1 00:00:05,760 --> 00:00:18,840 >>DR. JAYNE AND DR. REDDY 2 00:00:18,840 --> 00:00:22,880 IT IS MY PLEASURE AND HONOR TO 3 00:00:22,880 --> 00:00:27,480 WELCOME ALL MUCH -- ALL OF YOU 4 00:00:27,480 --> 00:00:31,200 TO THE WORKING SECOND OF THE 5 00:00:31,200 --> 00:00:33,720 NICHD STILLBIRTH GROUP. 6 00:00:33,720 --> 00:00:35,160 WE HAVE A BUSY AGENDA TODAY. 7 00:00:35,160 --> 00:00:41,400 OUR TASK IS TO GO THROUGH THE 8 00:00:41,400 --> 00:00:45,920 SECOND HALF OF OUR SUBJECT 9 00:00:45,920 --> 00:00:47,040 MATTER EXPERT PRESENTATIONS. 10 00:00:47,040 --> 00:00:52,560 WE COLLECT ED INFORMATION ON 11 00:00:52,560 --> 00:00:55,880 COLLECTING EVIDENCE ON 12 00:00:55,880 --> 00:00:58,640 STILLBIRTHS AND TODAY WE'LL 13 00:00:58,640 --> 00:01:01,560 FOCUS ON PSYCHOLOGICAL IMPACT ON 14 00:01:01,560 --> 00:01:04,080 MOTHERS FOLLOWING STILLBIRTH AND 15 00:01:04,080 --> 00:01:06,400 THEN FOCUS ON RISK FACTORS FOR 16 00:01:06,400 --> 00:01:07,000 STILLBIRTH. 17 00:01:07,000 --> 00:01:10,480 BEFORE I START INTRODUCING 18 00:01:10,480 --> 00:01:13,080 SPEAKERS I'D LIKE TO INVITE 19 00:01:13,080 --> 00:01:17,720 DR. ALISON CERNICH THE DEPUTY 20 00:01:17,720 --> 00:01:19,520 DIRECTOR OF NICHD TO FRAME THE 21 00:01:19,520 --> 00:01:23,640 TASK FORCE CHARGE AND THE ROLE 22 00:01:23,640 --> 00:01:24,800 OF FEDERAL AGENCIES. 23 00:01:24,800 --> 00:01:25,040 ALISON. 24 00:01:25,040 --> 00:01:31,640 >>THANK YOU SO MUCH, LUCKY. 25 00:01:31,640 --> 00:01:42,160 SO TO REMIND EVERYONE OF OUR 26 00:01:46,360 --> 00:01:48,920 CHARGE OF THE WORK GROUP AND 27 00:01:48,920 --> 00:01:50,160 THEN TO TALK A LITTLE BIT ABOUT 28 00:01:50,160 --> 00:01:51,520 TE ROLE OF THE DIFFERENT FEDERAL 29 00:01:51,520 --> 00:01:52,160 AGENCIES. 30 00:01:52,160 --> 00:01:53,400 THIS WAS RAISED DURING THE LAST 31 00:01:53,400 --> 00:01:55,640 SESSION AND I THINK WOULD BE 32 00:01:55,640 --> 00:01:56,400 HELPFUL FOR EVERYBODY TO GET A 33 00:01:56,400 --> 00:01:58,840 BIT OF AN ORIENTATION TO THIS. 34 00:01:58,840 --> 00:02:00,000 I ALSO WANT TO THANK OUR 35 00:02:00,000 --> 00:02:01,200 COLLEAGUES FROM THE OTHER 36 00:02:01,200 --> 00:02:03,160 FEDERAL AGENCIES WHO JOINED THIS 37 00:02:03,160 --> 00:02:07,920 WORKING GROUP AS EX-OFFICIOS 38 00:02:07,920 --> 00:02:09,440 BECAUSE I THINK IT WILL 39 00:02:09,440 --> 00:02:10,440 DEFINITELY HELP PEOPLE 40 00:02:10,440 --> 00:02:12,240 UNDERSTAND WHAT THE DIFFERENT 41 00:02:12,240 --> 00:02:17,720 ROLES ARE AS YOU ALL ARE 42 00:02:17,720 --> 00:02:18,080 PRESENTING. 43 00:02:18,080 --> 00:02:19,680 JUST BY WAY OF BACKGROUND WE 44 00:02:19,680 --> 00:02:21,320 FORMED THE WORKING GROUP OF OUR 45 00:02:21,320 --> 00:02:23,600 COUNCIL IN 2022 BECAUSE WE WERE 46 00:02:23,600 --> 00:02:24,560 ASKED BY THE DEPARTMENT OF 47 00:02:24,560 --> 00:02:27,680 HEALTH AND HUMAN SERVICES TO 48 00:02:27,680 --> 00:02:29,000 LEAD A TASK FORCE TO EXAMINE 49 00:02:29,000 --> 00:02:30,760 STILLBIRTH IN THE UNITED STATES. 50 00:02:30,760 --> 00:02:36,160 THE REQUEST FOR US AS A 51 00:02:36,160 --> 00:02:40,800 DEPARTMENT TO CREATE THIS TASK 52 00:02:40,800 --> 00:02:45,520 FORCE WAS DESCRIBED IN FISCAL 53 00:02:45,520 --> 00:02:48,160 YEAR 2022 U.S. HOUSE OF 54 00:02:48,160 --> 00:02:49,280 REPRESENTATIVES REPORT LANGUAGE. 55 00:02:49,280 --> 00:02:51,400 THE REPORT LANGUAGE REQUESTS 56 00:02:51,400 --> 00:02:53,320 FUNDING OF $1 MILLION AND THE 57 00:02:53,320 --> 00:02:54,760 APPROPRIATION TO SUPPORT THIS 58 00:02:54,760 --> 00:02:57,880 WORK IS ABOUT $750,000 IN THE 59 00:02:57,880 --> 00:03:06,920 APPROPRIATIONS ACT. 60 00:03:06,920 --> 00:03:08,800 SO OBVIOUSLY WE KNOW STILLBIRTH 61 00:03:08,800 --> 00:03:11,800 AFFECTS A NUMBER OF PREGNANCY AS 62 00:03:11,800 --> 00:03:16,160 A YEAR WITH 24,000 STILLBORN 63 00:03:16,160 --> 00:03:17,200 BABIES BORN EVERY YEAR AND THIS 64 00:03:17,200 --> 00:03:19,120 HAS REMAINED THE SAME FOR 30 65 00:03:19,120 --> 00:03:19,680 YEARS. 66 00:03:19,680 --> 00:03:21,400 THE REPORT ASKED US TO FORM THE 67 00:03:21,400 --> 00:03:24,000 TASK FORCE TO INCLUDE THE CDC, 68 00:03:24,000 --> 00:03:25,400 NIH, SPECIALTY ORGANIZATIONS AND 69 00:03:25,400 --> 00:03:29,080 MATERNAL AND FETAL MEDICINE 70 00:03:29,080 --> 00:03:31,160 SPECIALISTS AND ASKED US TO THEN 71 00:03:31,160 --> 00:03:32,520 PROVIDE A REPORT BACK TO 72 00:03:32,520 --> 00:03:33,120 CONGRESS ON THE FOUR AREAS OF 73 00:03:33,120 --> 00:03:35,200 FOCUS. 74 00:03:35,200 --> 00:03:37,400 SO ONE WAS THE CURRENT BARRIERS 75 00:03:37,400 --> 00:03:40,160 TO COLLECTING DATA ON 76 00:03:40,160 --> 00:03:40,880 STILLBIRTHS THROUGHOUT THE 77 00:03:40,880 --> 00:03:43,200 U.S. WHICH I THINK YOU HEARD A 78 00:03:43,200 --> 00:03:44,120 WONDERFUL PRESENTATION LAST 79 00:03:44,120 --> 00:03:44,320 WEEK. 80 00:03:44,320 --> 00:03:51,040 SORRY, LAST MEETING. 81 00:03:51,040 --> 00:03:52,680 AND INFORMATION ON SOME OF THE 82 00:03:52,680 --> 00:03:56,160 WAYS THE DATA IS COLLECTED AND 83 00:03:56,160 --> 00:03:57,880 BARRIERS IN THE ELECTRONIC 84 00:03:57,880 --> 00:04:00,080 HEALTH RECORDS AND COMMUNITIES 85 00:04:00,080 --> 00:04:01,480 OF HIGHER RISK OF STILLBIRTH. 86 00:04:01,480 --> 00:04:05,120 THE PSYCHOLOGICAL IMPACT AND 87 00:04:05,120 --> 00:04:06,120 TREATMENT FOR MOTHERS AND THE 88 00:04:06,120 --> 00:04:07,680 KNOWN RISK FACTORS FOR 89 00:04:07,680 --> 00:04:08,320 STILLBIRTH. 90 00:04:08,320 --> 00:04:10,720 THOSE FOUR AREAS ARE THE AREAS 91 00:04:10,720 --> 00:04:12,440 WE WERE ASKED TO COVER IN 92 00:04:12,440 --> 00:04:20,920 FORMING THE TASK FORCE. 93 00:04:20,920 --> 00:04:23,400 I WANT TO GO THROUGH THE ROLES 94 00:04:23,400 --> 00:04:25,040 OF OUR ORGANIZATIONS SO 95 00:04:25,040 --> 00:04:26,680 EVERYBODY IS AWARE OF WHAT WE DO 96 00:04:26,680 --> 00:04:27,640 IN THE DEPARTMENT OF HEALTH AND 97 00:04:27,640 --> 00:04:29,520 HUMAN SERVICES AND WHAT SOME OF 98 00:04:29,520 --> 00:04:31,240 OUR PARTNERS IN THE WORKING 99 00:04:31,240 --> 00:04:41,760 GROUP ARE ALSO RESPONSIBLE FOR. 100 00:04:42,240 --> 00:04:46,880 THE NATIONAL INSTITUTES OF 101 00:04:46,880 --> 00:04:48,120 HEALTH AND NICHD AND WE HAVE A 102 00:04:48,120 --> 00:04:50,560 NUMBER OF CENTERS AN OFFICES AND 103 00:04:50,560 --> 00:04:51,920 WE'RE THE LARGEST FUNDER OF 104 00:04:51,920 --> 00:04:53,600 MEDICAL AND BEHAVIORAL RESEARCH. 105 00:04:53,600 --> 00:04:55,680 WE WERE REQUESTED TO LEAD THE 106 00:04:55,680 --> 00:04:57,400 TASK FORCE BY HHS AND BRING 107 00:04:57,400 --> 00:05:01,080 TOGETHER A NUMBER OF GROUPS TO 108 00:05:01,080 --> 00:05:02,920 PROVIDE EVIDENCE-BASED 109 00:05:02,920 --> 00:05:04,360 RECOMMENDATIONS IN THE REPORT. 110 00:05:04,360 --> 00:05:07,080 OUR ROLE IS TO FUND RESEARCH 111 00:05:07,080 --> 00:05:07,400 PROJECTS. 112 00:05:07,400 --> 00:05:10,240 AND WHETHER THAT BE AT ACADEMIC 113 00:05:10,240 --> 00:05:15,200 MEDICAL CENTERS SMALL BUSINESSES 114 00:05:15,200 --> 00:05:17,160 OR PEDIATRIC HOSPITALS OR OTHER 115 00:05:17,160 --> 00:05:18,720 ACADEMIC INSTITUTIONS. 116 00:05:18,720 --> 00:05:20,160 THAT'S REALLY OUR ROLE IS TO 117 00:05:20,160 --> 00:05:24,720 FUND RESEARCH. 118 00:05:24,720 --> 00:05:27,800 WE DO PROVIDE SOME PUBLIC HEALTH 119 00:05:27,800 --> 00:05:29,680 COMMUNICATION SUPPORT AND DO 120 00:05:29,680 --> 00:05:32,240 HAVE SOME EDUCATION PROGRAMS BUT 121 00:05:32,240 --> 00:05:35,080 IN LARGE PART OUR GOAL IS TO 122 00:05:35,080 --> 00:05:36,560 FUND THE RESEARCH THAT PROVIDES 123 00:05:36,560 --> 00:05:40,160 THE EVIDENCE THAT CAN BE USED BY 124 00:05:40,160 --> 00:05:41,000 OTHER AGENCIES. 125 00:05:41,000 --> 00:05:43,240 OUR PARTNERS AT THE CENTERS FOR 126 00:05:43,240 --> 00:05:45,120 DISEASE CONTROL AND PREVENTION 127 00:05:45,120 --> 00:05:46,320 AND WE'RE VERY GRATEFUL THAT 128 00:05:46,320 --> 00:05:49,120 THEY HAVE JOINED US FROM TWO 129 00:05:49,120 --> 00:05:50,760 DIFFERENT DIVISIONS AT CDC. 130 00:05:50,760 --> 00:05:51,960 WE HAVE BOTH THE NATIONAL CENTER 131 00:05:51,960 --> 00:05:55,560 ON BIRTH DEFECTS AND 132 00:05:55,560 --> 00:05:58,160 DEVELOPMENTAL DISABILITIES YOU 133 00:05:58,160 --> 00:06:00,320 HEARD FROM AND THE NATIONAL 134 00:06:00,320 --> 00:06:01,680 CENTER FOR CHRONIC DISEASE 135 00:06:01,680 --> 00:06:02,960 PREVENTION AND PROMOTION AND THE 136 00:06:02,960 --> 00:06:05,520 DIVISION OF REPRODUCTIVE HEALTH. 