NSIDRC Journal Article Alert — June 12, 2009

Prepared by the National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center at Georgetown University.

Past issues of Resource Center journal alerts are available at http://www.sidscenter.org.
Availability of full-text journal articles is often limited to subscribers or through inter-library loan. Please see your local library for copies of these articles, or view PubMed's How to Get the Journal Article for more details.

Sudden Infant Death

1. Shao XM, Feldman JL

Central cholinergic regulation of respiration: nicotinic receptors

Acta Pharmacol Sin. 2009 Jun;30(6):761-70

Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1763, USA. mshao@ucla.edu

Nicotinic acetylcholine receptors (nAChRs) are expressed in brainstem and spinal cord regions involved in the control of breathing. These receptors mediate central cholinergic regulation of respiration and effects of the exogenous ligand nicotine on respiratory pattern. Activation of alpha4* nAChRs in the preBötzinger Complex (preBötC), an essential site for normal respiratory rhythm generation in mammals, modulates excitatory glutamatergic neurotransmission and depolarizes preBötC inspiratory neurons, leading to increases in respiratory frequency. nAChRs are also present in motor nuclei innervating respiratory muscles. Activation of post- and/or extra-synaptic alpha4* nAChRs on hypoglossal (XII) motoneurons depolarizes these neurons, potentiating tonic and respiratory-related rhythmic activity. As perinatal nicotine exposure may contribute to the pathogenesis of sudden infant death syndrome (SIDS), we discuss the effects of perinatal nicotine exposure on development of the cholinergic and other neurotransmitter systems involved in control of breathing. Advances in understanding of the mechanisms underlying central cholinergic/nicotinic modulation of respiration provide a pharmacological basis for exploiting nAChRs as therapeutic targets for neurological disorders related to neural control of breathing such as sleep apnea and SIDS.

2. Adams SM, Good MW, Defranco GM

Sudden infant death syndrome

Am Fam Physician. 2009 May 15;79(10):870-4

Department of Family Medicine, University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee 37403, USA. stephen.adams@erlanger.org

Sudden infant death syndrome is the leading cause of death among healthy infants, affecting 0.57 per 1,000 live births. The most easily modifiable risk factor for sudden infant death syndrome is sleeping position. To reduce the risk of sudden infant death syndrome, parents should be advised to place infants on their backs to sleep and avoid exposing the infant to cigarette smoke. Other recommendations include use of a firm sleeping surface and avoidance of sleeping with soft objects, bed sharing, and overheating the infant. Pacifier use appears to decrease the risk of sudden infant death syndrome, but should be avoided until one month of age in infants who are breastfed. The occurrence of apparent life-threatening events does not increase the risk of sudden infant death syndrome, and home apnea monitoring does not lower the risk of sudden infant death syndrome. Supine sleeping position has increased the incidence of flattening of the occiput (deformational plagiocephaly), but this condition can be prevented and treated by encouraging supervised "tummy time," meaning that when awake, infants should spend as much time as possible on their stomachs. All apparent deaths from sudden infant death syndrome should be carefully investigated to exclude other causes of death, including child abuse. Families who have an infant die from sudden infant death syndrome should be offered emotional support and grief counseling.

3. Issler RM, Marostica PJ, Giugliani ER

Infant sleep position: a randomized clinical trial of an educational intervention in the maternity ward in Porto Alegre, Brazil

Birth. 2009 Jun;36(2):115-21

Professor in the Department of Pediatrics, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre 90035-003, Brazil. robertoissler@terra.com.br

