits (AHR: 2.40; CI: 1.04–5.53) with stillbirth outcomes. Conclusion Our study found significant variation in stillbirth prevalence across birthing facilities and geographic locations, with notably higher stillbirth rates in polio-endemic regions. These findings highlight the need for integrated approaches that combine polio eradication efforts with enhanced maternal healthcare services including maternal immunizations to maximize efficiency and impact. Additionally, efforts are needed to ensure high-quality antenatal care services and efficient management of medical conditions and prematurity during pregnancy.

Background Segregation is the degree to which two or more groups live separately. While US research has linked segregation to increased stillbirth risk, studies from Latin America have yet to explore this. This study investigated the association between the racial and income segregation index (SI) and stillbirth prevalence in Brazil. Methods We used nationwide birth data from Brazil in 2018 (live births from Live Birth Information System, SINASC, and stillbirths from Mortality Information System, SIM). Income and racial SI were calculated using the 2010 national census and analyzed as quintiles with the least segregated group as the reference. Odds ratios were calculated using a logistic regression model, adjusting for infant sex, maternal age, education, previous fetal loss, and the municipal level percentage of the population earning less than half the minimum wage. The sub-analysis was stratified by city size, area-level stillbirth prevalence, and stillbirth type (intrapartum or antepartum). Results Two million seven hundred seventy-one thousand two hundred seventy-two live-born and stillborn in 2018 were included in the analysis. Women in municipalities with high income and racial SI were older, had more education, and had more previous fetal loss. Women in municipalities with the highest income SI had a 25.1% higher risk of delivering a stillbirth (95% CI: 1.202–1.303). Those in the highest racial SI municipalities had a 5.5% lower risk of delivering a stillbirth compared to those in the quintile with the lowest racial SI (95% CI: 0.908–0.984). In regions with low stillbirth prevalence, a dose-response relationship was observed between income segregation and stillbirth, with the risk of stillbirth among those with the highest income SI being more than twice that of the least segregated (OR 2.086, 95% CI: 1.494–2.911). In larger cities, racial and income segregation were associated with reduced odds of stillbirth. The effect of income SI was larger for intrapartum stillbirths. Conclusions We observed that income segregation increases the odds of stillbirth, especially in municipalities with low stillbirth prevalence, while the association for racial segregation was less consistent.

Background Despite improvements in maternity healthcare services over the last few decades, more than 2.7 million babies worldwide are stillborn each year. The global health agenda is silent about stillbirth, perhaps, in part, because its wider impact has not been systematically analysed or understood before now across the world. Our study aimed to systematically review, evaluate and summarise the current evidence regarding the psychosocial impact of stillbirth to parents and their families, with the aim of improving guidance in bereavement care worldwide. Methods Systematic review and meta-summary (quantitative aggregation of qualitative findings) of quantitative, qualitative, and mixed-methods studies. All languages and countries were included. Results Two thousand, six hundred and nineteen abstracts were identified; 144 studies were included. Frequency effect sizes (FES %) were calculated for each theme, as a measure of their prevalence in the literature. Themes ranged from negative psychological symptoms post bereavement (77 · 1) and in subsequent pregnancies (27 · 1), to disenfranchised grief (31 · 2), and incongruent grief (28 · 5), There was also impact on siblings (23 · 6) and on the wider family (2 · 8). They included mixed-feelings about decisions made when the baby died (12 · 5), avoidance of memories (13 · 2), anxiety over other children (7 · 6), chronic pain and fatigue (6 · 9), and a different approach to the use of healthcare services (6 · 9). Some themes were particularly prominent in studies of fathers; grief suppression (avoidance)(18 · 1), employment difficulties, financial debt (5 · 6), and increased substance use (4 · 2). Others found in studies specific to mothers included altered body image (3 · 5) and impact on quality of life (2 · 1). Counter-intuitively, Some themes had mixed connotations. These included parental pride in the baby (5 · 6), motivation for engagement in healthcare improvement (4 · 2) and changed approaches to life and death, self-esteem, and own identity (25 · 7). In studies from low/middle income countries, stigmatisation (13 · 2) and pressure to prioritise or delay conception (9) were especially prevalent. Conclusion Experiencing the birth of a stillborn child is a life-changing event. The focus of the consequences may vary with parent gender and country. Stillbirth can have devastating psychological, physical and social costs, with ongoing effects on interpersonal relationships and subsequently born children. However, parents who experience the tragedy of stillbirth can develop resilience and new life-skills and capacities. Future research should focus on developing interventions that may reduce the psychosocial cost of stillbirth.

Introduction In this report, we present a unique case of a stillbirth accompanied by significant unexplained retroperitoneal hematoma (RPH). Patient Information A 36-year-old patient at 31 6/7 weeks of gestation was confirmed stillbirth accompanied by clinical signs of significant blood loss. Diagnosis, Treatment and prognosis After laparotomy and CTA examination, we clearly diagnosed the retroperitoneal hematoma. Arterial angiography revealed bleeding in the left inferior phrenic artery and an embolization was performed, successfully controlled the bleeding. Discussion This case gives clinician a clue for searching for the causes in pregnant women presenting with unexplained bleeding and provides some tips for searching for the bleeding vessels of retroperitoneal hematoma. It also suggests that the huge retroperitoneal hematoma might be a cause of stillbirth.

Background Each year, about 5.3 million babies die in the perinatal period. Understanding of causes of death is critical for prevention, yet there is no globally acceptable classification system. Instead, many disparate systems have been developed and used. We aimed to identify all systems used or created between 2009 and 2014, with their key features, including extent of alignment with the International Classification of Diseases (ICD) and variation in features by region, to inform the World Health Organization’s development of a new global approach to classifying perinatal deaths. Methods A systematic literature review (CINAHL, EMBASE, Medline, Global Health, and PubMed) identified published and unpublished studies and national reports describing new classification systems or modifications of existing systems for causes of perinatal death, or that used or tested such systems, between 2009 and 2014. Studies reporting ICD use only were excluded. Data were independently double-extracted (except from non-English publications). Subgroup analyses explored variation by extent and region. Results Eighty-one systems were identified as new, modifications of existing systems, or having been used between 2009 and 2014, with an average of ten systems created/modified each year. Systems had widely varying characteristics: (i) comprehensiveness (40 systems classified both stillbirths and neonatal deaths); (ii) extent of use (systems were created in 28 countries and used in 40; 17 were created for national use; 27 were widely used); (iii) accessibility (three systems available in e-format); (iv) underlying cause of death (64 systems required a single cause of death); (v) reliability (10 systems tested for reliability, with overall Kappa scores ranging from .35–.93); and (vi) ICD alignment (17 systems used ICD codes). Regional databases were not searched, so system numbers may be underestimated. Some non-differential misclassification of systems was possible. Conclusions The plethora of systems in use, and continuing system development, hamper international efforts to improve understanding of causes of death. Recognition of the features of currently used systems, combined with a better understanding of the drivers of continued system creation, may help the development of a truly effective global system.