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<ns4:p><ns4:bold>Background</ns4:bold> <ns4:italic>: </ns4:italic>No universal  demarcation of gestational age  distinguishes miscarriage and stillbirth or extreme preterm birth (exPTB). This study provides a synopsis of outcome between 22 to &lt;28 weeks gestation from a low resource setting.</ns4:p><ns4:p> <ns4:bold>Methods</ns4:bold> <ns4:italic>: </ns4:italic>A retrospective record review of a population on the Thailand-Myanmar border was conducted. Outcomes were classified as miscarriage, late expulsion of products between 22 to &lt; 28 weeks gestation with evidence of non-viability (mostly ultrasound absent fetal heart beat) prior to 22 weeks; or  exPTB (stillbirth/live born) between 22 to &lt; 28 weeks gestation when the fetus was viable at ≥22 weeks. Termination of pregnancy and gestational trophoblastic disease were excluded.</ns4:p><ns4:p> <ns4:bold>Results</ns4:bold> <ns4:italic>: </ns4:italic>From 1995-2015, 80.9% (50,046/ 61,829) of registered women had a known pregnancy outcome, of whom 99.8% (49,931) had a known gestational age. Delivery  between 22 to &lt;28 weeks gestation included 0.9% (472/49,931) of pregnancies after removing 18 cases (3.8%) who met an exclusion criteria. Most  pregnancies had an ultrasound: 72.5% (n=329/454);  43.6% (n=197) were classified as  miscarriage and 56.4% (n=257) exPTB.  Individual record review of miscarriages estimated that fetal death had occurred at a median of 16 weeks, despite late expulsion between 22 to &lt;28 weeks. With available data (n=252, 5 missing) the proportion of stillbirth was 47.6% (n=120), congenital abnormality 10.5% (24/228, 29 missing) and neonatal death was 98.5% (128/131, 1 missing). Introduction of ultrasound was associated with a 2-times higher odds of classification of outcome as exPTB rather than miscarriage.</ns4:p><ns4:p> <ns4:bold>Conclusion</ns4:bold> <ns4:italic>: </ns4:italic>In this low resource setting few (&lt;1%) pregnancy outcomes occurred in the 22 to &lt;28 weeks gestational window; four in ten  were miscarriage (late expulsion) and neonatal mortality approached 100%.  In the scale-up to preventable newborns deaths (at least initially) greater benefits will be obtained by focusing on the viable newborns of ≥ 28 weeks gestation.</ns4:p>

Original publication

DOI

10.12688/wellcomeopenres.10352.3

Type

Journal article

Journal

Wellcome Open Research

Publisher

F1000 Research, Ltd.

Volume

1

Pages

32 - 32