BACKGROUND: Few studies in Brazil have been published about sudden infant death syndrome (SIDS), and none has addressed the mother's orientation about placing the infant to sleep in the supine position. The aim of this study was to evaluate the effect on mothers of an individual educational intervention in the maternity ward about infant sleep position. METHODS: A randomized clinical trial was conducted with a study sample of 228 mother-infant pairs assigned to an intervention or a control group. The intervention consisted of an individual orientation session at the maternity ward, at which folders and an oral explanation were given to mothers at discharge about the importance of the supine position as a preventive measure for SIDS. The outcome was the sleeping position at 3 months of age assessed during a home visit. The variables with p< 0.2 at a bivariate analysis were included in a logistic regression model. RESULTS: Among mothers in the intervention group, 42.9 percent put their infants to sleep in a supine position at the 3-month visit, compared with 24 percent of mothers in the control group (p = 0.009). In a multivariate analysis, the intervention at the hospital was the only variable that influenced maternal practices with respect to infant sleep positioning (OR 2.22; 95% CI 1.17-4.19). CONCLUSIONS: An individual educational session in the maternity ward about infant sleep position significantly increased the prevalence of supine position for sleeping in the infant's third month. Nevertheless, the intervention was not sufficient to guarantee that most mothers would put their infants to sleep in the recommended position.

Miscarriage/Stillbirth/Prenatal Issues

1. Tabor A, Vestergaard CH, Lidegaard O

Fetal loss rate after chorionic villus sampling and amniocentesis: an 11-year national registry study

Ultrasound Obstet Gynecol. 2009 Jun 5. [Epub ahead of print]

Department of Fetal Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.

OBJECTIVE: To assess the fetal loss rate following amniocentesis and chorionic villus sampling (CVS). METHODS: This was a national registry-based cohort study, including all singleton pregnant women who had an amniocentesis (n = 32 852) or CVS (n = 31 355) in Denmark between 1996 and 2006. Personal registration numbers of women having had an amniocentesis or a CVS were retrieved from the Danish Central Cytogenetic Registry, and cross-linked with the National Registry of Patients to determine the outcome of each pregnancy. Postprocedural fetal loss rate was defined as miscarriage or intrauterine demise before 24 weeks of gestation. RESULTS: The miscarriage rates were 1.4% (95% CI, 1.3-1.5) after amniocentesis and 1.9% (95% CI, 1.7-2.0) after CVS. The postprocedural loss rate for both procedures did not change during the 11-year study period, and was not correlated with maternal age. The number of procedures a department performed had a significant effect on the risk of miscarriage. In departments performing fewer than 500 amniocenteses, the odds ratio for fetal loss was 2.2 (95% CI, 1.6-3.1) when compared to departments performing more than 1500 procedures during the 11-year period. For CVS the risk of miscarriage was 40% greater in departments performing 500-1000 and 1001-1500 as compared to those performing more than 1500 procedures. CONCLUSIONS: The miscarriage rates (i.e. spontaneous loss and procedure-related loss) after amniocentesis and CVS were 1.4% and 1.9%, respectively. This difference may be explained by the difference in gestational age at the time of the procedures. The miscarriage rate was inversely correlated with the number of procedures performed in a department. Copyright (c) 2009 ISUOG. Published by John Wiley & Sons, Ltd.

2. Bottomley C, Bourne T

Diagnosing miscarriage

Best Pract Res Clin Obstet Gynaecol. 2009 Jun 5. [Epub ahead of print]

St George's University of London, Cranmer Terrace, London SW17 0RE, UK.

Miscarriage is the most common serious pregnancy complication affecting approximately 30% of biochemical pregnancies and 11-20% of clinically recognised pregnancies. The diagnosis of miscarriage is made most commonly by trans-vaginal ultrasound (TVS) assessment. Evidence-based criteria should be employed for the diagnosis of delayed and incomplete miscarriage. Complete miscarriage should not be diagnosed with TVS alone without serial biochemical confirmation (unless an intrauterine gestation sac has previously been visualised). After a clinical assessment suggesting complete miscarriage, 45% of women will have retained tissue on ultrasound, whilst women with an ultrasound scan showing an empty uterus with a history suggestive of miscarriage will be found to have an ectopic pregnancy in 6% of cases. Prediction of the diagnosis of miscarriage using maternal history and ultrasound features may be helpful in counselling women towards likely pregnancy outcome and planning appropriate further assessment. Use of three-dimensional ultrasound has not improved diagnosis of miscarriage. After a diagnosis of miscarriage, half the women undergo significant psychological effects, which may last for up to 12 months.

