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Fetal deaths: challenges for knowledge and intervention

Grant number: 16/07765-0
Support type:Research Projects - Thematic Grants
Duration: May 01, 2018 - April 30, 2023
Field of knowledge:Health Sciences - Collective Health
Principal Investigator:Nelson da Cruz Gouveia
Grantee:Nelson da Cruz Gouveia
Home Institution: Faculdade de Medicina (FM). Universidade de São Paulo (USP). São Paulo, SP, Brazil
Co-Principal Investigators:Hillegonda Maria Dutilh Novaes ; Marcia Furquim de Almeida ; Rossana Pulcineli Vieira Francisco
Assoc. researchers:Andrés Jimenez Galisteo Jr ; Clarisse Martins Machado ; Expedito José de Albuquerque Luna ; Gerusa Maria Figueiredo ; Gizelton Pereira Alencar ; Heitor Franco de Andrade Junior ; Laura Cunha Rodrigues ; Luciana Regina Meireles Jaguaribe Ekman ; Mara Sandra Hoshida ; Maria Cristina Domingues da Silva Fink ; Paulo Hilário Nascimento Saldiva ; Zilda Pereira da Silva

Abstract

Although fetal mortality is an increasingly important component of mortality in childhood, it is still insufficiently known, valued and studied as a public health problem, especially through approaches that integrate the biological, epidemiological and social dimensions. The proposed project aims to contribute to decreasing fetal mortality by increasing understanding of the complex network of causation and needs related to fetal death, using a multidisciplinary approach, to produce evidence to inform the development of public policies and clinical protocols for antenatal care and delivery care that incorporate prevention of fetal deaths and adequate support to bereaved families. We propose a prospective case control study with 415 cases (stillbirths) e 415 controls (randomly selected liveborns) ascertained in 15 SUS hospitals (which include a high proportion of all fetal deaths in the city of Sao Paulo). Mothers of cases and controls will be interviewed in the maternity hospitals, hospital records reviewed and information abstracted in a standard form, ante natal care card photographed; blood will be collected from mothers of cases and controls, cord blood collected from controls, and placenta stored for investigation of serum and tissue markers of angiogenesis, markers of infection and exposure to air pollutants. Non invasive autopsy will be conducted in all stillbirths, by imaging and histopathology guided by image as well as traditional autopsy. Administrators of hospitals and the antenatal care program Rede Cegonha/Mãe Paulistana will be interviewed; women who had a stillbirth will be interviewed at home 2 months after the fetal death in a sample of 100 cases. Analysis will identify risk factors for still birth, investigate their interrelationships and estimate the individual contributions to fetal mortality in this setting as well as needs for support for bereaved families; results will be disseminated in the policy and scientific community. (AU)