137 00:06:05,520 --> 00:06:08,560 THEY ARE BOTH ON THIS CALL. 138 00:06:08,560 --> 00:06:11,200 AND CDC'S ROLE IS TO PREVENT, 139 00:06:11,200 --> 00:06:12,880 DETECT AND RESPOND TO DISEASES 140 00:06:12,880 --> 00:06:15,880 AND PREVENTIBLE CONDITIONS AND 141 00:06:15,880 --> 00:06:16,800 RESPOND TO PUBLIC HEALTH 142 00:06:16,800 --> 00:06:19,080 EMERGENCIES AS WE'VE SEEN WITH 143 00:06:19,080 --> 00:06:20,720 THE COVID PANDEMIC. 144 00:06:20,720 --> 00:06:22,800 THEIR ROLE IS TO HELP IN TERMS 145 00:06:22,800 --> 00:06:30,680 OF GETTING US EVIDENCE IN TERMS 146 00:06:30,680 --> 00:06:35,400 OF EPIDEMIOLOGY RESEARCH AND DO 147 00:06:35,400 --> 00:06:37,280 THE CAMPAIGN LED BY 148 00:06:37,280 --> 00:06:38,080 DR. BARFIELD. 149 00:06:38,080 --> 00:06:40,840 YOU'LL HEAR FROM THEM AGAIN FROM 150 00:06:40,840 --> 00:06:41,800 A DIFFERENT DIVISION AND THEY 151 00:06:41,800 --> 00:06:46,640 CAN SPEAK MORE TO THEIR ROLE. 152 00:06:46,640 --> 00:06:48,160 FOR THE NATIONAL CENTER OF 153 00:06:48,160 --> 00:06:49,920 HEALTH STATISTICS, PART OF CDC, 154 00:06:49,920 --> 00:06:51,600 YOU HEARD FROM THEM LAST 155 00:06:51,600 --> 00:06:53,360 MEETING, THEY COLLECT, ANALYZE 156 00:06:53,360 --> 00:06:57,760 AND DISSEMINATE HEALTH DATA AND 157 00:06:57,760 --> 00:07:03,840 STATISTICS INCLUDING VITAL 158 00:07:03,840 --> 00:07:04,160 STATISTICS. 159 00:07:04,160 --> 00:07:07,240 THESE ARE FOLKS RELATED TO BIRTH 160 00:07:07,240 --> 00:07:07,800 CERTIFICATES OR MORTALITY 161 00:07:07,800 --> 00:07:09,640 REPORTING. 162 00:07:09,640 --> 00:07:12,200 OUR PARTNERS AT THE HEALTH 163 00:07:12,200 --> 00:07:13,760 RESOURCES AND SERVICES 164 00:07:13,760 --> 00:07:14,800 ADMINISTRATION PROVIDE HEALTH 165 00:07:14,800 --> 00:07:16,840 CARE AND SERVICE TO PEOPLE WHO 166 00:07:16,840 --> 00:07:19,560 ARE GEOGRAPHICALLY ISOLATED, 167 00:07:19,560 --> 00:07:22,840 MEDICALLY VULNERABLE AND HAVE A 168 00:07:22,840 --> 00:07:25,200 ROLE IN TRAINING HEALTH CARE 169 00:07:25,200 --> 00:07:28,920 PROFESSI 170 00:07:28,920 --> 00:07:29,600 PROFESSIONALS. 171 00:07:29,600 --> 00:07:31,920 OUR COLLEAGUES FROM HRSA ARE 172 00:07:31,920 --> 00:07:33,200 HERE TO LISTEN AND LEARN AND 173 00:07:33,200 --> 00:07:35,880 THINK HOW IT WILL IMPACT THEIR 174 00:07:35,880 --> 00:07:37,000 NATIONAL PROGRAMS. 175 00:07:37,000 --> 00:07:40,400 I THINK IN TERMS OF HEALTH CARE 176 00:07:40,400 --> 00:07:41,640 PROFESSIONAL TRAINING, IN TERMS 177 00:07:41,640 --> 00:07:43,080 OF THE MATERNAL AND HEALTH 178 00:07:43,080 --> 00:07:46,200 PROGRAMS PROVIDED THROUGH HRSA, 179 00:07:46,200 --> 00:07:49,920 OFTEN FUNDED THROUGH THE STATES 180 00:07:49,920 --> 00:07:51,760 THROUGH BLOCK GRANT PROGRAMS, 181 00:07:51,760 --> 00:07:53,960 THEY'RE REALLY MORE IN 182 00:07:53,960 --> 00:07:57,720 SUPPORTING DIRECT CARE AND 183 00:07:57,720 --> 00:07:58,800 TRAINING HEALTH CARE 184 00:07:58,800 --> 00:07:59,800 PROFESSIONALS. 185 00:07:59,800 --> 00:08:04,880 FINALLY, OUR COLLEAGUES AT THE 186 00:08:04,880 --> 00:08:09,080 INDIAN HEALTH SERVICES TO 187 00:08:09,080 --> 00:08:16,040 PROVIDE AMERICAN INDIANS AND 188 00:08:16,040 --> 00:08:18,400 ALASKA NATIVES HELP ACCESS 189 00:08:18,400 --> 00:08:18,880 QUALITY CARE. 190 00:08:18,880 --> 00:08:20,240 THEY'RE ACTIVE PARTNERS WITH THE 191 00:08:20,240 --> 00:08:26,520 REST OF US TO HELP ENSURE WE 192 00:08:26,520 --> 00:08:29,960 KNOW OUR AMERICAN INDIAN AND 193 00:08:29,960 --> 00:08:31,920 ALASKA NATIVE POPULATION NOT ALL 194 00:08:31,920 --> 00:08:38,440 LOCATED IN ONE PLACE AND USE THE 195 00:08:38,440 --> 00:08:40,960 INDIAN COLLABORATIVE BUT USE 196 00:08:40,960 --> 00:08:45,800 RESOURCES AND AWARE MANY 197 00:08:45,800 --> 00:08:47,040 AMERICAN INDIAN AND ALASKAN 198 00:08:47,040 --> 00:08:51,280 NATIVES DON'T LIVE NEAR 199 00:08:51,280 --> 00:08:54,200 FACILITIES AND OFTEN ACCESS THE 200 00:08:54,200 --> 00:08:57,240 SAME CARE OTHER MEDICALLY OR 201 00:08:57,240 --> 00:08:58,480 ECONOMICALLY VULNERABLE 202 00:08:58,480 --> 00:09:00,120 INDIVIDUALS ARE ACCESSING. 203 00:09:00,120 --> 00:09:02,360 I THINK WE ARE VERY AWARE WE ARE 204 00:09:02,360 --> 00:09:04,440 A LARGE ECO SYSTEM IN THE 205 00:09:04,440 --> 00:09:06,600 DEPARTMENT HEALTH AND HUMAN 206 00:09:06,600 --> 00:09:09,760 SERVICES AND EACH OF US PLAYS A 207 00:09:09,760 --> 00:09:10,600 VITAL ROLE IN THIS PARTICULAR 208 00:09:10,600 --> 00:09:11,400 ISSUE. 209 00:09:11,400 --> 00:09:14,280 I WANT TO TAKE A MOMENT TO THANK 210 00:09:14,280 --> 00:09:19,320 OUR COLLEAGUES WHO ARE HERE IN 211 00:09:19,320 --> 00:09:26,000 AN EX OFFICIO CAPACITY AND 212 00:09:26,000 --> 00:09:26,800 HELPING IN THE RECOMMENDATIONS 213 00:09:26,800 --> 00:09:32,040 AND THE REPORT TO CONGRESS. 214 00:09:32,040 --> 00:09:35,160 WITH THAT TO SAY THE ROLE OF 215 00:09:35,160 --> 00:09:37,880 NON-GOVERNMENTAL ORGANIZATIONS 216 00:09:37,880 --> 00:09:39,880 AND THESE ARE OUR COLLEAGUES 217 00:09:39,880 --> 00:09:42,560 HERE WITH US THAT REPRESENT THE 218 00:09:42,560 --> 00:09:44,680 AMERICAN COLLEGE OF OBSTETRICS 219 00:09:44,680 --> 00:09:47,480 AND GYNECOLOGY AND THE SOCIETY 220 00:09:47,480 --> 00:09:50,200 OF MATERNAL AND FETAL MEDICINE 221 00:09:50,200 --> 00:09:52,000 AND PEDIATRICS PROVIDERS AND THE 222 00:09:52,000 --> 00:09:54,840 ORGANIZATION LIKE THE MARCH OF 223 00:09:54,840 --> 00:09:56,640 DIMES, THESE FOLKS PLAY KEY 224 00:09:56,640 --> 00:09:56,840 ROLES. 225 00:09:56,840 --> 00:10:00,640 I WANT TO SAY IT'S IMPORTANT TO 226 00:10:00,640 --> 00:10:01,840 MAKE SURE THESE GROUPS ARE AWARE 227 00:10:01,840 --> 00:10:05,280 OF WHAT WE'RE DOING IN THIS 228 00:10:05,280 --> 00:10:07,000 REPORT WILL ALSO BE BROADLY 229 00:10:07,000 --> 00:10:07,920 DISSEMINATED TO THEM. 230 00:10:07,920 --> 00:10:09,480 THE GROUPS DO A NUMBER OF THINGS 231 00:10:09,480 --> 00:10:11,080 INCLUDING ACCESS TO EDUCATIONAL 232 00:10:11,080 --> 00:10:13,240 RESOURCE OR TRAINING TO PATIENTS 233 00:10:13,240 --> 00:10:19,960 AND PROVIDERS, PUBLISHING 234 00:10:19,960 --> 00:10:23,640 EVIDENCE-BASED INFORMATION FOR 235 00:10:23,640 --> 00:10:26,880 PROVIDERS AND ADVOCATING FOR 236 00:10:26,880 --> 00:10:29,000 GROUPS ON RELEVANT ISSUES AND 237 00:10:29,000 --> 00:10:30,240 MANY ARE AWARE ADVOCACY IS 238 00:10:30,240 --> 00:10:32,040 IMPORTANT TO GAIN RESOURCES THAT 239 00:10:32,040 --> 00:10:36,840 WE NEED TO BE ABLE TO DO THIS 240 00:10:36,840 --> 00:10:41,280 WORK THEY ALSO SERVE AS FOCAL 241 00:10:41,280 --> 00:10:45,120 POINTS FOR DIVERSE COMMUNITIES 242 00:10:45,120 --> 00:10:47,080 AND FACILITATE KNOWLEDGE 243 00:10:47,080 --> 00:10:47,320 SHARING. 244 00:10:47,320 --> 00:10:49,920 THAT'S WHERE OUR 245 00:10:49,920 --> 00:10:51,360 NON-GOVERNMENTAL ORGANIZATION 246 00:10:51,360 --> 00:10:52,720 INVOLVED AND WE WANT TO THANK 247 00:10:52,720 --> 00:10:53,600 THEM FOR THEIR ATTENTION AND 248 00:10:53,600 --> 00:11:00,480 CONTINUED SUPPORT OF THIS WORK. 249 00:11:00,480 --> 00:11:04,120 WITH THAT I WILL END AND I'M 250 00:11:04,120 --> 00:11:05,920 HAPPY TO EITHER LOOK AND HE SEE 251 00:11:05,920 --> 00:11:08,160 IF THERE ARE QUESTIONS ABOUT 252 00:11:08,160 --> 00:11:15,120 THIS ONE OR I CAN ALSO BE 253 00:11:15,120 --> 00:11:17,520 AVAILABLE IN THE CHAT I KNOW WE 254 00:11:17,520 --> 00:11:28,080 HAVE A PACKED AGENDA SO I YIELD 255 00:11:29,040 --> 00:11:33,760 TO YOU ALL. 256 00:11:33,760 --> 00:11:35,400 >>WE HAVE NO QUESTIONS AT THE 257 00:11:35,400 --> 00:11:37,800 MOMENT I THINK WE'RE TAKING IT 258 00:11:37,800 --> 00:11:40,480 IN AND WE CAN START WITH THE 259 00:11:40,480 --> 00:11:44,240 FIRST SECTION THE PSYCHOLOGICAL 260 00:11:44,240 --> 00:11:51,080 IMPACT AND TREATMENT FOR MOTHERS 261 00:11:51,080 --> 00:11:52,280 FOLLOWING STILLBIRTH AND WE HAVE 262 00:11:52,280 --> 00:11:56,400 THE DIVISION DIRECTOR OF THE 263 00:11:56,400 --> 00:11:57,520 NATIONAL CENTER FOR CHRONIC 264 00:11:57,520 --> 00:11:58,520 DISEASE PROMOTION AND CENTER FOR 265 00:11:58,520 --> 00:12:08,840 DISEASE CONTROL AND PREVENTION. 266 00:12:08,840 --> 00:12:09,840 >>THANK YOU. 267 00:12:09,840 --> 00:12:13,160 I WANT TO SAY MANY THANKS FOR 268 00:12:13,160 --> 00:12:15,000 THE OPPORTUNITY TO PRESENT SO 269 00:12:15,000 --> 00:12:17,640 THIS GROUP AND THANK YOU SO 270 00:12:17,640 --> 00:12:21,160 MUCH, ALISON, FOR THE GREAT 271 00:12:21,160 --> 00:12:21,920 INTRODUCTION IN TERMS OF THE 272 00:12:21,920 --> 00:12:26,160 COLLECTIVE WORK WE'RE DOING. 273 00:12:26,160 --> 00:12:29,640 I DIRECT THE DIVISION OF 274 00:12:29,640 --> 00:12:31,520 REPRODUCTIVE HEALTH IN THE 275 00:12:31,520 --> 00:12:33,280 NATIONAL CENTER FOR DISEASE 276 00:12:33,280 --> 00:12:34,840 PREVENTION AND PROMOTION AND OUR 277 00:12:34,840 --> 00:12:37,360 FOCUS IS WOMEN'S REPRODUCTIVE 278 00:12:37,360 --> 00:12:39,120 HEALTH AND MATERNAL HEALTH AND 279 00:12:39,120 --> 00:12:39,600 INFANT HEALTH. 