3. Farley D, Dudley DJ

Fetal assessment during pregnancy

Pediatr Clin North Am. 2009 Jun;56(3):489-504

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, MSC 7836, San Antonio, TX 78229-3900, USA.

Fetal monitoring during pregnancy is used to prevent fetal death. This article addresses the goals of fetal monitoring during pregnancy. Methods of fetal surveillance are reviewed, as well as the meaning of abnormal fetal testing and how these results relate to fetal and neonatal outcome. Overall, pediatricians who understand the goals, methods, and interpretation of fetal testing can communicate more effectively with the delivering obstetric team in anticipation of optimizing obstetric and pediatric outcomes.

4. Chan YM, Sahota DS, Chan OK, Leung TY, Lau TK

Miscarriage after invasive prenatal diagnostic procedures: how much risk our pregnant women are willing to take?

Prenat Diagn. 2009 Jun 4. [Epub ahead of print]

Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.

OBJECTIVES: To elicit the level of risk of prenatal diagnostic procedure-related miscarriage that Chinese pregnant women were willing to accept. METHODS: An interviewer-administered survey was conducted on 276 women who presented to the University Obstetric Unit. Using the standard gamble approach, subjects were asked to choose between a screening test with a 90% detection rate and a diagnostic test which is definitive but carries a finite risk of abortion. This probability of abortion was varied until the subject was indifferent between the two choices, and the value was called the utility score. RESULTS: When compared with a screening test with 90% detection rate, the median utility score was 0.989 (IQR: 0.970-0.999). The median risk of abortion below which the subjects would rather opt for an invasive test instead of a screening test was 1.1%. The percentage of patients who could accept a procedure-related miscarriage risk of 0.2, 0.5, 1 and 2% were 76, 67, 59.8 and 38.4%, respectively. CONCLUSIONS: Pregnant Chinese women agreed to trade a definitive chromosomal diagnostic test from a highly effective screening test with a small risk of undiagnosed aneuploidy provided that the procedure-related miscarriage risk was 1.1% or lower. Copyright (c) 2009 John Wiley & Sons, Ltd.

5. Warland J, McCutcheon H, Baghurst P

Placental position and late stillbirth: a case-control study

J Clin Nurs. 2009 Jun;18(11):1602-6

University of South Australia, Adelaide, Australia. jane.warland@unisa.edu.au

AIMS AND OBJECTIVES: The aim of this study was to determine whether there is a relationship between placental position and stillbirth with the objective of establishing if placental position impacted on stillbirth risk. BACKGROUND: Whilst there has been extensive research on low placental implantation because of the importance of detecting placenta praevia, little research has been undertaken on other aspects of placental position and possible impact on pregnancy outcome. DESIGN: A matched case-control study of stillbirth and placental position was conducted using case-notes from two tertiary obstetric referral centres. METHODS: Notes were retrospectively examined and Placental position as documented in the case-notes at the routine mid-trimester (20 week) ultrasound was identified. Placental position for a total of 124 pregnancies culminating in stillbirth was compared with placental position in 243 (matched) pregnancies resulting in a live born baby. RESULTS: Women who had a posterior located placenta were statistically more likely to suffer a stillbirth than women who had a placenta in any other position OR 1.64 (95%CI 1.02-2.65 p = 0.04). CONCLUSION: Posterior located placenta may be a contributory risk factor for stillbirth. Further research is warranted. Implications for practice. Nurses and midwives should be aware of this potential risk factor to monitor foetal well-being closely.

