What is good grief support? Exploring the actors and actions in social support after traumatic grief.

Social support seems to enhance wellbeing and health in many populations. Conversely, poor social support and loneliness are a social determinant of poor health outcomes and can adversely affect physical, emotional, and mental well-being. Social support is especially important in traumatic grief.

Obstetric Care Consensus #10: Management of Stillbirth: (Replaces Practice Bulletin Number 102, March 2009).

Stillbirth is one of the most common adverse pregnancy outcomes, occurring in 1 in 160 deliveries in the United States. In developed countries, the most prevalent risk factors associated with stillbirth are non-Hispanic black race, nulliparity, advanced maternal age, obesity, preexisting diabetes, chronic hypertension, smoking, alcohol use, having a pregnancy using assisted reproductive technology, multiple gestation, male fetal sex, unmarried status, and past obstetric history. Although some of these factors may be modifiable (such as smoking), many are not.

Risk of Stillbirth for Fetuses With Specific Birth Defects.

Objective: To estimate the risk of stillbirth (fetal death at 20 weeks of gestation or more) associated with specific birth defects.

Methods: We identified a population-based retrospective cohort of neonates and fetuses with selected major birth defects and without known or strongly suspected chromosomal or single-gene disorders from active birth defects surveillance programs in nine states. Abstracted medical records were reviewed by clinical geneticists to confirm and classify all birth defects and birth defect patterns.

Alternatives to Autopsy for Fetal and Early Neonatal (Perinatal) Deaths: Insights from the Wisconsin Stillbirth Service Program.

Background: Although autopsy is a key component of the etiologic evaluation following fetal and early neonatal death, and traditionally has been the preferred method to determine the cause of death, an alternative may be suitable when traditional autopsy by a perinatal pathologist is not available or declined.

Methods: Among 3137 cases evaluated through the Wisconsin Stillbirth Service Program (WiSSP), a community-based program for etiologic evaluation of second trimester miscarriage, stillbirth, and early neonatal death, most diagnoses are based on multiple types of data including placental pathology, clinical examination, photographs, maternal records, radiographs, and laboratory testing.

Results: Cases in the WiSSP cohort without autopsy have nearly the same overall rate of diagnosis as those with traditional autopsy (56% vs.

Stillbirth: knowledge and practice among U.S. obstetrician-gynecologists.

Objective: To determine knowledge of U.S. obstetrician-gynecologists (OBGYNs) and individual and institutional practices regarding stillbirth.

Psychological impact of stillbirths on obstetricians.

Objective: To assess the psychological impact on US obstetricians when they care for women who have suffered a stillbirth and explore whether demographic (e.g. age, gender) and practice (e.

Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis.

Background: Stillbirth rates in high-income countries have shown little or no improvement over the past two decades. Prevention strategies that target risk factors could be important in rate reduction. This systematic review and meta-analysis was done to identify priority areas for stillbirth prevention relevant to those countries.

Stillbirths: the way forward in high-income countries.

Stillbirth rates in high-income countries declined dramatically from about 1940, but this decline has slowed or stalled over recent times. The present variation in stillbirth rates across and within high-income countries indicates that further reduction in stillbirth is possible. Large disparities (linked to disadvantage such as poverty) in stillbirth rates need to be addressed by providing more educational opportunities and improving living conditions for women.

Stillbirth epidemiology, risk factors, and opportunities for stillbirth prevention.

World-wide, there are between 3 and 4 million stillbirths delivered each year, 98% of these deaths occur in the developing world. Although there are very significant differences in the rate and causes of stillbirth in these settings, the study of stillbirth globally gives insight into the interaction between the fetal and maternal conditions in the setting of varying access to healthy food, access to medical care, treatment of infections, screening of congenital anomalies, education, and access to antepartum and intrapartum care.

Implementation of uniform information on fetal movement in a Norwegian population reduced delayed reporting of decreased fetal movement and stillbirths in primiparous women - a clinical quality improvement.

Background: Delayed maternal reporting of decreased fetal movement (DFM) is associated with adverse pregnancy outcomes. Inconsistent information on fetal activity to women during the antenatal period may result in delayed reporting of DFM. We aimed to evaluate an intervention of implementation of uniform information on fetal activity to women during the antenatal period.

Stillbirth classification--developing an international consensus for research: executive summary of a National Institute of Child Health and Human Development workshop.

Stillbirth is a major obstetric complication, with 3.2 million stillbirths worldwide and 26,000 stillbirths in the United States every year. The Eunice Kennedy Shriver National Institute of Child Health and Human Development held a workshop from October 22-24, 2007, to review the pathophysiology of conditions underlying stillbirth to define causes of death.