280 00:12:39,600 --> 00:12:44,440 WITH THAT WE'RE EXCITED TO TALK 281 00:12:44,440 --> 00:12:47,480 ABOUT THE OPPORTUNITY WITH THE 282 00:12:47,480 --> 00:12:48,880 WORK AROUND STILLBIRTHS. 283 00:12:48,880 --> 00:12:54,480 I'LL HAVE TWO COLLEAGUES 284 00:12:54,480 --> 00:12:54,760 PARTICIPATE. 285 00:12:54,760 --> 00:13:00,200 THE FIRST IS AN EPIDEMIOLOGIST 286 00:13:00,200 --> 00:13:01,520 FOR THE PREGNANCY RISK 287 00:13:01,520 --> 00:13:03,320 ASSESSMENT TEAM IN THE WOMEN'S 288 00:13:03,320 --> 00:13:05,640 HEALTH AND FERTILITY BRANCH. 289 00:13:05,640 --> 00:13:07,840 AND SHE WILL ALSO BE ACCOMPANIED 290 00:13:07,840 --> 00:13:14,000 BY ANOTHER COMMITTEE MEMBER, WHO 291 00:13:14,000 --> 00:13:16,360 IS AN EPIDEMIOLOGIST IN THE 292 00:13:16,360 --> 00:13:18,840 PERINATAL AND INFANT HEALTH TEAM 293 00:13:18,840 --> 00:13:20,040 IN THE MATERNAL AND INFANT 294 00:13:20,040 --> 00:13:30,280 HEALTH BRANCH. 295 00:13:30,280 --> 00:13:31,520 >>THANK YOU. 296 00:13:31,520 --> 00:13:32,280 I'LL GO AHEAD AND SHARE MY 297 00:13:32,280 --> 00:13:42,400 SCREEN. 298 00:14:00,320 --> 00:14:00,760 >>AN EVERYONE SEE THE 299 00:14:00,760 --> 00:14:03,360 PRESENTATION? 300 00:14:03,360 --> 00:14:06,760 >>YES, YOU'RE NOT IN A 301 00:14:06,760 --> 00:14:07,200 PRESENTER MOOD. 302 00:14:07,200 --> 00:14:17,760 NOT SURE YOU'RE ABLE TO DO THAT. 303 00:14:43,360 --> 00:14:45,720 >>THANK YOU, GOOD MORNING AND 304 00:14:45,720 --> 00:14:48,880 THANK YOU FOR THE INTRODUCTION. 305 00:14:48,880 --> 00:14:50,160 AND THANK YOU TO THE NICHD 306 00:14:50,160 --> 00:14:52,680 STILLBIRTH COUNCIL AS WELL FOR 307 00:14:52,680 --> 00:14:54,160 THE OPPORTUNITY TO PRESENT TODAY 308 00:14:54,160 --> 00:14:57,040 ON CDC'S EFFORTS TO LISTEN AND 309 00:14:57,040 --> 00:15:00,080 CAPTURE THE VOICES OF THOSE WHO 310 00:15:00,080 --> 00:15:02,000 HAVE EXPERIENCED A STILLBIRTH. 311 00:15:02,000 --> 00:15:04,080 AS YOU HEARD BEFORE, MY NAME IS 312 00:15:04,080 --> 00:15:10,040 DR. DIEKE AND I HELP SERVE TO 313 00:15:10,040 --> 00:15:14,200 PROVIDE TECHNICAL ASSISTANCE TO 314 00:15:14,200 --> 00:15:16,440 THE PLANS GRANTEE INCLUDING UTAH 315 00:15:16,440 --> 00:15:20,560 WHO IS LOOKED AT THE ASSOCIATED 316 00:15:20,560 --> 00:15:23,640 RISK OF STILLBIRTHS ALSO KNOWN 317 00:15:23,640 --> 00:15:31,240 AS THE SOURCE PROJECT. 318 00:15:31,240 --> 00:15:35,200 THE OBJECTIVES ARE TO PROVIDE A 319 00:15:35,200 --> 00:15:39,960 BRIEF PLAN OVERVUND GIVE YOU -- 320 00:15:39,960 --> 00:15:44,600 VIEW AND TO GIVE YOU THE SOURCE 321 00:15:44,600 --> 00:15:47,440 PROTOCOL AND PRESENT KEY COVERS 322 00:15:47,440 --> 00:15:48,400 ON THE SURVEY AND PRELIMINARY 323 00:15:48,400 --> 00:15:51,960 DATA AND NEXT STEPS AND WHAT 324 00:15:51,960 --> 00:15:54,120 SOARS AND A SNAPSHOT OF THE 325 00:15:54,120 --> 00:15:57,720 DIVISION OF REPRODUCTIVE HEALTH 326 00:15:57,720 --> 00:15:59,960 HEAR HER CAMPAIGN AS IT PERTAINS 327 00:15:59,960 --> 00:16:10,520 TO STILLBIRTH PREVENTION. 328 00:16:10,520 --> 00:16:11,680 PRAMS IS A SURVEILLANCE SYSTEM 329 00:16:11,680 --> 00:16:14,520 ESTABLISHED IN 1987 AS PART OF 330 00:16:14,520 --> 00:16:20,480 THE CDC SAFE MOTHERHOOD AND 331 00:16:20,480 --> 00:16:24,640 INFANT HEALTH SURVEILLANCE 332 00:16:24,640 --> 00:16:27,200 SYSTEM FOR BEFORE, AFTER AND 333 00:16:27,200 --> 00:16:28,560 SHORTLY AFTER LIVE BIRTH AND 334 00:16:28,560 --> 00:16:34,960 INFORMATION FROM THE BIRTH 335 00:16:34,960 --> 00:16:36,920 CERTIFICATE AND IT HAS ESTIMATES 336 00:16:36,920 --> 00:16:40,160 OF MANY MATERNAL AND CHILD 337 00:16:40,160 --> 00:16:45,160 HEALTH INDICATORS. 338 00:16:45,160 --> 00:16:48,440 THE CURRENT FIVE-YEAR FUNDING 339 00:16:48,440 --> 00:16:50,280 CYCLE FOR PRAMS INCLUDES 46 340 00:16:50,280 --> 00:16:53,600 STATES AND FOUR CITIES OR 341 00:16:53,600 --> 00:16:54,720 TERRITORIES, D.C., NEW YORK 342 00:16:54,720 --> 00:16:58,800 CITY, PUERTO RICO AND THE 343 00:16:58,800 --> 00:17:01,080 COMMONWEALTH OF NORTHERN MARIANA 344 00:17:01,080 --> 00:17:03,800 ISLANDS AND IT REPRESENTS AROUND 345 00:17:03,800 --> 00:17:14,240 81% OF ALL LIVE BIRTHS. 346 00:17:15,000 --> 00:17:16,920 IT COMPROMISES INDIVIDUALS WHO 347 00:17:16,920 --> 00:17:19,640 HAD A LIVE BIRTH AND AS A 348 00:17:19,640 --> 00:17:21,280 RESIDENT OF THE STATE, CITY OR 349 00:17:21,280 --> 00:17:21,560 TERRITORY. 350 00:17:21,560 --> 00:17:23,400 THEY'VE HAD A BIRTH WITHIN THE 351 00:17:23,400 --> 00:17:24,800 CALENDAR YEAR OF DATA COLLECTION 352 00:17:24,800 --> 00:17:26,800 AND THEY'RE RANDOMLY SAMPLED 353 00:17:26,800 --> 00:17:29,120 FROM THAT JURISDICTION'S BIRTH 354 00:17:29,120 --> 00:17:32,160 CERTIFICATE RECORDS. 355 00:17:32,160 --> 00:17:33,360 ADDITIONALLY, THE PRAMS 356 00:17:33,360 --> 00:17:36,160 POPULATION IS CONTACTED WHEN 357 00:17:36,160 --> 00:17:38,600 THEIR BABY IS 2 TO 6 MONTHS OLD 358 00:17:38,600 --> 00:17:40,840 AND JURISDICTIONS EACH SAMPLE 359 00:17:40,840 --> 00:17:41,800 APPROXIMATELY 1,000 TO 3,000 360 00:17:41,800 --> 00:17:48,720 WOMEN PER YEAR. 361 00:17:48,720 --> 00:17:50,640 PRAMS HAS CONSISTENTLY COLLECTED 362 00:17:50,640 --> 00:17:53,400 DATA ON PRE CONCEPTION AND 363 00:17:53,400 --> 00:17:56,160 PRENATAL CARE TO INFANT SLEEP 364 00:17:56,160 --> 00:17:58,400 ENVIRONMENT. 365 00:17:58,400 --> 00:18:01,600 AND CURRENTLY, PRAMS IS 366 00:18:01,600 --> 00:18:03,600 UNDERGOING A REVISION AND NEW 367 00:18:03,600 --> 00:18:06,240 PHASE OF QUESTIONS FOR THE NINTH 368 00:18:06,240 --> 00:18:07,880 PHASE OF REVISION FOR PRAMS STAR 369 00:18:07,880 --> 00:18:11,720 GET FORD IMPLEMENTATION AN APRIL 370 00:18:11,720 --> 00:18:11,920 2023. 371 00:18:11,920 --> 00:18:13,280 THIS SLIDE SHOWS A FEW OF THE 372 00:18:13,280 --> 00:18:16,040 NEW INDICATORS IN THE UPCOMING 373 00:18:16,040 --> 00:18:17,640 PHASE 9 QUESTIONNAIRE INCLUDING 374 00:18:17,640 --> 00:18:20,400 THE TOPICS SHOWN ON THE SLIDE. 375 00:18:20,400 --> 00:18:23,000 OF NOTE, INCLUDING EXPERIENCES 376 00:18:23,000 --> 00:18:30,280 OF DISCRIMINATION. 377 00:18:30,280 --> 00:18:32,120 PRAMS DATA COLLECTION PROCEDURE 378 00:18:32,120 --> 00:18:35,120 ARE STANDARDIZED TO FACILITATE 379 00:18:35,120 --> 00:18:38,040 COMPARISONS BETWEEN SITES FOR 380 00:18:38,040 --> 00:18:40,800 SINGLE AND MULTI-SITE ANALYSES. 381 00:18:40,800 --> 00:18:41,280 THEY'RE IN THE MODEL 382 00:18:41,280 --> 00:18:42,720 SURVEILLANCE PROTOCOL YOU CAN 383 00:18:42,720 --> 00:18:48,000 FIND ON THE CDC PRAMS WEBSITE. 384 00:18:48,000 --> 00:18:51,640 PRAMS HAS A MAIL SURVEY WITH 385 00:18:51,640 --> 00:18:53,520 MULTIPLE FOLLOW-UP ATTEMPTS SO 386 00:18:53,520 --> 00:18:55,040 THERE'S UP TO THREE MAILED 387 00:18:55,040 --> 00:18:57,040 SURVEYS AND TWO LETTER REMINDERS 388 00:18:57,040 --> 00:18:58,880 AND A FOLLOW-UP IF THERE'S NO 389 00:18:58,880 --> 00:18:59,480 MAIL RESPONSE. 390 00:18:59,480 --> 00:19:02,400 AND FOR THE PHONE SURVEY, 391 00:19:02,400 --> 00:19:04,200 INTERVIEWERS HAVE UP TO 15 CALL 392 00:19:04,200 --> 00:19:05,640 ATTEMPT TO MAKE CONTACT WITH THE 393 00:19:05,640 --> 00:19:09,480 PARTICIPANT. 394 00:19:09,480 --> 00:19:11,240 FINALLY, WE HAVE PILOT TESTED 395 00:19:11,240 --> 00:19:14,760 OUR THIRD MODE, THE WEB MODULE 396 00:19:14,760 --> 00:19:17,280 WITH FIVE PRAMS SITES, MARYLAND, 397 00:19:17,280 --> 00:19:18,400 PUERTO RICO, SOUTH CAROLINA, 398 00:19:18,400 --> 00:19:19,600 VIRGINIA AND WYOMING. 399 00:19:19,600 --> 00:19:28,160 WE HOPE TO GET ALL PRAM SITES BY 400 00:19:28,160 --> 00:19:28,920 FALL OF 2023. 401 00:19:28,920 --> 00:19:31,640 NOW THAT I'VE PRESENTED ON 402 00:19:31,640 --> 00:19:32,760 DETAILS OF PRAMS LET'S LOOK AT 403 00:19:32,760 --> 00:19:34,080 HOW IT MAY HAVE HELPED IN THE 404 00:19:34,080 --> 00:19:41,720 FORMATION OF SOURCE. 405 00:19:41,720 --> 00:19:44,200 A CASE CONTROL STUDY WAS DONE BY 406 00:19:44,200 --> 00:19:45,440 THE COLLABORATIVE RESEARCH 407 00:19:45,440 --> 00:19:48,160 NETWORK THAT IDENTIFIED 408 00:19:48,160 --> 00:19:49,840 CHARACTERISTICS ASSOCIATED WITH 409 00:19:49,840 --> 00:19:50,920 RACIAL ETHNIC DISPARITY AND 410 00:19:50,920 --> 00:19:53,240 INTERPERSONAL AND ENVIRONMENTAL 411 00:19:53,240 --> 00:19:53,680 STRESSORS. 