6. Murphy F, Merrell J

Negotiating the transition: caring for women through the experience of early miscarriage

J Clin Nurs. 2009 Jun;18(11):1583-91

Senior Lecturer, School of Health Science, University of Wales Swansea, Swansea, Wales, UK. f.murphy@swan.ac.uk

AIM: To explore women's experiences of having an early miscarriage in a hospital gynaecological unit. BACKGROUND: Miscarriage is a global health issue affecting significant numbers of women and is usually considered a distressing experience. This distress is often interpreted as being characteristic of grief. Nurses and other health professionals in hospital and community settings are therefore expected to provide appropriate care to meet the physical and emotional needs of the woman. DESIGN: A qualitative, ethnographic study of a hospital gynaecological unit in the UK. METHODS: The primary method was 20 months of part-time participant observation. Data were also collected through documentary analysis of key documents in the setting and formal interviews. These were with eight women who had an early miscarriage and 16 health professionals (nurses, doctors, ultrasonographers) working in the unit. RESULTS: Three clear phases emerged in the women's experience of miscarriage and hospital admission; first signs and confirmation, losing the baby and the aftermath. These were interpreted as being components of a process of transition. The hospital admission emerged as vital in these early phases in which the importance of nurses and other health professionals providing sensitive, engaged care to meet the emotional and physical needs of the woman was identified. CONCLUSIONS: The hospital setting emerged as highly influential in shaping the care that was given to women and influencing their experiences. Transition models were felt to be more appropriate than grief and bereavement models in guiding the psychological care given to women. RELEVANCE TO CLINICAL PRACTICE: The experience of hospital admission and the actions of nurses and other health professionals is influential in how women negotiate the transition through miscarriage.

Prepared by the
National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center
Georgetown University
2115 Wisconsin Avenue, N.W., Suite 601
Washington, DC 20007
(866) 866-7437 toll free
(202) 687-7466 local
(202) 784-9777 fax
info@sidscenter.org
http://www.sidscenter.org