Detection and management of decreased fetal movements in Australia and New Zealand: a survey of obstetric practice.

Background: Decreased fetal movement (DFM) is associated with increased risk of adverse pregnancy outcome. However, there is limited research to inform practice in the detection and management of DFM.

Aims: To identify current practices and views of obstetricians in Australia and New Zealand regarding DFM.

Reduction of late stillbirth with the introduction of fetal movement information and guidelines - a clinical quality improvement.

Background: Women experiencing decreased fetal movements (DFM) are at increased risk of adverse outcomes, including stillbirth. Fourteen delivery units in Norway registered all cases of DFM in a population-based quality assessment. We found that information to women and management of DFM varied significantly between hospitals.

Causes of death and associated conditions (Codac): a utilitarian approach to the classification of perinatal deaths.

A carefully classified dataset of perinatal mortality will retain the most significant information on the causes of death. Such information is needed for health care policy development, surveillance and international comparisons, clinical services and research. For comparability purposes, we propose a classification system that could serve all these needs, and be applicable in both developing and developed countries.

New indications for antepartum testing: making the case for antepartum surveillance or timed delivery for women of advanced maternal age.

Maternal age is an independent risk factor for stillbirth; a moderate number of these occur in normally formed babies near term. For a woman 40 years of age or older giving birth, her risk of having a chromosomal anomaly is 1/66. What is not appreciated is that even without medical risk factors, her risk of having a stillbirth after 37 weeks of gestation is 1/116.

Management of decreased fetal movements.

Maternal perception of decreased fetal activity is a common complaint, and one of the most frequent causes of unplanned visits in pregnancy. No proposed definitions of decreased fetal movements have ever been proven to be superior to a subjective maternal perception in terms of identifying a population at risk. Women presenting with decreased fetal movements do have higher risk of stillbirth, fetal growth restriction, fetal distress, preterm birth, and other associated outcomes.

Fetal movement assessment.

Maternal perception of fetal movements is the oldest and most commonly used method to assess fetal well-being. While almost all pregnant women adhere to it, organized screening by fetal movements has seen variable popularity among health professionals. Early results of screening were promising and fetal movement counting is the only antepartum testing method that has shown effect in reducing mortality in a randomized controlled trial comparing testing versus no testing.

Stillbirth.

In the UK, about one in 200 infants is stillborn, and rates of stillbirth have recently slightly increased. This recent rise might reflect increasing frequency of some important maternal risk factors for stillbirth, including nulliparity, advanced age, and obesity. Most stillbirths are related to placental dysfunction, which in many women is evident from the first half of pregnancy and is associated with fetal growth restriction.

Etiology and prevention of stillbirth.

Objective: This is a systematic review of the literature on the causes of stillbirth and clinical opinion regarding strategies for its prevention.

Study Design: We reviewed the causes of stillbirth by performing a Medline search limited to articles in English published in core clinical journals from January 1, 1995, to January 1, 2005. Articles before this date were included if they added historical information relevant to the topic.

Should older women have antepartum testing to prevent unexplained stillbirth?

Objective: Older women are at an increased risk for unexplained stillbirth late in pregnancy. The purpose of this study was to compare 3 strategies for the prevention of unexplained fetal death in women aged 35 years and older. We compared usual care (no antepartum testing or induction before 41 weeks), weekly testing at 37 weeks with induction after a positive test, and no testing with induction at 41 weeks.

Association of age, race, and obstetric history with urinary symptoms among women in the Nurses' Health Study.

Objective: The purpose of this study was to better understand associations among age, race, obstetric history, and urinary incontinence in women.

Study Design: Race and obstetric history were assessed through the use of biennial mailed questionnaires from 1976 to 1996 among participants of the Nurses' Health Study. In 1996, 83,168 women aged 50 to 75 years reported their frequency of leaking urine and quantity leaked.

Impact of labor induction, gestational age, and maternal age on cesarean delivery rates.

Objective: To quantify the impact of labor induction and maternal age on cesarean delivery rates in nulliparous and multiparous women between 36 and 42 weeks' gestation.

Methods: We performed a retrospective cohort study on 14,409 women delivering at two teaching hospitals in metropolitan Boston during 1998 and 1999. Women who had contraindications to labor, including a prior cesarean delivery, were excluded.

The evolution of menopause and human life span.

Noteworthy data is emerging to support the existence of longevity-enabling genes. Our observations of the relationship between reproductive fitness and longevity among centenarians support theories that posit strong selective forces in the determination of how fast humans age and their susceptibility to diseases associated with ageing. Current data support the idea that there is no selective advantage for humans to have a lifespan of approximately 100 years.