412 00:19:53,680 --> 00:19:56,000 SO THE 13 ITEMS SIGNIFICANT LIFE 413 00:19:56,000 --> 00:20:01,280 EVENT SCALE OR SLE SCALE ALSO 414 00:20:01,280 --> 00:20:04,160 CALLED OUR STRESSORS QUESTION 415 00:20:04,160 --> 00:20:06,200 WAS USED. 416 00:20:06,200 --> 00:20:09,080 IN 2012 TO 2013, EMORY 417 00:20:09,080 --> 00:20:10,880 RESEARCHERS USED THE PRAMS 418 00:20:10,880 --> 00:20:12,840 MET 419 00:20:12,840 --> 00:20:16,520 METHODOLOGY OF A STILLBIRTH 420 00:20:16,520 --> 00:20:18,560 STUDY FROM GEORGIA'S FETAL DEATH 421 00:20:18,560 --> 00:20:25,000 CERTIFICATES. 422 00:20:25,000 --> 00:20:27,160 IN TERMS OF FUNDING FOR SOURCE 423 00:20:27,160 --> 00:20:28,960 PROJECT AS PART OF THE 2016 TO 424 00:20:28,960 --> 00:20:32,400 2019 FUNDING CYCLE, CDC'S PRAMS 425 00:20:32,400 --> 00:20:36,840 NOTICE OF FUNDING AWARD THEN 426 00:20:36,840 --> 00:20:39,240 INCLUDED A NEW COMPONENT TO FUND 427 00:20:39,240 --> 00:20:41,760 ONE PRAMS GRANTEE TO HAVE A 428 00:20:41,760 --> 00:20:43,640 STILLBIRTH PILOT IN THEIR STATE 429 00:20:43,640 --> 00:20:47,240 AND UTAH WAS THE SOLE RECIPIENT 430 00:20:47,240 --> 00:20:51,360 AND WORKED TO CREATE THE SOARS 431 00:20:51,360 --> 00:20:51,600 PROJECT. 432 00:20:51,600 --> 00:20:53,360 AFTER DEVELOPMENT AND WORKING 433 00:20:53,360 --> 00:20:55,120 THROUGH CHALLENGES WITH THE DATA 434 00:20:55,120 --> 00:20:56,960 COLLECTION SYSTEM THE UTAH SOARS 435 00:20:56,960 --> 00:20:59,040 WAS ABLE TO COLLECT DATA FROM 436 00:20:59,040 --> 00:21:03,400 MAY 2018 TO JUNE 2019. 437 00:21:03,400 --> 00:21:05,360 SOARS WAS NOT ABLE TO BE FUNDED 438 00:21:05,360 --> 00:21:08,240 BY THE CDC BUT WAS FUNDED BY A 439 00:21:08,240 --> 00:21:10,440 UTAH PRAMS PARTNER. 440 00:21:10,440 --> 00:21:13,000 AND THEN AGAIN CDC DID OFFER THE 441 00:21:13,000 --> 00:21:15,600 OPPORTUNITY FOR STILLBIRTH DATA 442 00:21:15,600 --> 00:21:16,800 COLLECTION IN OUR CURRENT 443 00:21:16,800 --> 00:21:19,320 FUNDING CYCLE BETWEEN THE YEARS 444 00:21:19,320 --> 00:21:22,320 OF 2021 TO 2025 OF WHICH UTAH 445 00:21:22,320 --> 00:21:28,920 WAS THE SOLE APPLICANT AND 446 00:21:28,920 --> 00:21:33,400 RECIPIENT AND 2021 DATA HAS 447 00:21:33,400 --> 00:21:35,960 COLLECTED AND 2022 IS IN 448 00:21:35,960 --> 00:21:36,880 PROGRESS AND BOTH WILL BE 449 00:21:36,880 --> 00:21:37,560 AVAILABLE IN THE FUTURE. 450 00:21:37,560 --> 00:21:40,440 AND UTAH HAS BEEN ABLE TO HELP 451 00:21:40,440 --> 00:21:42,680 OTHER STATES LIKE OHIO AND NORTH 452 00:21:42,680 --> 00:21:47,920 DAKOTA NOT CURRENTLY FUND BY CDC 453 00:21:47,920 --> 00:21:50,000 PRAMS TO CREATE THEIR OWN SBRJ 454 00:21:50,000 --> 00:21:52,200 PROJECTS. 455 00:21:52,200 --> 00:22:00,880 STILLBIRTH PROJECTS. 456 00:22:00,880 --> 00:22:05,160 BOTH HAVE A PROTOCOL APPROVED BY 457 00:22:05,160 --> 00:22:09,440 CDC AND IRB AND BOTH CONTACTED 458 00:22:09,440 --> 00:22:12,640 PARTICIPANTS AFTER THE LIVE BORN 459 00:22:12,640 --> 00:22:14,240 OR STILLBORN. 460 00:22:14,240 --> 00:22:14,920 PRAMS PROVIDED INFORMATION FROM 461 00:22:14,920 --> 00:22:18,040 A SAMPLE OF INDIVIDUALS WITH THE 462 00:22:18,040 --> 00:22:23,680 LIVE BORN INFANT IN THE DATA 463 00:22:23,680 --> 00:22:25,960 COLLECTION YEAR. 464 00:22:25,960 --> 00:22:27,000 SOARS COMBINES INFORMATION FROM 465 00:22:27,000 --> 00:22:28,360 ALL FETAL DEATHS OR CENSUS IN 466 00:22:28,360 --> 00:22:32,320 THE DATA COLLECTION YEAR. 467 00:22:32,320 --> 00:22:34,720 TO ENCOURAGE RESPONSES PRAMS 468 00:22:34,720 --> 00:22:36,600 PROTOCOL ALLOWS AN INCENTIVE FOR 469 00:22:36,600 --> 00:22:42,880 PARTICIPATION AND/OR REWARD UPON 470 00:22:42,880 --> 00:22:44,120 COMPLETION. 471 00:22:44,120 --> 00:22:46,520 SOARS PROTOCOL HAS A NECKLACE 472 00:22:46,520 --> 00:22:53,040 WEDGE A PENDANT OF A SWALLOW IN 473 00:22:53,040 --> 00:22:55,760 MEMORIAM OF THE LOST FETUS AND A 474 00:22:55,760 --> 00:22:59,400 CONSULTATION WITH A FETAL 475 00:22:59,400 --> 00:23:01,320 MATERNAL MEDICINE PART OF THE 476 00:23:01,320 --> 00:23:03,080 STILLBIRTH COUNCIL. 477 00:23:03,080 --> 00:23:04,640 BOTH PROJECTS OFFER INFORMED 478 00:23:04,640 --> 00:23:07,760 CONSENT WITH SENSITIVE LANGUAGE 479 00:23:07,760 --> 00:23:08,560 AND FOR SOARS THE INFORMED 480 00:23:08,560 --> 00:23:11,520 CONSENT SENT TO THE SAMPLED MOMS 481 00:23:11,520 --> 00:23:13,400 INCLUDE ADDITIONAL SENSITIVE 482 00:23:13,400 --> 00:23:14,400 LANGUAGE THAT RECOGNIZES THE 483 00:23:14,400 --> 00:23:16,200 DIFFICULTY AND SENSITIVITY OF 484 00:23:16,200 --> 00:23:21,160 THEIR LOSS. 485 00:23:21,160 --> 00:23:23,640 PRAMS HAS THREE MAILINGS OF THE 486 00:23:23,640 --> 00:23:24,640 QUESTIONNAIRE PACKAGE WITH THE 487 00:23:24,640 --> 00:23:27,040 PHONE FOLLOW-UP FOR 488 00:23:27,040 --> 00:23:28,800 NON-RESPONDENTS OF UP TO 15 CALL 489 00:23:28,800 --> 00:23:29,160 ATTEMPTS. 490 00:23:29,160 --> 00:23:32,160 TO AVOID OVERWHELMING THE 491 00:23:32,160 --> 00:23:34,680 PARTICIPANT WHO MAY STILL BE 492 00:23:34,680 --> 00:23:36,280 GRIEVING, SOARS HAS TWO MAILINGS 493 00:23:36,280 --> 00:23:39,360 AND A PHONE FOLLOW-UP FOR 494 00:23:39,360 --> 00:23:40,160 NON-RESPONDENTS UP TO FIVE CALL 495 00:23:40,160 --> 00:23:48,520 ATTEMPTS. 496 00:23:48,520 --> 00:23:51,680 HERE ARE THE TOPICS COVERED BY 497 00:23:51,680 --> 00:23:54,520 THE SOARS QUESTIONNAIRE. 498 00:23:54,520 --> 00:23:58,240 PRENATAL AND POST NATAL CARE, 499 00:23:58,240 --> 00:24:01,080 SOCIAL SUPPORT AND STRESS AND 500 00:24:01,080 --> 00:24:01,880 BEREAVEMENT SUPPORT AND SUPPORT 501 00:24:01,880 --> 00:24:04,560 FROM THE HOSPITALS AFTER A 502 00:24:04,560 --> 00:24:06,040 STILLBIRTH OCCURS AND TESTS THAT 503 00:24:06,040 --> 00:24:08,080 MAY HAVE BEEN OFFERED AFTER THE 504 00:24:08,080 --> 00:24:09,440 STILLBIRTH, USE OF ALCOHOL, 505 00:24:09,440 --> 00:24:12,720 TOBACCO AND E-CIGARETTES. 506 00:24:12,720 --> 00:24:14,600 PHYSICAL ABUSE, CHRONIC HEALTH 507 00:24:14,600 --> 00:24:19,960 CONDITIONS OF THE MOTHER AND 508 00:24:19,960 --> 00:24:21,800 HEALTH INSURANCE COVERAGE. 509 00:24:21,800 --> 00:24:24,200 A LITTLE MORE ABOUT SOARS. 510 00:24:24,200 --> 00:24:24,920 THE SOARS PROGRAM USED A LOGO OF 511 00:24:24,920 --> 00:24:27,720 A SWALLOW TO SYMBOLIZE HOPE FOR 512 00:24:27,720 --> 00:24:28,920 NEW BEGINS. 513 00:24:28,920 --> 00:24:31,360 THE SWALLOW WAS USED IN THE 514 00:24:31,360 --> 00:24:34,480 PENDANT OF A NECKLACE DESIGN BY 515 00:24:34,480 --> 00:24:37,080 A LOCAL UTAH ARTIST WITH A 516 00:24:37,080 --> 00:24:39,280 CONNECTION TO PREGNANCY LOST. 517 00:24:39,280 --> 00:24:40,680 THEY CHARGED UTAH FOR THE 518 00:24:40,680 --> 00:24:41,720 SUPPLIES FOR THE FIRST TWO YEARS 519 00:24:41,720 --> 00:24:43,440 OF THE PROJECT AND BEGINNING IN 520 00:24:43,440 --> 00:24:44,920 YEAR THREE THEY WERE ABLE TO USE 521 00:24:44,920 --> 00:24:47,000 A DIFFERENT LOCAL JEWELER ABLE 522 00:24:47,000 --> 00:24:48,480 TO MEET THE BUDGETARY LIMITS. 523 00:24:48,480 --> 00:24:53,840 THE IMPORTANCE OF THIS PENDANT 524 00:24:53,840 --> 00:25:03,640 IS THAT IT HELPS MEMORIALIZE THE 525 00:25:03,640 --> 00:25:04,160 LOST BABY. 526 00:25:04,160 --> 00:25:05,480 THE ADVISORY COMMITTEE HAS BEEN 527 00:25:05,480 --> 00:25:08,120 IMPORTANT TO THE SUCCESS OF 528 00:25:08,120 --> 00:25:10,880 IMPLEMENTING UTAH SOARS. 529 00:25:10,880 --> 00:25:12,320 THE ADVISORY COMMITTEE IS 530 00:25:12,320 --> 00:25:13,880 COMPRISED OF THE GROUP OF 531 00:25:13,880 --> 00:25:15,120 EXPERTS YOU SEE HERE INCLUDING 532 00:25:15,120 --> 00:25:16,640 WOMEN WHO EXPERIENCED A FETAL 533 00:25:16,640 --> 00:25:17,600 LOSS. 534 00:25:17,600 --> 00:25:20,400 THIS IS CRITICAL TO ENSURING THE 535 00:25:20,400 --> 00:25:21,680 VOICES OF THOSE THAT HAVE 536 00:25:21,680 --> 00:25:24,760 EXPERIENCED A LOSS ARE EXCLUDED 537 00:25:24,760 --> 00:25:27,160 IN THE CONSTRUCTION OF 538 00:25:27,160 --> 00:25:30,040 STILLBIRTH STUDIES. 539 00:25:30,040 --> 00:25:32,160 THE ADVISORY COMMITTEE HELPED IN 540 00:25:32,160 --> 00:25:33,800 PARTNERS AND CONSULTATION WITH 541 00:25:33,800 --> 00:25:36,240 THE SPECIALISTS REGARDING 542 00:25:36,240 --> 00:25:37,920 POTENTIAL CAUSES OF THE LOSS AND 543 00:25:37,920 --> 00:25:41,080 RISK OF THE FUTURE LOSS. 544 00:25:41,080 --> 00:25:42,880 AND THIS HELPED PROVIDE ADVICE 545 00:25:42,880 --> 00:25:44,600 ON THE SURVEY QUESTIONS WHICH 546 00:25:44,600 --> 00:25:46,400 CAME FROM THE EMORY PILOT AND 547 00:25:46,400 --> 00:25:51,320 PRAMS AS WELL. 548 00:25:51,320 --> 00:25:53,520 HERE ARE A FEW SAMPLE QUESTIONS 549 00:25:53,520 --> 00:25:53,800 FROM SOARS. 550 00:25:53,800 --> 00:25:55,560 ON THE LEFT THERE'S A QUESTION 551 00:25:55,560 --> 00:25:58,320 THAT ASKS ABOUT PROBLEMS 552 00:25:58,320 --> 00:26:02,800 ENCOUNTERED DURING PREGNANCY. 