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	Center Resources Bereavement Support Bibliographies Child Care and SIDS Definitions En Español First Responders For Families Infant Mortality Journal Alerts MCH Alert Multimedia Pregnancy Loss Professional Resources Safe Sleep Environment Statistics Training Toolkit Partner SIDS/ID Centers National SIDS & Infant Death Program Support Center / First Candle National SIDS & Infant Death Project IMPACT National Center for Cultural Competence SIDS/ID Project For more information on maternal and child health topics, visit the MCH Library	NSIDRC Journal Article Alert — June 12, 2009 Prepared by the National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center at Georgetown University. Past issues of Resource Center journal alerts are available at http://www.sidscenter.org. Availability of full-text journal articles is often limited to subscribers or through inter-library loan. Please see your local library for copies of these articles, or view PubMed's How to Get the Journal Article for more details. Sudden Infant Death 1. Shao XM, Feldman JL Central cholinergic regulation of respiration: nicotinic receptors Acta Pharmacol Sin. 2009 Jun;30(6):761-70 Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1763, USA. mshao@ucla.edu Nicotinic acetylcholine receptors (nAChRs) are expressed in brainstem and spinal cord regions involved in the control of breathing. These receptors mediate central cholinergic regulation of respiration and effects of the exogenous ligand nicotine on respiratory pattern. Activation of alpha4* nAChRs in the preBötzinger Complex (preBötC), an essential site for normal respiratory rhythm generation in mammals, modulates excitatory glutamatergic neurotransmission and depolarizes preBötC inspiratory neurons, leading to increases in respiratory frequency. nAChRs are also present in motor nuclei innervating respiratory muscles. Activation of post- and/or extra-synaptic alpha4* nAChRs on hypoglossal (XII) motoneurons depolarizes these neurons, potentiating tonic and respiratory-related rhythmic activity. As perinatal nicotine exposure may contribute to the pathogenesis of sudden infant death syndrome (SIDS), we discuss the effects of perinatal nicotine exposure on development of the cholinergic and other neurotransmitter systems involved in control of breathing. Advances in understanding of the mechanisms underlying central cholinergic/nicotinic modulation of respiration provide a pharmacological basis for exploiting nAChRs as therapeutic targets for neurological disorders related to neural control of breathing such as sleep apnea and SIDS. 2. Adams SM, Good MW, Defranco GM Sudden infant death syndrome Am Fam Physician. 2009 May 15;79(10):870-4 Department of Family Medicine, University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee 37403, USA. stephen.adams@erlanger.org Sudden infant death syndrome is the leading cause of death among healthy infants, affecting 0.57 per 1,000 live births. The most easily modifiable risk factor for sudden infant death syndrome is sleeping position. To reduce the risk of sudden infant death syndrome, parents should be advised to place infants on their backs to sleep and avoid exposing the infant to cigarette smoke. Other recommendations include use of a firm sleeping surface and avoidance of sleeping with soft objects, bed sharing, and overheating the infant. Pacifier use appears to decrease the risk of sudden infant death syndrome, but should be avoided until one month of age in infants who are breastfed. The occurrence of apparent life-threatening events does not increase the risk of sudden infant death syndrome, and home apnea monitoring does not lower the risk of sudden infant death syndrome. Supine sleeping position has increased the incidence of flattening of the occiput (deformational plagiocephaly), but this condition can be prevented and treated by encouraging supervised "tummy time," meaning that when awake, infants should spend as much time as possible on their stomachs. All apparent deaths from sudden infant death syndrome should be carefully investigated to exclude other causes of death, including child abuse. Families who have an infant die from sudden infant death syndrome should be offered emotional support and grief counseling. 3. Issler RM, Marostica PJ, Giugliani ER Infant sleep position: a randomized clinical trial of an educational intervention in the maternity ward in Porto Alegre, Brazil Birth. 2009 Jun;36(2):115-21 Professor in the Department of Pediatrics, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre 90035-003, Brazil. robertoissler@terra.com.br BACKGROUND: Few studies in Brazil have been published about sudden infant death syndrome (SIDS), and none has addressed the mother's orientation about placing the infant to sleep in the supine position. The aim of this study was to evaluate the effect on mothers of an individual educational intervention in the maternity ward about infant sleep position. METHODS: A randomized clinical trial was conducted with a study sample of 228 mother-infant pairs assigned to an intervention or a control group. The intervention consisted of an individual orientation session at the maternity ward, at which folders and an oral explanation were given to mothers at discharge about the importance of the supine position as a preventive measure for SIDS. The outcome