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Featured researches published by Jason Gardosi.


The Lancet | 2011

Stillbirths: Where? When? Why? How to make the data count?

Joy E Lawn; Hannah Blencowe; Robert Clive Pattinson; Simons Cousens; Rajesh Kumar; Ibinabo Ibiebele; Jason Gardosi; Louise T. Day; Cynthia Stanton

Despite increasing attention and investment for maternal, neonatal, and child health, stillbirths remain invisible-not counted in the Millennium Development Goals, nor tracked by the UN, nor in the Global Burden of Disease metrics. At least 2·65 million stillbirths (uncertainty range 2·08 million to 3·79 million) were estimated worldwide in 2008 (≥1000 g birthweight or ≥28 weeks of gestation). 98% of stillbirths occur in low-income and middle-income countries, and numbers vary from 2·0 per 1000 total births in Finland to more than 40 per 1000 total births in Nigeria and Pakistan. Worldwide, 67% of stillbirths occur in rural families, 55% in rural sub-Saharan Africa and south Asia, where skilled birth attendance and caesarean sections are much lower than that for urban births. In total, an estimated 1·19 million (range 0·82 million to 1·97 million) intrapartum stillbirths occur yearly. Most intrapartum stillbirths are associated with obstetric emergencies, whereas antepartum stillbirths are associated with maternal infections and fetal growth restriction. National estimates of causes of stillbirths are scarce, and multiple (>35) classification systems impede international comparison. Immediate data improvements are feasible through household surveys and facility audit, and improvements in vital registration, including specific perinatal certificates and revised International Classification of Disease codes, are needed. A simple, programme-relevant stillbirth classification that can be used with verbal autopsy would provide a basis for comparable national estimates. A new focus on all deaths around the time of birth is crucial to inform programmatic investment.


British Journal of Obstetrics and Gynaecology | 2001

Perinatal outcome in SGA births defined by customised versus population-based birthweight standards

Britt Clausson; Jason Gardosi; Andre Francis; Sven Cnattingius

Objective To determine whether customised birthweight standard improves the definition of small for gestational age and its association with adverse pregnancy outcomes such as stillbirth, neonatal death, or low Apgar score.


BMJ | 2005

Classification of stillbirth by relevant condition at death (ReCoDe): population based cohort study

Jason Gardosi; Sue M. Kady; Pat McGeown; Andre Francis; Ann Tonks

Abstract Objective To develop and test a new classification system for stillbirths to help improve understanding of the main causes and conditions associated with fetal death. Design Population based cohort study. Setting West Midlands region. Subjects 2625 stillbirths from 1997 to 2003. Main outcome measures Categories of death according to conventional classification methods and a newly developed system (ReCoDe, relevant condition at death). Results By the conventional Wigglesworth classification, 66.2% of the stillbirths (1738 of 2625) were unexplained. The median gestational age of the unexplained group was 237 days, significantly higher than the stillbirths in the other categories (210 days; P < 0.001). The proportion of stillbirths that were unexplained was high regardless of whether a postmortem examination had been carried out or not (67% and 65%; P = 0.3). By the ReCoDe classification, the most common condition was fetal growth restriction (43.0%), and only 15.2% of stillbirths remained unexplained. ReCoDe identified 57.7% of the Wigglesworth unexplained stillbirths as growth restricted. The size of the category for intrapartum asphyxia was reduced from 11.7% (Wigglesworth) to 3.4% (ReCoDe). Conclusion The new ReCoDe classification system reduces the predominance of stillbirths currently categorised as unexplained. Fetal growth restriction is a common antecedent of stillbirth, but its high prevalence is hidden by current classification systems. This finding has profound implications for maternity services, and raises the question whether some hitherto “unexplained” stillbirths may be avoidable.


BMJ | 2013

Maternal and fetal risk factors for stillbirth: population based study

Jason Gardosi; Vichithranie Madurasinghe; Mandy Williams; Asad Malik; Andre Francis

