Still Births

Pregnancy complications such as pre-eclampsia (high blood pressure during pregnancy), poor fetal growth, unexplained stillbirth, and spontaneous preterm birth are major causes of illness and death for mothers and babies in sub-Saharan Africa. These conditions, known as the Great Obstetrical Syndromes, are thought to result from problems with the development of the placenta early in pregnancy. However, there is limited information from African populations to help identify women at risk or improve prevention and treatment. This study will enroll 4,000 first-time pregnant women in Uganda before 18 weeks of pregnancy and follow them throughout pregnancy until delivery. Participants will attend routine study visits where information about their health, pregnancy, and social circumstances will be collected. Physical examinations, ultrasound scans, and blood samples will be obtained at several time points during pregnancy, and blood and placental samples will be collected at birth. Some samples will be analyzed during the study, while others will be stored for future research with appropriate ethical approval. The study will examine which clinical, biological, and social factors are associated with pregnancy complications. Researchers will use statistical methods and artificial intelligence (AI) techniques to identify patterns that may help predict which women are at increased risk of developing these conditions. The knowledge gained from this study may support the development of better screening tools and strategies for preventing pregnancy complications, improve maternal and newborn health outcomes in Uganda and other African settings, and establish a valuable biobank to support future maternal and newborn health research.

The goal of this proof-of-concept, case-control, clinical trial is to evaluate the efficacy of using two newer ultrasound technologies, quantitative ultrasound (QUS) and ultrafast power Doppler imaging (uPDI), to evaluate the health of the placenta, visualize blood flow through the placental vasculature by color Doppler imaging in singleton pregnancies with and without fetal growth restriction (FGR). * Our primary objective is to investigate the ability of using these ultrasound technologies to distinguish healthy pregnancies from those affected by FGR, a condition characterized by a fetal weight below the 10th percentile for the gestational age or abdominal circumference of the pregnancy. * Secondary aims include longitudinal evaluation of differences in QUS and uPDI imaging over gestation and changes in these measures with evolution of utero-placental insufficiency including with the development of abnormal umbilical-artery Doppler testing, diagnosis of severe FGR, identification of stillbirth, and detection of preeclampsia or preterm birth. Investigators will compare QUS/uPDI imaging and values in pregnancies determined to be healthy by approved, standard-of-care growth ultrasounds to those diagnosed with FGR. Participants will receive research ultrasounds with the experimental Verasonics Vantage 256 system (Verasonics, Inc, Kirkland, WA) utilizing uPDI/QUS every three weeks following their routine growth ultrasound evaluation until delivery. Demographic, obstetric, and delivery-related information, as well as portions of subjects' past medical history will be utilized by researchers to further contextualize imaging and variables gathered during the research ultrasounds.

Perinatal bereavement is a condition that can lead to serious psychological problems for parents and their families. Bereaved women are at high risk of mental health problems (e.g. anxiety, post-traumatic stress disorder and depression). They may also blame themselves and their bodies for the loss and feel inadequate. Inadequate support from their environment in this process may lead them to experience social isolation. Research highlights the impact of caring for bereaved parents on health professionals, and that inadequate training can have a negative impact. In this context, there is a need for well-structured and tailored training programmes that focus on the specific needs and skills required to provide appropriate bereavement care to parents experiencing pregnancy loss and perinatal death. In this context, this study was planned both to prepare a training programme with evidence of effectiveness and to investigate the effectiveness of perinatal bereavement counselling training for midwives.