was the sleeping position at 3 months of age assessed during a home visit. The variables with p< 0.2 at a bivariate analysis were included in a logistic regression model. RESULTS: Among mothers in the intervention group, 42.9 percent put their infants to sleep in a supine position at the 3-month visit, compared with 24 percent of mothers in the control group (p = 0.009). In a multivariate analysis, the intervention at the hospital was the only variable that influenced maternal practices with respect to infant sleep positioning (OR 2.22; 95% CI 1.17-4.19). CONCLUSIONS: An individual educational session in the maternity ward about infant sleep position significantly increased the prevalence of supine position for sleeping in the infant's third month. Nevertheless, the intervention was not sufficient to guarantee that most mothers would put their infants to sleep in the recommended position. Miscarriage/Stillbirth/Prenatal Issues 1. Tabor A, Vestergaard CH, Lidegaard O Fetal loss rate after chorionic villus sampling and amniocentesis: an 11-year national registry study Ultrasound Obstet Gynecol. 2009 Jun 5. [Epub ahead of print] Department of Fetal Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. OBJECTIVE: To assess the fetal loss rate following amniocentesis and chorionic villus sampling (CVS). METHODS: This was a national registry-based cohort study, including all singleton pregnant women who had an amniocentesis (n = 32 852) or CVS (n = 31 355) in Denmark between 1996 and 2006. Personal registration numbers of women having had an amniocentesis or a CVS were retrieved from the Danish Central Cytogenetic Registry, and cross-linked with the National Registry of Patients to determine the outcome of each pregnancy. Postprocedural fetal loss rate was defined as miscarriage or intrauterine demise before 24 weeks of gestation. RESULTS: The miscarriage rates were 1.4% (95% CI, 1.3-1.5) after amniocentesis and 1.9% (95% CI, 1.7-2.0) after CVS. The postprocedural loss rate for both procedures did not change during the 11-year study period, and was not correlated with maternal age. The number of procedures a department performed had a significant effect on the risk of miscarriage. In departments performing fewer than 500 amniocenteses, the odds ratio for fetal loss was 2.2 (95% CI, 1.6-3.1) when compared to departments performing more than 1500 procedures during the 11-year period. For CVS the risk of miscarriage was 40% greater in departments performing 500-1000 and 1001-1500 as compared to those performing more than 1500 procedures. CONCLUSIONS: The miscarriage rates (i.e. spontaneous loss and procedure-related loss) after amniocentesis and CVS were 1.4% and 1.9%, respectively. This difference may be explained by the difference in gestational age at the time of the procedures. The miscarriage rate was inversely correlated with the number of procedures performed in a department. Copyright (c) 2009 ISUOG. Published by John Wiley & Sons, Ltd. 2. Bottomley C, Bourne T Diagnosing miscarriage Best Pract Res Clin Obstet Gynaecol. 2009 Jun 5. [Epub ahead of print] St George's University of London, Cranmer Terrace, London SW17 0RE, UK. Miscarriage is the most common serious pregnancy complication affecting approximately 30% of biochemical pregnancies and 11-20% of clinically recognised pregnancies. The diagnosis of miscarriage is made most commonly by trans-vaginal ultrasound (TVS) assessment. Evidence-based criteria should be employed for the diagnosis of delayed and incomplete miscarriage. Complete miscarriage should not be diagnosed with TVS alone without serial biochemical confirmation (unless an intrauterine gestation sac has previously been visualised). After a clinical assessment suggesting complete miscarriage, 45% of women will have retained tissue on ultrasound, whilst women with an ultrasound scan showing an empty uterus with a history suggestive of miscarriage will be found to have an ectopic pregnancy in 6% of cases. Prediction of the diagnosis of miscarriage using maternal history and ultrasound features may be helpful in counselling women towards likely pregnancy outcome and planning appropriate further assessment. Use of three-dimensional ultrasound has not improved diagnosis of miscarriage. After a diagnosis of miscarriage, half the women undergo significant psychological effects, which may last for up to 12 months. 3. Farley D, Dudley DJ Fetal assessment during pregnancy Pediatr Clin North Am. 2009 Jun;56(3):489-504 Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, MSC 7836, San Antonio, TX 78229-3900, USA. Fetal monitoring during pregnancy is used to prevent fetal death. This article addresses the goals of fetal monitoring during pregnancy. Methods of fetal surveillance are reviewed, as well as the meaning of abnormal fetal testing and how these results relate to fetal and neonatal outcome. Overall, pediatricians who understand the goals, methods, and interpretation of fetal testing can communicate more effectively with the delivering obstetric team in anticipation of optimizing obstetric and pediatric outcomes. 4. Chan YM, Sahota DS, Chan OK, Leung TY, Lau TK Miscarriage after invasive prenatal diagnostic procedures: how much risk our pregnant women are willing to take? Prenat Diagn. 