553 00:26:02,800 --> 00:26:04,600 AN OPTION J ASKED ABOUT 554 00:26:04,600 --> 00:26:06,360 DECREASED FETAL MOVEMENT. 555 00:26:06,360 --> 00:26:08,240 I REMEMBER THIS BEING A KEY 556 00:26:08,240 --> 00:26:09,840 DISCUSSION POINT DURING THE 557 00:26:09,840 --> 00:26:12,560 PARENT GROUP THAT SPOKE FROM THE 558 00:26:12,560 --> 00:26:13,280 FIRST STILLBIRTH COUNCIL MEETING 559 00:26:13,280 --> 00:26:15,000 AND QUESTIONS ABOUT THE OFFER 560 00:26:15,000 --> 00:26:18,800 AND RECEIPT OF CERTAIN TESTS. 561 00:26:18,800 --> 00:26:20,800 IN THE MIDDLE A QUESTION READS 562 00:26:20,800 --> 00:26:22,880 WERE ANY TESTS OFFERED TO YOU 563 00:26:22,880 --> 00:26:24,400 DURING YOUR HOSPITAL STAY. 564 00:26:24,400 --> 00:26:26,560 YOU'LL NOTICE THAT OPTION C 565 00:26:26,560 --> 00:26:28,160 SPECIFIED WHETHER AN AUTOPSY WAS 566 00:26:28,160 --> 00:26:29,920 OFFERED. 567 00:26:29,920 --> 00:26:35,000 THEN ON THE RIGHT QUESTION 54 568 00:26:35,000 --> 00:26:37,640 READS WHAT WERE THE REASONS THE 569 00:26:37,640 --> 00:26:40,160 AUTOPSY WAS NOT DONE TO GET TO 570 00:26:40,160 --> 00:26:41,640 THE POSSIBLE REASONS FOR THE 571 00:26:41,640 --> 00:26:43,560 LACK OF AN AUTOPSY. 572 00:26:43,560 --> 00:26:47,440 THIS IS INFORMATION THAT CAN'T 573 00:26:47,440 --> 00:26:50,800 BE GLEANED FROM A FETAL DEATH 574 00:26:50,800 --> 00:26:51,080 CERTIFICATE. 575 00:26:51,080 --> 00:26:53,720 HERE'S A FEW MORE QUESTIONS TO 576 00:26:53,720 --> 00:26:55,920 THE PSYCHOSOCIAL ASPECT AND 577 00:26:55,920 --> 00:26:56,960 QUESTION 50 ASKS ABOUT THE TYPE 578 00:26:56,960 --> 00:26:59,040 OF SUPPORT SERVICES AT THE 579 00:26:59,040 --> 00:26:59,840 HOSPITAL INCLUDING GRIEF 580 00:26:59,840 --> 00:27:00,320 SUPPORT. 581 00:27:00,320 --> 00:27:03,320 AND THEN ON THE RIGHT, A FEW 582 00:27:03,320 --> 00:27:05,040 PRAMS QUESTIONS ON MENTAL HEALTH 583 00:27:05,040 --> 00:27:08,160 CONDITIONS THAT THE MOTHER MAY 584 00:27:08,160 --> 00:27:13,840 HAVE HAD DURING PREGNANCY. 585 00:27:13,840 --> 00:27:15,200 THERE'S ALSO THE STRESSORS 586 00:27:15,200 --> 00:27:17,080 QUESTION LIKE I MENTIONED BEFORE 587 00:27:17,080 --> 00:27:20,480 THAT COULD ALSO BE CATEGORIZED 588 00:27:20,480 --> 00:27:22,400 INTO SEOH INDICATORS. 589 00:27:22,400 --> 00:27:24,280 FOR INSTANCE, HOUSING 590 00:27:24,280 --> 00:27:26,120 INSECURITY, FINANCIAL INSECURITY 591 00:27:26,120 --> 00:27:28,520 AND INCARCERATION EXPOSURE ARE 592 00:27:28,520 --> 00:27:33,720 ALL ASPECTS OF SEOH PRESENT ON 593 00:27:33,720 --> 00:27:36,160 THE SOAR SURVEY. 594 00:27:36,160 --> 00:27:40,840 OTHER SOARS QUESTIONS NOT 595 00:27:40,840 --> 00:27:42,280 PICTURED ASK ABOUT HEALTH CARE 596 00:27:42,280 --> 00:27:44,000 ACCESS AND INSURANCE WHICH ARE 597 00:27:44,000 --> 00:27:48,080 ALSO SDOH INDICATORS. 598 00:27:48,080 --> 00:27:52,640 SO IN THE STUDY LED BY ANOTHER 599 00:27:52,640 --> 00:27:53,960 MEMBER OF THIS COUNCIL WE LOOKED 600 00:27:53,960 --> 00:27:57,840 AT WHETHER THE SOURCE PILOT WAS 601 00:27:57,840 --> 00:28:01,160 FEASIBLE AMONG THE STILLBIRTH 602 00:28:01,160 --> 00:28:05,720 POPULATION WITHIN AN EXISTING 603 00:28:05,720 --> 00:28:07,000 PRAM SITE. 604 00:28:07,000 --> 00:28:09,160 THERE WERE 288 UTAH RESIDENTS 605 00:28:09,160 --> 00:28:12,680 THAT EXPERIENCED A STILLBIRTH. 606 00:28:12,680 --> 00:28:14,640 THE SOURCE UNRELATED RESPONSE 607 00:28:14,640 --> 00:28:19,640 RATE OF 58% WAS HIGHER THAN THE 608 00:28:19,640 --> 00:28:23,920 2018 UTAH PRAMS RATE OF 54%. 609 00:28:23,920 --> 00:28:28,080 AND MOST OF THE SOURCE 610 00:28:28,080 --> 00:28:30,520 PARTICIPANTS RESPONDED BY MAIL 611 00:28:30,520 --> 00:28:33,240 COMPARED WITH 68.3% OF THE 612 00:28:33,240 --> 00:28:39,800 PARTICIPANTS IN THE 2018 UTAH 613 00:28:39,800 --> 00:28:40,160 PRAMS SURVEY. 614 00:28:40,160 --> 00:28:42,760 WOMEN OFTEN LIKE TO GET THE 615 00:28:42,760 --> 00:28:44,840 PACKET IN THE MAIL AND THEY WERE 616 00:28:44,840 --> 00:28:46,240 INTERESTED IN COMPLETING THE 617 00:28:46,240 --> 00:28:48,320 SURVEY BUT NOT IN PERSON OR NOT 618 00:28:48,320 --> 00:28:53,640 BY TELEPHONE. 619 00:28:53,640 --> 00:28:55,080 THERE WERE A HIGHER PROPORTION 620 00:28:55,080 --> 00:28:56,560 OF WOMEN NON-HISPANIC WHITE, 621 00:28:56,560 --> 00:28:59,880 MARRIED AND HAD MORE THAN A HIGH 622 00:28:59,880 --> 00:29:01,440 SCHOOL DIPLOMA THAT RESPONDED TO 623 00:29:01,440 --> 00:29:05,120 THE SURVEY THAN WOMEN OF OTHER 624 00:29:05,120 --> 00:29:08,680 RACES, ETHNICITIES AND WE FOUND 625 00:29:08,680 --> 00:29:09,480 SIGNIFICANT DIFFERENCES BETWEEN 626 00:29:09,480 --> 00:29:11,560 RESPONDERS AND NON-RESPONDERS BY 627 00:29:11,560 --> 00:29:15,640 MATERNAL AGE, GESTATIONAL AGE OF 628 00:29:15,640 --> 00:29:23,200 THE FETUS OR MONTH AND DELIVERY. 629 00:29:23,200 --> 00:29:25,440 ITEM NON-RESPONSE WAS LOW AND 630 00:29:25,440 --> 00:29:26,560 MOST WOMEN IN THE UTAH PROJECT 631 00:29:26,560 --> 00:29:29,480 WERE WILLING TO RESPONSE TO THE 632 00:29:29,480 --> 00:29:31,000 SURVEY QUESTIONS. 633 00:29:31,000 --> 00:29:32,720 THE QUESTION ABOUT INCOME WHICH 634 00:29:32,720 --> 00:29:35,640 TYPICALLY GETS US THE HIGHEST 635 00:29:35,640 --> 00:29:38,800 ITEM NON-RESPONSE RATE IN PRAMS 636 00:29:38,800 --> 00:29:41,520 HAD A SLIGHTLY LOWER RATE IN 637 00:29:41,520 --> 00:29:44,720 SOARS THAN IN THE UTAH PRAMS 638 00:29:44,720 --> 00:29:48,840 SURVEY AND SOARS WAS 14.8% AND 639 00:29:48,840 --> 00:29:51,640 THE MOST SENSITIVE SURVEY 640 00:29:51,640 --> 00:29:52,960 QUESTION HAS LOW ITEM NON 641 00:29:52,960 --> 00:29:55,000 RESPONSE RATES ABOUT TESTS 642 00:29:55,000 --> 00:29:57,600 OFFERED AND QUESTIONS ABOUT 643 00:29:57,600 --> 00:29:58,120 TESTS PERFORMED. 644 00:29:58,120 --> 00:30:01,120 THESE QUESTIONS WERE TYPICALLY 645 00:30:01,120 --> 00:30:02,520 MORE SENSITIVE BUT THEN IN THE 646 00:30:02,520 --> 00:30:04,640 UTAH SOURCE PROJECT WE FOUND 647 00:30:04,640 --> 00:30:08,160 THAT THE ITEM NON-RESPONSE RATES 648 00:30:08,160 --> 00:30:10,080 WERE FAIRLY LOW. 649 00:30:10,080 --> 00:30:12,320 AND NON-RESPONSE AT THE 650 00:30:12,320 --> 00:30:13,160 BEGINNING OF THE SURVEY DIDN'T 651 00:30:13,160 --> 00:30:16,840 DIFFER AT THE END OF THE SURVEY 652 00:30:16,840 --> 00:30:18,320 WHICH SUGGESTS THAT WOMEN 653 00:30:18,320 --> 00:30:19,600 COMPLETED THE SURVEY ALL THE WAY 654 00:30:19,600 --> 00:30:23,680 DREW. 655 00:30:23,680 --> 00:30:23,960 -- THROUGH. 656 00:30:23,960 --> 00:30:29,240 SO IN SHORT THE SOURCE PILOT IN 657 00:30:29,240 --> 00:30:31,080 UTAH IS FEASIBLE FOR THIS 658 00:30:31,080 --> 00:30:32,040 POPULATION OF WOMEN EXPERIENCING 659 00:30:32,040 --> 00:30:38,160 STILLBIRTH TO PARTICIPATE IN. 660 00:30:38,160 --> 00:30:39,920 HERE ARE PRELIMINARY DATA FROM 661 00:30:39,920 --> 00:30:42,200 2018 TO 2019 FROM UTAH SOARS. 662 00:30:42,200 --> 00:30:45,280 YOU CAN SEE BY THE LINK AT THE 663 00:30:45,280 --> 00:30:46,640 BOTTOM, UTAH HAS RELEASED A 664 00:30:46,640 --> 00:30:48,920 HEALTH STATUS UPDATE ON THE 665 00:30:48,920 --> 00:30:50,120 SOURCE SOARS DATA AVAILABLE ON 666 00:30:50,120 --> 00:30:51,120 THEIR WEBSITE. 667 00:30:51,120 --> 00:30:52,760 THERE'S SOME KEY FINDINGS. 668 00:30:52,760 --> 00:30:54,840 IF YOU LOOK ON THE LEFT OF YOUR 669 00:30:54,840 --> 00:30:56,760 SCREEN, FIGURE 1 SHOWS THE 670 00:30:56,760 --> 00:30:58,560 MAJORITY OF THE WOMEN RECEIVED 671 00:30:58,560 --> 00:31:01,280 SOME TYPE OF SUPPORT GESTURE 672 00:31:01,280 --> 00:31:03,800 AFTER THE STILLBIRTH. 673 00:31:03,800 --> 00:31:05,000 FOR EXAMPLE, FOOTPRINT 674 00:31:05,000 --> 00:31:07,280 IMPRESSION WERE ABLE TO HOLD THE 675 00:31:07,280 --> 00:31:07,560 BABY. 676 00:31:07,560 --> 00:31:12,280 SOME OF THE SOURCE RESULTS 677 00:31:12,280 --> 00:31:14,640 INDICATED THE MAJORITY OF THE 678 00:31:14,640 --> 00:31:15,600 WOMEN WERE GIVEN OPPORTUNITIES 679 00:31:15,600 --> 00:31:18,000 TO ASK QUESTIONS AND FELT 680 00:31:18,000 --> 00:31:20,320 ADEQUATELY SUPPORTED BY HOSPITAL 681 00:31:20,320 --> 00:31:22,240 STAFF REGARDING THEIR BRIEF, 86% 682 00:31:22,240 --> 00:31:27,600 TO 97% AND FEWER SAID THEY WERE 683 00:31:27,600 --> 00:31:29,560 GIVEN INFORMATION ABOUT WHAT TO 684 00:31:29,560 --> 00:31:31,320 DO WHEN THEIR BREAST MILK CAME 685 00:31:31,320 --> 00:31:31,520 IN. 686 00:31:31,520 --> 00:31:33,800 SOURCE RESULTS ALSO SHOW THAT 687 00:31:33,800 --> 00:31:35,520 WHILE 24% OF THE WOMEN DID NOT 688 00:31:35,520 --> 00:31:39,360 FEEL ADEQUATELY SUPPORTED BY 689 00:31:39,360 --> 00:31:40,640 GRIEF COUNSELORS DURING THEIR 690 00:31:40,640 --> 00:31:42,560 HOSPITAL STAY, MORE THAN HALF, 691 00:31:42,560 --> 00:31:47,440 52% OF THE WOMEN WENT ON TO 692 00:31:47,440 --> 00:31:49,760 PROCESS GRIEF COUNSELLING IN THE 693 00:31:49,760 --> 00:31:52,160 EARLY MONTHS FOLLOWING THEIR 694 00:31:52,160 --> 00:31:52,720 STILLBIRTH DELIVERY. 