Objective To assess the main risk factors associated with stillbirth in a multiethnic English maternity population. Design Cohort study. Setting National Health Service region in England. Population 92 218 normally formed singletons including 389 stillbirths from 24 weeks of gestation, delivered during 2009-11. Main outcome measure Risk of stillbirth. Results Multivariable analysis identified a significant risk of stillbirth for parity (para 0 and para ≥3), ethnicity (African, African-Caribbean, Indian, and Pakistani), maternal obesity (body mass index ≥30), smoking, pre-existing diabetes, and history of mental health problems, antepartum haemorrhage, and fetal growth restriction (birth weight below 10th customised birthweight centile). As potentially modifiable risk factors, maternal obesity, smoking in pregnancy, and fetal growth restriction together accounted for 56.1% of the stillbirths. Presence of fetal growth restriction constituted the highest risk, and this applied to pregnancies where mothers did not smoke (adjusted relative risk 7.8, 95% confidence interval 6.6 to 10.9), did smoke (5.7, 3.6 to 10.9), and were exposed to passive smoke only (10.0, 6.6 to 15.8). Fetal growth restriction also had the largest population attributable risk for stillbirth and was fivefold greater if it was not detected antenatally than when it was (32.0% v 6.2%). In total, 195 of the 389 stillbirths in this cohort had fetal growth restriction, but in 160 (82%) it had not been detected antenatally. Antenatal recognition of fetal growth restriction resulted in delivery 10 days earlier than when it was not detected: median 270 (interquartile range 261-279) days v 280 (interquartile range 273-287) days. The overall stillbirth rate (per 1000 births) was 4.2, but only 2.4 in pregnancies without fetal growth restriction, increasing to 9.7 with antenatally detected fetal growth restriction and 19.8 when it was not detected. Conclusion Most normally formed singleton stillbirths are potentially avoidable. The single largest risk factor is unrecognised fetal growth restriction, and preventive strategies need to focus on improving antenatal detection.


American Journal of Obstetrics and Gynecology | 2011

Intrauterine growth restriction: new concepts in antenatal surveillance, diagnosis, and management

Francesc Figueras; Jason Gardosi

Intrauterine growth restriction (IUGR) remains one of the main challenges in maternity care. Improvements have to start from a better definition of IUGR, applying the concept of the fetal growth potential. Customized standards for fetal growth and birthweight improve the detection of IUGR by better distinction between physiological and pathological smallness and have led to internationally applicable norms. Such developments have resulted in new insights in the assessment of risk and surveillance during pregnancy. Serial fundal height measurement plotted on customized charts is a useful screening tool, whereas fetal biometry and Doppler flow are the mainstay for investigation and diagnosis of IUGR. Appropriate protocols based on available evidence as well as individualized clinical assessment are essential to ensure good management and timely delivery.


Acta Obstetricia et Gynecologica Scandinavica | 2004

Restricted fetal growth in sudden intrauterine unexplained death

J Frederik Frøen; Jason Gardosi; Anne Thurmann; Andre Francis; Babill Stray-Pedersen

Background.  Unexplained antepartum stillbirth is a common cause of perinatal death, and identifying the fetus at risk is a challenge for obstetric practice. Intrauterine growth restriction (IUGR) is associated with a variety of adverse perinatal outcomes, but reports on its impact on unexplained stillbirths by population‐based birthweight standards have been varying, including both unexplained and unexplored stillbirths.


British Journal of Obstetrics and Gynaecology | 1998

Analysis of birthweight and gestational age in anteparturn stillbirths

Jason Gardosi; Theo Mul; Max Mongelli; David Fagan

Objective To study the characteristics of birthweight and gestational age of third trimester fetal deaths which occurred before the onset of labour.


American Journal of Obstetrics and Gynecology | 2009

Adverse pregnancy outcome and association with small for gestational age birthweight by customized and population-based percentiles

Jason Gardosi; Andre Francis

OBJECTIVE The objective of the study was to investigate the association between pregnancy complications and small for gestational age (SGA) birthweight, comparing SGA based on the customized growth potential with SGA based on the birthweight standard of the same population. STUDY DESIGN This was a retrospective analysis of a database from a US multicenter study. Pregnancy complications included threatened preterm labor, antepartum hemorrhage, pregnancy-induced hypertension, preeclampsia, stillbirth, and early neonatal death. RESULTS Compared with SGA by the birthweight standard, SGA by customized growth potential showed higher risk for each of the 6 adverse indicators. A third of the SGA group was small by customized centiles but not by population-based centiles, yet was strongly associated with each of the pregnancy complications studied. This subgroup of unrecognized SGA babies included 26% preterm deliveries. In contrast, a subgroup that was SGA by the population standard but not by the customized standard (17.2%), was not associated with any of the indicators of adverse outcome. CONCLUSION SGA defined by customized growth potential improves the differentiation between physiologically and pathologically small babies.


Australian & New Zealand Journal of Obstetrics & Gynaecology | 2004

A customised birthweight centile calculator developed for a New Zealand population.

Lesley McCowan; Alistair W. Stewart; Andre Francis; Jason Gardosi

Background:  Traditionally, small for gestational age is defined as birthweight <10th percentile using sex‐adjusted centile charts. However, this criterion includes constitutional variation due to maternal height, weight, ethnic group and parity.


British Journal of Obstetrics and Gynaecology | 1999

Controlled trial of fundal height measurement plotted on customised antenatal growth charts

Jason Gardosi; Andre Francis

Objective The purpose of this study was to evaluate the effect of a policy of standard antenatal care which included plotting fundal height measurements on customised antenatal charts in the community.

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Max Mongelli

The Chinese University of Hong Kong

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Vicki Flenady

University of Queensland

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Emma Allanson

World Health Organization

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Theo Mul

University of Nottingham

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J Frederik Frøen

Norwegian Institute of Public Health

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