2009 Jun 4. [Epub ahead of print] Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China. OBJECTIVES: To elicit the level of risk of prenatal diagnostic procedure-related miscarriage that Chinese pregnant women were willing to accept. METHODS: An interviewer-administered survey was conducted on 276 women who presented to the University Obstetric Unit. Using the standard gamble approach, subjects were asked to choose between a screening test with a 90% detection rate and a diagnostic test which is definitive but carries a finite risk of abortion. This probability of abortion was varied until the subject was indifferent between the two choices, and the value was called the utility score. RESULTS: When compared with a screening test with 90% detection rate, the median utility score was 0.989 (IQR: 0.970-0.999). The median risk of abortion below which the subjects would rather opt for an invasive test instead of a screening test was 1.1%. The percentage of patients who could accept a procedure-related miscarriage risk of 0.2, 0.5, 1 and 2% were 76, 67, 59.8 and 38.4%, respectively. CONCLUSIONS: Pregnant Chinese women agreed to trade a definitive chromosomal diagnostic test from a highly effective screening test with a small risk of undiagnosed aneuploidy provided that the procedure-related miscarriage risk was 1.1% or lower. Copyright (c) 2009 John Wiley & Sons, Ltd. 5. Warland J, McCutcheon H, Baghurst P Placental position and late stillbirth: a case-control study J Clin Nurs. 2009 Jun;18(11):1602-6 University of South Australia, Adelaide, Australia. jane.warland@unisa.edu.au AIMS AND OBJECTIVES: The aim of this study was to determine whether there is a relationship between placental position and stillbirth with the objective of establishing if placental position impacted on stillbirth risk. BACKGROUND: Whilst there has been extensive research on low placental implantation because of the importance of detecting placenta praevia, little research has been undertaken on other aspects of placental position and possible impact on pregnancy outcome. DESIGN: A matched case-control study of stillbirth and placental position was conducted using case-notes from two tertiary obstetric referral centres. METHODS: Notes were retrospectively examined and Placental position as documented in the case-notes at the routine mid-trimester (20 week) ultrasound was identified. Placental position for a total of 124 pregnancies culminating in stillbirth was compared with placental position in 243 (matched) pregnancies resulting in a live born baby. RESULTS: Women who had a posterior located placenta were statistically more likely to suffer a stillbirth than women who had a placenta in any other position OR 1.64 (95%CI 1.02-2.65 p = 0.04). CONCLUSION: Posterior located placenta may be a contributory risk factor for stillbirth. Further research is warranted. Implications for practice. Nurses and midwives should be aware of this potential risk factor to monitor foetal well-being closely. 6. Murphy F, Merrell J Negotiating the transition: caring for women through the experience of early miscarriage J Clin Nurs. 2009 Jun;18(11):1583-91 Senior Lecturer, School of Health Science, University of Wales Swansea, Swansea, Wales, UK. f.murphy@swan.ac.uk AIM: To explore women's experiences of having an early miscarriage in a hospital gynaecological unit. BACKGROUND: Miscarriage is a global health issue affecting significant numbers of women and is usually considered a distressing experience. This distress is often interpreted as being characteristic of grief. Nurses and other health professionals in hospital and community settings are therefore expected to provide appropriate care to meet the physical and emotional needs of the woman. DESIGN: A qualitative, ethnographic study of a hospital gynaecological unit in the UK. METHODS: The primary method was 20 months of part-time participant observation. Data were also collected through documentary analysis of key documents in the setting and formal interviews. These were with eight women who had an early miscarriage and 16 health professionals (nurses, doctors, ultrasonographers) working in the unit. RESULTS: Three clear phases emerged in the women's experience of miscarriage and hospital admission; first signs and confirmation, losing the baby and the aftermath. These were interpreted as being components of a process of transition. The hospital admission emerged as vital in these early phases in which the importance of nurses and other health professionals providing sensitive, engaged care to meet the emotional and physical needs of the woman was identified. CONCLUSIONS: The hospital setting emerged as highly influential in shaping the care that was given to women and influencing their experiences. Transition models were felt to be more appropriate than grief and bereavement models in guiding the psychological care given to women. RELEVANCE TO CLINICAL PRACTICE: The experience of hospital admission and the actions of nurses and other health professionals is influential in how women negotiate the transition through miscarriage. Prepared by the National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center Georgetown University 2115 Wisconsin Avenue, N.W., Suite 601 Washington, DC 20007 (866) 866-7437 toll free (202) 687-7466 local (202) 784-9777 fax info@sidscenter.org http://www.sidscenter.org
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NSIDRC Journal Article Alert — June 12, 2009

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