695 00:31:52,720 --> 00:31:54,200 AND THEN LOOKING TO THE FAR 696 00:31:54,200 --> 00:31:56,520 RIGHT A MAJORITY OF THE WOMEN 697 00:31:56,520 --> 00:31:58,440 WHO DID NOT RECEIVE GRIEF 698 00:31:58,440 --> 00:32:00,160 COUNSELLING SAID IT WAS BECAUSE 699 00:32:00,160 --> 00:32:02,160 IT WAS NOT NEEDED AND OTHERS 700 00:32:02,160 --> 00:32:06,640 SAID THEY WERE NOT YET READY FOR 701 00:32:06,640 --> 00:32:07,680 IT. 702 00:32:07,680 --> 00:32:09,440 13.7% OF THE WOMEN DIDN'T KNOW 703 00:32:09,440 --> 00:32:17,440 WHERE TO GO TO GET IT. 704 00:32:17,440 --> 00:32:19,560 SO IN CLOSING THERE'S A FEW NEXT 705 00:32:19,560 --> 00:32:22,160 STEPS FOR CDC AND SOARS. 706 00:32:22,160 --> 00:32:24,440 THEY ARE CONTINUED ANALYSIS OF 707 00:32:24,440 --> 00:32:26,920 THE WEIGHTED DATA FROM YEAR 1. 708 00:32:26,920 --> 00:32:29,080 THAT'S THE JUNE 2018 OF MAY 2019 709 00:32:29,080 --> 00:32:30,840 DATA WE MENTIONED. 710 00:32:30,840 --> 00:32:33,120 AND THEN WAITING FROM SUBSEQUENT 711 00:32:33,120 --> 00:32:36,480 YEARS OF DATA COLLECTION FROM 712 00:32:36,480 --> 00:32:37,680 2020 AND 2021. 713 00:32:37,680 --> 00:32:40,440 WE ALSO LIKE TO TAKE ACCOUNT OF 714 00:32:40,440 --> 00:32:42,400 THE SOARS SURVEY QUESTION MAY 715 00:32:42,400 --> 00:32:43,040 NEED REVISION FOR FUTURE PHASES 716 00:32:43,040 --> 00:32:45,560 OF THE SURVEY. 717 00:32:45,560 --> 00:32:47,680 WE'D ALSO LIKE TO CONTINUE TO 718 00:32:47,680 --> 00:32:48,760 OBSERVE PROGRESS WITH CHANGES IN 719 00:32:48,760 --> 00:32:51,120 THE DATA COLLECTION SYSTEM THAT 720 00:32:51,120 --> 00:32:53,240 IS USED WHERE RED CAP IS 721 00:32:53,240 --> 00:32:56,440 CURRENTLY USED VERSUS EPI-INFO 722 00:32:56,440 --> 00:32:59,720 AND THEN OF COURSE CONTINUED 723 00:32:59,720 --> 00:33:00,720 DATA DISSEMINATION. 724 00:33:00,720 --> 00:33:02,440 AND THEN ALSO YOU'VE LIKELY 725 00:33:02,440 --> 00:33:03,880 NOTICED THERE'S JUST ONE SITE 726 00:33:03,880 --> 00:33:06,560 ABLE TO BE FUNDED BY CDC FOR THE 727 00:33:06,560 --> 00:33:08,560 SOURCE PROJECT. 728 00:33:08,560 --> 00:33:10,760 AND WE HOPE TO EXPLORE 729 00:33:10,760 --> 00:33:11,680 OPPORTUNITIES FOR OTHER PRAMS 730 00:33:11,680 --> 00:33:12,600 SITES TO BE FUNDED WITH 731 00:33:12,600 --> 00:33:19,920 STILLBIRTH STUDIES AS WELL. 732 00:33:19,920 --> 00:33:21,520 CDC'S HEAR HER CAMPAIGN WAS 733 00:33:21,520 --> 00:33:25,800 CREATED TO RAISE AWARENESS OF 734 00:33:25,800 --> 00:33:28,040 URGENT MATERNAL WARNING SIGNS 735 00:33:28,040 --> 00:33:30,000 DURING AND AFTER PREGNANCY AND 736 00:33:30,000 --> 00:33:31,760 TO IMPROVE COMMUNICATION BETWEEN 737 00:33:31,760 --> 00:33:34,080 THE PATIENTS AND THEIR HEALTH 738 00:33:34,080 --> 00:33:35,880 CARE PROVIDERS AND THIS INCLUDES 739 00:33:35,880 --> 00:33:37,080 FETAL MOVEMENT AS ONE OF THE 740 00:33:37,080 --> 00:33:40,400 SIGNS AND SYMPTOMS THAT INDICATE 741 00:33:40,400 --> 00:33:42,760 A NEED TO SEEK IMMEDIATE MEDICAL 742 00:33:42,760 --> 00:33:43,120 CARE. 743 00:33:43,120 --> 00:33:46,320 A SLOWING OR STOPPAGE IN 744 00:33:46,320 --> 00:33:47,800 MOVEMENT MAY INDICATE FETAL 745 00:33:47,800 --> 00:33:50,480 DISTRESS AND INFECTION OF THE 746 00:33:50,480 --> 00:33:52,560 UTERUS OR NOT HAVING ENOUGH 747 00:33:52,560 --> 00:33:53,480 AMNIOTIC FLUIDS. 748 00:33:53,480 --> 00:33:56,200 SO RECOGNIZING THE URGENT 749 00:33:56,200 --> 00:33:57,000 MATERNAL WARNING SIGNS, GETTING 750 00:33:57,000 --> 00:34:00,480 AN ACCURATE AND TIMELY DIAGNOSIS 751 00:34:00,480 --> 00:34:02,280 AND QUALITY CARE CAN SAVE LIVES 752 00:34:02,280 --> 00:34:04,160 AND HEAR HER ENCOURAGES 753 00:34:04,160 --> 00:34:07,040 PARTNERS, FRIENDS, FAMILY AND 754 00:34:07,040 --> 00:34:08,360 HEALTH CARE PROVIDERS ANYONE WHO 755 00:34:08,360 --> 00:34:12,320 SUPPORTS PREGNANT AND POSTPARTUM 756 00:34:12,320 --> 00:34:14,760 PEOPLE TO LISTEN WHEN SHE SAYS 757 00:34:14,760 --> 00:34:16,880 SOMETHING DOESN'T FEEL RIGHT. 758 00:34:16,880 --> 00:34:20,080 A HEALTH CARE PROFESSIONAL CAN 759 00:34:20,080 --> 00:34:21,640 AID AND HELP IN PATIENTS 760 00:34:21,640 --> 00:34:23,080 UNDERSTAND THE URGENT MATERNAL 761 00:34:23,080 --> 00:34:25,080 WARNING SIGNS AND WHEN TO SEEK 762 00:34:25,080 --> 00:34:26,720 MEDICAL CARE RIGHT AWAY AND FOR 763 00:34:26,720 --> 00:34:29,040 MORE INFORMATION ON THIS 764 00:34:29,040 --> 00:34:30,960 CAMPAIGN, YOU CAN VISIT 765 00:34:30,960 --> 00:34:37,200 CDC.gov/HEAR HER. 766 00:34:37,200 --> 00:34:39,240 AND WITH THAT I'D LIKE TO 767 00:34:39,240 --> 00:34:42,880 ACKNOWLEDGE MY COLLEAGUES WHO 768 00:34:42,880 --> 00:34:46,360 HELP WITH THE PRESENTATION AS 769 00:34:46,360 --> 00:34:47,960 WELL THE GROUP OF THE PARTNERS 770 00:34:47,960 --> 00:34:48,840 LISTED ON THE SLIDE AND THANK 771 00:34:48,840 --> 00:34:51,760 YOU FOR LISTENING AND ATTENDING 772 00:34:51,760 --> 00:34:52,240 THIS PRESENTATION TODAY. 773 00:34:52,240 --> 00:34:57,800 THANK YOU. 774 00:34:57,800 --> 00:35:00,640 >>THANK YOU, DR. DIEKE. 775 00:35:00,640 --> 00:35:05,720 I'M NOT SURE BASED ON THE 776 00:35:05,720 --> 00:35:10,400 PRESENTATION INTRODUCTION THERE 777 00:35:10,400 --> 00:35:11,600 WAS GOING TO BE SHARING OF DATA? 778 00:35:11,600 --> 00:35:14,240 I WANT TO BE SURE I WAS NOT 779 00:35:14,240 --> 00:35:15,720 CUTTING YOU OFF IN CASE THERE 780 00:35:15,720 --> 00:35:18,600 WAS SOMETHING ELSE. 781 00:35:18,600 --> 00:35:20,400 >>NO JUST FOR OBSERVATION OF 782 00:35:20,400 --> 00:35:23,720 THE TIME WE WANTED TO KEEP THE 783 00:35:23,720 --> 00:35:25,680 PRESENTATION RELATIVELY SHORT 784 00:35:25,680 --> 00:35:26,520 AND HAVE AN OPPORTUNITY FOR 785 00:35:26,520 --> 00:35:31,520 QUESTIONS AND ANSWERS. 786 00:35:31,520 --> 00:35:32,840 >>WONDERFUL. 787 00:35:32,840 --> 00:35:36,040 WE'RE GOING TO THE PANEL FOR THE 788 00:35:36,040 --> 00:35:40,160 DISCUSSION AT THE END OF THE 789 00:35:40,160 --> 00:35:40,560 FIRST SESSION. 790 00:35:40,560 --> 00:35:46,320 SO THANK YOU FOR ALL THE 791 00:35:46,320 --> 00:35:47,000 INSIGHTFUL WONDERFUL 792 00:35:47,000 --> 00:35:48,720 PRESENTATION ALL THE WORK YOU'RE 793 00:35:48,720 --> 00:35:50,400 DOING AND THE EXAMPLE YOU'RE 794 00:35:50,400 --> 00:35:53,440 MAKING WITH THE SOARS IN UTAH. 795 00:35:53,440 --> 00:35:54,960 IT'S A GOOD RESOURCE AND EXPAND 796 00:35:54,960 --> 00:35:57,080 AND WE HAVE WILL HAVE QUESTIONS 797 00:35:57,080 --> 00:35:58,840 FOR YOU BUT WE'LL KEEP IT FOR 798 00:35:58,840 --> 00:36:02,960 WHEN WE GET TO THE PANEL. 799 00:36:02,960 --> 00:36:13,480 THE NEXT PRESENTER IS DR. JOANNE 800 00:36:15,960 --> 00:36:19,920 CACCIATORE AT THE WATTS COLLEGE 801 00:36:19,920 --> 00:36:20,800 OF PUBLIC HEALTH AND WILL TALK 802 00:36:20,800 --> 00:36:21,680 ABOUT PSYCHOLOGICAL IMPACT AND 803 00:36:21,680 --> 00:36:24,120 TREATMENT. 804 00:36:24,120 --> 00:36:24,960 THANK YOU SO MUCH FOR ACCEPTING 805 00:36:24,960 --> 00:36:27,920 TO BE WITH US TODAY. 806 00:36:27,920 --> 00:36:31,600 >>THANK YOU, EVERYONE FOR THE 807 00:36:31,600 --> 00:36:31,920 INVITATION. 808 00:36:31,920 --> 00:36:34,200 I'M GRATEFUL TO BE HERE AND 809 00:36:34,200 --> 00:36:35,920 ENCOURAGED BY THESE KINDS OF 810 00:36:35,920 --> 00:36:36,200 MEETINGS. 811 00:36:36,200 --> 00:36:38,200 WOULD IT BE BETTER IF I DID A 812 00:36:38,200 --> 00:36:40,560 SHARE SCREEN IT APPEARS SOME OF 813 00:36:40,560 --> 00:36:42,880 MY FONTS DIDN'T TRANSLATE IN THE 814 00:36:42,880 --> 00:36:43,160 E-MAIL. 815 00:36:43,160 --> 00:36:46,040 I'M HAPPY TO DO A SHARE SCREEN 816 00:36:46,040 --> 00:36:47,680 IF THAT CAN WORK. 817 00:36:47,680 --> 00:36:53,480 THANK YOU. 818 00:36:53,480 --> 00:36:55,680 I AM GOING TO BE TALKING 819 00:36:55,680 --> 00:36:56,480 TODAY -- I'LL TRY TO MINIMIZE 820 00:36:56,480 --> 00:36:59,960 THIS. 821 00:36:59,960 --> 00:37:02,680 I'LL BE TALKING TODAY ABOUT THE 822 00:37:02,680 --> 00:37:04,160 COLLISION OF BIRTH AND DEATH. 823 00:37:04,160 --> 00:37:06,160 THAT'S ONE OF THE UNIQUE ASPECTS 824 00:37:06,160 --> 00:37:11,560 OF THE DEATH OF A BABY THAT I 825 00:37:11,560 --> 00:37:15,240 THINK A LOT OF GRIEVING PARENTS 826 00:37:15,240 --> 00:37:17,160 WITH WHO I WORK STRUGGLE WITH 827 00:37:17,160 --> 00:37:17,920 AND A LITTLE BIT ABOUT ME 828 00:37:17,920 --> 00:37:18,200 BRIEFLY. 829 00:37:18,200 --> 00:37:20,440 I'M A PROFESSOR AT ARIZONA STATE 830 00:37:20,440 --> 00:37:21,000 UNIVERSITY. 831 00:37:21,000 --> 00:37:26,880 I DON'T JUST STUDY PERINATAL 832 00:37:26,880 --> 00:37:29,560 DEATH, I STUDY GRIEF AND PART OF 833 00:37:29,560 --> 00:37:32,960 THE MISS FOUNDATION AND PROVIDE 834 00:37:32,960 --> 00:37:35,040 AID TO FAMILIES WHO'S CHILDREN 835 00:37:35,040 --> 00:37:40,360 ARE DYING FROM ANY AGE OR CAUSE. 836 00:37:40,360 --> 00:37:42,240 WE'VE BEEN AROUND MORE THAN A 837 00:37:42,240 --> 00:37:45,120 QUARTER OF A CENTURY AND IT HAS 838 00:37:45,120 --> 00:37:47,240 CULMINATED IN THE RECENT 839 00:37:47,240 --> 00:37:49,200 FORMATION OF WHAT YOU MAY HAVE 840 00:37:49,200 --> 00:37:52,720 SEEN IN PRINCE HARRY AND OPRAH 841 00:37:52,720 --> 00:37:54,680 WINFREY'S SERIES THE ME YOU 842 00:37:54,680 --> 00:37:57,080 CAN'T SEE AND SO I'M GOING TO 843 00:37:57,080 --> 00:37:58,680 TALK A LITTLE BIT ABOUT NOT JUST 844 00:37:58,680 --> 00:38:00,840 MY RESEARCH BUT MY PRACTICE IN 845 00:38:00,840 --> 00:38:02,360 MORE THAN A QUARTER OF A CENTURY 846 00:38:02,360 --> 00:38:05,520 AND ALSO THE MOTHER OF A BABY 847 00:38:05,520 --> 00:38:11,720 WHO DIED DURING BIRTH IN 1994. 848 00:38:11,720 --> 00:38:14,720 SO A SIMPLE CHILD WHO LIGHTLY 849 00:38:14,720 --> 00:38:16,560 DRAWS HIS BREATH AND FEELS HIS 850 00:38:16,560 --> 00:38:20,160 LIFE IN EVERY LIMB, WHAT SHOULD 851 00:38:20,160 --> 00:38:21,040 WE KNOW OF DEATH? 852 00:38:21,040 --> 00:38:28,000 SOME OF THE DEFINING AND UNIQUE 853 00:38:28,000 --> 00:38:30,560 EXPERIENCES OF THE DEATH OF A 854 00:38:30,560 --> 00:38:31,800 BABY INCLUDE MANY THINGS. 855 00:38:31,800 --> 00:38:34,240 WE'D BE HERE LONGER THAN 30 856 00:38:34,240 --> 00:38:35,080 MINUTES AND I'LL TOUCH ON THE 857 00:38:35,080 --> 00:38:37,320 KEY PARTS OF MY RESEARCH I THINK 858 00:38:37,320 --> 00:38:38,880 WILL BE MOST USING FOR MOST 859 00:38:38,880 --> 00:38:39,400 ATTENDING TODAY. 860 00:38:39,400 --> 00:38:41,720 WE'LL COVER A LITTLE BIT ABOUT 861 00:38:41,720 --> 00:38:43,960 THE PSYCHOLOGICAL AND EMOTIONAL, 862 00:38:43,960 --> 00:38:47,000 THE SOCIAL AND INTERPERSONAL AND 863 00:38:47,000 --> 00:38:49,760 ECONOMIC AND EXISTENTIAL AND 864 00:38:49,760 --> 00:38:50,640 SPIRITUAL AS WELL AS THE 865 00:38:50,640 --> 00:38:53,600 PHYSICAL BECAUSE THE DEATH OF A 866 00:38:53,600 --> 00:38:56,080 BABY DURING BIRTH OR BEFORE 867 00:38:56,080 --> 00:38:58,280 BIRTH IS AN INCREDIBLY PHYSICAL 868 00:38:58,280 --> 00:38:58,880 AND SOMATIC EXPERIENCE. 869 00:38:58,880 --> 00:39:01,560 FROM THE WRITER, ADRIAN RICH, 870 00:39:01,560 --> 00:39:02,760 PROBABLY THERE IS NOTHING IN 871 00:39:02,760 --> 00:39:04,280 NATURE MORE RESONANT WITH 872 00:39:04,280 --> 00:39:07,880 CHARGES THAN THE FLOW OF ENERGY 873 00:39:07,880 --> 00:39:11,400 BETWEEN TWO BIOLOGICALLY ALIKE 874 00:39:11,400 --> 00:39:15,000 BODIES ONE OF WHICH GLEANED IN 875 00:39:15,000 --> 00:39:16,960 AMNIOTIC BLISS AND ONE LABORED 876 00:39:16,960 --> 00:39:18,040 TO GIVE BIRTH TO THE OTHER. 877 00:39:18,040 --> 00:39:23,560 THE MATERIALS ARE HERE FOR THE 878 00:39:23,560 --> 00:39:28,840 DEEPEST MUTUALITY AND PAINFUL 879 00:39:28,840 --> 00:39:29,160 ESTRANGEMENT. 880 00:39:29,160 --> 00:39:31,040 IN TERMS OF THE PSYCHOLOGICAL 881 00:39:31,040 --> 00:39:31,920 AND EMOTIONAL EFFECTS. 882 00:39:31,920 --> 00:39:34,880 IN MY RESEARCH IN TRAUMATIC 883 00:39:34,880 --> 00:39:36,920 GRIEF, DEFINITELY WOMEN WHO 884 00:39:36,920 --> 00:39:38,880 EXPERIENCE PERINATAL DEATH, THE 885 00:39:38,880 --> 00:39:43,680 DEATH OF A BABY TO STILLBIRTH 886 00:39:43,680 --> 00:39:47,480 HAVE THE CHARACTERISTICS OF 887 00:39:47,480 --> 00:39:51,400 TRAUMATIC GRIEF WHICH OVERLAPS 888 00:39:51,400 --> 00:39:54,920 WITH POSTTRAUMATIC GRIEF AND WE 889 00:39:54,920 --> 00:39:56,600 HAVE SEEN THIS AND THE 890 00:39:56,600 --> 00:39:57,880 CHARACTERISTICS OF WHAT IS 891 00:39:57,880 --> 00:40:00,840 TRAUMATIC GRIEF AND THE LOSS IS 892 00:40:00,840 --> 00:40:02,640 USUALLY SUDDEN AND UNEXPECTED 893 00:40:02,640 --> 00:40:03,240 AND THE BRIEFING PERSON FEELS 894 00:40:03,240 --> 00:40:06,040 OUT OF CONTROL. 895 00:40:06,040 --> 00:40:08,160 AT THE RESULT OF ALL TRAUMA 896 00:40:08,160 --> 00:40:09,960 INCLUDES THE EMOTIONS OF FEAR 897 00:40:09,960 --> 00:40:14,520 AND CAN REACH THE THRESHOLD OF 898 00:40:14,520 --> 00:40:17,440 TERROR AND WHAT I HEAR FROM 899 00:40:17,440 --> 00:40:23,880 WOMEN WHOSE BABIES DIE AND WHEN 900 00:40:23,880 --> 00:40:26,000 THE OUTCOME IS THE DEATH OF YOUR 901 00:40:26,000 --> 00:40:29,160 BABY IT'S A LEVEL OF TERROR THAT 902 00:40:29,160 --> 00:40:32,200 IS INEXPLICABLE AND FEAR AND 903 00:40:32,200 --> 00:40:33,960 TERROR BECOME CORE EMOTIONAL 904 00:40:33,960 --> 00:40:36,880 EXPERIENCES OF THE DEATH OF A 905 00:40:36,880 --> 00:40:37,320 BABY. 906 00:40:37,320 --> 00:40:39,600 ALSO CHALLENGES TO CORE IDENTITY 907 00:40:39,600 --> 00:40:41,680 ARE COMMON AMONGST PEOPLE WHO 908 00:40:41,680 --> 00:40:43,160 HAVE TRAUMATIC GRIEF. 909 00:40:43,160 --> 00:40:45,560 AND FOR PEOPLE WHO LOSE THEIR 910 00:40:45,560 --> 00:40:47,520 CHILDREN, THEIR BABIES, THIS IS 911 00:40:47,520 --> 00:40:51,320 AN ABSOLUTE CHALLENGE TO THEIR 912 00:40:51,320 --> 00:40:51,720 CORE IDENTITY. 913 00:40:51,720 --> 00:40:53,600 IN PARTICULAR I HAVE A HEART FOR 914 00:40:53,600 --> 00:40:56,080 MOTHERS WHO LOSE THEIR FIRST 915 00:40:56,080 --> 00:40:59,480 CHILD OR ONLY CHILD IN PERINATAL 916 00:40:59,480 --> 00:41:02,400 DEATH BECAUSE THE QUESTION IS AM 917 00:41:02,400 --> 00:41:06,360 I STILL A MOTHER, AM I STILL A 918 00:41:06,360 --> 00:41:06,600 FATHER? 919 00:41:06,600 --> 00:41:09,320 IN SIBLINGS THIS CAN APPLY TO 920 00:41:09,320 --> 00:41:10,440 SIBLINGS AS WELL BUT THE 921 00:41:10,440 --> 00:41:11,880 CHALLENGE TO CORE IDENTITY IS 922 00:41:11,880 --> 00:41:13,080 REALLY IMPORTANT BECAUSE 923 00:41:13,080 --> 00:41:15,040 ESPECIALLY FOR PARENTS WHO LOSE 924 00:41:15,040 --> 00:41:16,640 THEIR ONLY CHILD, OTHER PEOPLE 925 00:41:16,640 --> 00:41:18,800 IN THE WORLD DO NOT SEE THEM AS 926 00:41:18,800 --> 00:41:20,480 A PARENT AND YET THEY HAVE TO 927 00:41:20,480 --> 00:41:22,040 FIGURE OUT HOW TO PARENT A CHILD 928 00:41:22,040 --> 00:41:23,640 WHO HAS DIED. 929 00:41:23,640 --> 00:41:27,120 THERE CAN BE SOME REAL CORE 930 00:41:27,120 --> 00:41:27,440 CHALLENGES. 931 00:41:27,440 --> 00:41:29,160 AND FOR THE MOTHER THAT INCLUDES 932 00:41:29,160 --> 00:41:31,760 PHYSICAL CHALLENGES FOR THE 933 00:41:31,760 --> 00:41:32,840 BIRTHING PARENT THAT INCLUDES 934 00:41:32,840 --> 00:41:35,400 PHYSICAL CHALLENGES INCLUDING 935 00:41:35,400 --> 00:41:38,520 ONGOING BREAST MILK, INCLUDING 936 00:41:38,520 --> 00:41:40,040 MATERNAL HORMONES PUMPING 937 00:41:40,040 --> 00:41:40,800 THROUGH HER BLOODSTREAM AND 938 00:41:40,800 --> 00:41:42,640 PEOPLE ASKING HER IN PUBLIC 939 00:41:42,640 --> 00:41:46,480 SPHERES, HOW IS YOUR BABY, 940 00:41:46,480 --> 00:41:49,520 WHERE'S YOUR BABY AND HER 941 00:41:49,520 --> 00:41:50,280 REPEATEDLY HAVING TO TELL PEOPLE 942 00:41:50,280 --> 00:41:57,680 HER BABY DIED AND BE MET WITH A 943 00:41:57,680 --> 00:41:59,320 RELATIVELY UNSYMPATHETIC 944 00:41:59,320 --> 00:41:59,840 RESPONSE OF THE WORLD. 945 00:41:59,840 --> 00:42:02,000 THERE WAS THE IDEA OF THE 946 00:42:02,000 --> 00:42:03,000 SHATTERED WORLD ASSUMPTION. 947 00:42:03,000 --> 00:42:06,160 THERE'S A SHATTERING OF THE 948 00:42:06,160 --> 00:42:09,320 WORLD ASSUMPTIONS WHEN SOMEONE'S 949 00:42:09,320 --> 00:42:10,760 CHILD DIES BECAUSE WE ASSUME 950 00:42:10,760 --> 00:42:12,400 WE'LL OUTLIVE OUR CHILD. 951 00:42:12,400 --> 00:42:13,440 PARTICULARLY BABIES. 952 00:42:13,440 --> 00:42:15,480 WE DON'T IMAGINE THEY'LL DIE IN 953 00:42:15,480 --> 00:42:16,320 TODAY'S WORLD. 954 00:42:16,320 --> 00:42:17,800 THERE'S A RETICENCE TO TALK 955 00:42:17,800 --> 00:42:18,440 ABOUT THIS. 956 00:42:18,440 --> 00:42:22,080 THIS IS ONGOING AND WORKING WITH 957 00:42:22,080 --> 00:42:24,320 PEOPLE YOUNGER MOTHERS COMING IN 958 00:42:24,320 --> 00:42:25,760 AND FATHERS COMING IN WHEN THEY 959 00:42:25,760 --> 00:42:28,160 TALK ABOUT THE DEATH OF THEIR 960 00:42:28,160 --> 00:42:30,120 BABY, OFTEN IT DOESN'T INCLUDE, 961 00:42:30,120 --> 00:42:35,040 YES WE HAD A CONVERSATION ABOUT 962 00:42:35,040 --> 00:42:39,240 THE DEATH OF THE BABY AND KICK 963 00:42:39,240 --> 00:42:39,640 COUNTS. 964 00:42:39,640 --> 00:42:43,480 IT'S STILL PART OF THE 965 00:42:43,480 --> 00:42:47,040 PSYCHOSOCIAL CARING OF PREGNANT 966 00:42:47,040 --> 00:42:47,320 FAMILIES. 967 00:42:47,320 --> 00:42:49,240 AND GUILT, REGRET, FEAR, SHAME 968 00:42:49,240 --> 00:42:49,840 AND STIGMA IN MOTHERS AND 969 00:42:49,840 --> 00:42:52,040 FATHERS. 970 00:42:52,040 --> 00:42:57,160 GUILT IS VERY BIG. 971 00:42:57,160 --> 00:43:07,720 THIS IDEA OF JUDAS BABY AND THE 972 00:43:08,560 --> 00:43:11,720 MOTHER'S GUILT AND WHEN THE BABY 973 00:43:11,720 --> 00:43:16,520 DOESN'T COME HOME ALL EYES TURN 974 00:43:16,520 --> 00:43:18,640 TO MOM AND THE LAST MONTH 975 00:43:18,640 --> 00:43:20,160 THEY'RE ASKING ARE YOU STRATEGY 976 00:43:20,160 --> 00:43:21,280 BRAXTON HICKS CONTRACTIONS AND 977 00:43:21,280 --> 00:43:22,520 EVERYBODY'S EXCITED FOR HER TO 978 00:43:22,520 --> 00:43:23,840 BRING THE BABY HOME AND DOESN'T 979 00:43:23,840 --> 00:43:26,880 GET TO BRING THE BABY HOME IT'S 980 00:43:26,880 --> 00:43:29,680 A COMPLEX BLEND OF SHAME AND 981 00:43:29,680 --> 00:43:34,080 GUILT FOR MANY MOTHERS WITH WHOM 982 00:43:34,080 --> 00:43:34,480 I WORK. 983 00:43:34,480 --> 00:43:37,320 IN ADDITION, BOTH PARENTS OFTEN 984 00:43:37,320 --> 00:43:42,360 EXPRESS TO ME THEY HAVE A LOT OF 985 00:43:42,360 --> 00:43:42,680 REGRETS. 986 00:43:42,680 --> 00:43:44,520 THEY REGRET CERTAIN DECISION 987 00:43:44,520 --> 00:43:46,800 CARE, IF THEY HAVE CHOSEN AN AT 988 00:43:46,800 --> 00:43:49,520 HOME BIRTH THEY REGRET AN AT 989 00:43:49,520 --> 00:43:52,440 HOME BIRTH AND IF THEY CHOSE A 990 00:43:52,440 --> 00:43:53,560 HOSPITAL BIRTH THEY ARE REGRET 991 00:43:53,560 --> 00:43:53,840 THAT. 992 00:43:53,840 --> 00:43:57,000 I PUBLISHED A STUDY ON 993 00:43:57,000 --> 00:44:00,680 RUMINATION AND TRAUMATIC GRIEF. 994 00:44:00,680 --> 00:44:01,880 RUMINATION IS QUITE COMMON AMONG 995 00:44:01,880 --> 00:44:03,520 PEOPLE WHO HAVE EXPERIENCED 996 00:44:03,520 --> 00:44:04,280 TRAUMATIC GRIEF. 997 00:44:04,280 --> 00:44:07,520 WE KNOW STIGMA IS BIG ESPECIALLY 998 00:44:07,520 --> 00:44:17,320 IN STILLBIRTH AND PERINATAL AND 999 00:44:17,320 --> 00:44:19,960 THEY BELIEVE JUST BECAUSE YOURY 1000 00:44:19,960 --> 00:44:21,680 DIES BEFORE BIRTH YOU'LL HAVE A 1001 00:44:21,680 --> 00:44:23,800 LESSER GRIEF REACTION. 1002 00:44:23,800 --> 00:44:26,600 IT'S LESS SIGNIFICANT THAN THE 1003 00:44:26,600 --> 00:44:33,600 DEATH OF A BABY 1 YEAR OR 10 1004 00:44:33,600 --> 00:44:36,160 YEARS OLD AND THERE'S A STIGMA 1005 00:44:36,160 --> 00:44:38,440 AND OFTEN THEY ARE NOT IN 1006 00:44:38,440 --> 00:44:40,560 AGREEMENT WITH THOSE FEELINGS 1007 00:44:40,560 --> 00:44:42,520 AND YET THEY'RE FEELING IT FROM 1008 00:44:42,520 --> 00:44:43,680 EVEN CLOSE FAMILY MEMBERS. 1009 00:44:43,680 --> 00:44:46,000 IT COULD BE VERY ISOLATING AND 1010 00:44:46,000 --> 00:44:50,080 THAT CAN RESULT IN SOCIAL 1011 00:44:50,080 --> 00:44:51,560 WITHDRAW WHICH IS 1012 00:44:51,560 --> 00:44:51,960 UNDERSTANDABLE. 1013 00:44:51,960 --> 00:44:54,640 AND ANGER AND JEALOUSY AND 1014 00:44:54,640 --> 00:44:56,600 WANTING TO DIE TO BE WITH THE 1015 00:44:56,600 --> 00:44:59,720 BABY AND THINK OF HORMONES AND 1016 00:44:59,720 --> 00:45:05,680 HOW POWERFUL THEY CAN BE AS THEY 1017 00:45:05,680 --> 00:45:07,480 PUMP THROUGH YOUR BLOODSTREAM 1018 00:45:07,480 --> 00:45:09,040 AND I'VE HAD THOSE FEELINGS AS 1019 00:45:09,040 --> 00:45:11,160 WELL AND IN PARTICULAR MOTHERS 1020 00:45:11,160 --> 00:45:12,520 BUT ALSO SOMETIMES FATHERS 1021 00:45:12,520 --> 00:45:13,880 EXPRESS THIS TO ME. 1022 00:45:13,880 --> 00:45:15,960 THEY ARE RETICENT TO SHARE IT 1023 00:45:15,960 --> 00:45:16,880 WITH OTHER PEOPLE BECAUSE 1024 00:45:16,880 --> 00:45:18,720 THEY'RE AFRAID OF BEING 1025 00:45:18,720 --> 00:45:20,160 HOSPITALIZED OR AFRAID THAT 1026 00:45:20,160 --> 00:45:22,560 PEOPLE WILL THINK THEY'RE NOT 1027 00:45:22,560 --> 00:45:22,960 OKAY. 1028 00:45:22,960 --> 00:45:26,960 SO ANGER, JEALOUSY ALSO CAN 1029 00:45:26,960 --> 00:45:27,760 HAPPEN. 1030 00:45:27,760 --> 00:45:29,600 ANGER CAN SOMETIMES BE 1031 00:45:29,600 --> 00:45:30,760 MISDIRECTED AT VARIOUS PEOPLE 1032 00:45:30,760 --> 00:45:33,040 AND SOMETIMES IT CAN BE DIRECTED 1033 00:45:33,040 --> 00:45:35,000 AT PEOPLE WHO PARENTS MAY FEEL 1034 00:45:35,000 --> 00:45:35,840 ARE RESPONSIBLE IN SOME WAY 1035 00:45:35,840 --> 00:45:44,320 INCLUDING THEMSELVES. 1036 00:45:44,320 --> 00:45:46,080 JEALOUSY OF OTHER BABIES THAT 1037 00:45:46,080 --> 00:45:47,880 LIVED AND I WORK RIGHT NOW WITH 1038 00:45:47,880 --> 00:45:51,320 A FAMILY AND THIS MOTHER LOST 1039 00:45:51,320 --> 00:45:52,880 HER BABY AT FULL TERM AND HER 1040 00:45:52,880 --> 00:45:54,200 SISTER WAS PREGNANT THE SAME 1041 00:45:54,200 --> 00:45:55,920 TIME AND TWO WEEKS AFTER HER 1042 00:45:55,920 --> 00:45:58,800 BABY DIED, HER SISTER'S BABY WAS 1043 00:45:58,800 --> 00:46:00,360 BORN AND WANTS TO BE A GOOD AUNT 1044 00:46:00,360 --> 00:46:03,480 TO HER NIECE BUT IS VERY JEALOUS 1045 00:46:03,480 --> 00:46:05,560 AND FEELS VERY OVERWHELMED IN 1046 00:46:05,560 --> 00:46:07,360 HER PRESENCE AND HAS WITHDRAWN 1047 00:46:07,360 --> 00:46:11,000 AND OUR WORK TOGETHER IS ABOUT 1048 00:46:11,000 --> 00:46:12,400 HELPING HER TO DEVELOP A GOOD 1049 00:46:12,400 --> 00:46:13,920 HONEST WAY TO TALK TO HER SISTER 1050 00:46:13,920 --> 00:46:16,600 ABOUT IT TO TALK ABOUT HER PAIN 1051 00:46:16,600 --> 00:46:19,120 AND TO BE ABLE TO RE-INTEGRATE 1052 00:46:19,120 --> 00:46:23,360 WITH HER SISTER AND HER NIECE. 1053 00:46:23,360 --> 00:46:24,400 SOCIAL AND INTERPERSONAL AND 1054 00:46:24,400 --> 00:46:26,320 THERE COULD BE MARITAL CONFLICT 1055 00:46:26,320 --> 00:46:28,280 AND THERE'S A HIGHER RISK OF 1056 00:46:28,280 --> 00:46:35,600 MARITAL DISSOLUTION AND 1057 00:46:35,600 --> 00:46:37,360 MISCARRIAGE DOES NOT INCREASE 1058 00:46:37,360 --> 00:46:38,960 THE RISK OF MARITAL DISSOLUTION 1059 00:46:38,960 --> 00:46:42,600 BUT THE DEATH OF A BABY IN 1060 00:46:42,600 --> 00:46:46,040 PERINATAL DEATH OR OLDER CHILD 1061 00:46:46,040 --> 00:46:47,680 DID INCREASE THE RISK OF 1062 00:46:47,680 --> 00:46:48,920 MARRIAGE DISSOLUTION. 1063 00:46:48,920 --> 00:46:50,960 THERE'S IMPACT ON SURVIVING 1064 00:46:50,960 --> 00:46:53,720 SUBSEQUENTLY BORN CHILDREN. 1065 00:46:53,720 --> 00:46:57,320 I IN PARTICULAR WRITE ABOUT 1066 00:46:57,320 --> 00:46:59,160 INTERGENERATIONAL TRAUMA AND 1067 00:46:59,160 --> 00:47:01,560 PERINATAL TOGETHER AND OTHER 1068 00:47:01,560 --> 00:47:06,520 LOSSES AND TRAUMAS BUT IT CAN 1069 00:47:06,520 --> 00:47:08,040 AFFECT PARENTING STYLE AND GRIEF 1070 00:47:08,040 --> 00:47:09,680 AND COPING OF THE OTHER 1071 00:47:09,680 --> 00:47:10,000 CHILDREN. 1072 00:47:10,000 --> 00:47:12,160 HOW THE OTHER CHILDREN COPE WITH 1073 00:47:12,160 --> 00:47:13,000 THEIR GRIEF AND COMMUNICATE 1074 00:47:13,000 --> 00:47:14,600 THEIR GRIEF OFTEN DEPENDS ON 1075 00:47:14,600 --> 00:47:17,680 THEIR FAMILY OF ORIGIN. 1076 00:47:17,680 --> 00:47:21,240 IT OFTEN DEPENDS ON THE PARENT'S 1077 00:47:21,240 --> 00:47:21,720 STYLE. 1078 00:47:21,720 --> 00:47:25,080 IT CAN IMPACT THE SIBLING'S ROLE 1079 00:47:25,080 --> 00:47:27,520 ADJUSTMENT IF THE OLDEST CHILD 1080 00:47:27,520 --> 00:47:29,120 DIED DURING BIRTH OR BEFORE 1081 00:47:29,120 --> 00:47:31,000 BIRTH AND PARENTS GO ON AND HAVE 1082 00:47:31,000 --> 00:47:33,200 ANOTHER CHILD, IS THIS THE FIRST 1083 00:47:33,200 --> 00:47:35,280 CHILD THE OLDEST CHILD. 1084 00:47:35,280 --> 00:47:36,640 THAT CAN BE A ROLE ADJUSTMENT 1085 00:47:36,640 --> 00:47:38,000 PARTICULARLY IF IT'S NOT WELL 1086 00:47:38,000 --> 00:47:38,880 INTEGRATED AND WELL COMMUNITY 1087 00:47:38,880 --> 00:47:41,280 AND THE FAMILY DOESN'T HAVE A 1088 00:47:41,280 --> 00:47:43,320 LOT OF GOOD SOCIAL SUPPORT 1089 00:47:43,320 --> 00:47:46,280 AROUND HOW TO COMMUNICATE AND 1090 00:47:46,280 --> 00:47:48,160 PROCESS GRIEF WITH SURVIVING 1091 00:47:48,160 --> 00:47:49,040 SUBSEQUENTLY BORN CHILDREN. 1092 00:47:49,040 --> 00:47:52,920 AND IMPACTING ON SURVIVING 1093 00:47:52,920 --> 00:47:54,480 SUBSEQUENTLY BORN CHILDREN AS IT 1094 00:47:54,480 --> 00:47:56,600 BECOMES TO RITUAL PRACTICES AND 1095 00:47:56,600 --> 00:47:57,480 INTEGRATION LATER. 1096 00:47:57,480 --> 00:47:59,680 AS THE SUBSEQUENTLY BORN 1097 00:47:59,680 --> 00:48:01,040 CHILDREN AGE OR SURVIVING 1098 00:48:01,040 --> 00:48:04,000 CHILDREN AGE, WHAT DOES IT MEAN 1099 00:48:04,000 --> 00:48:07,960 TO THEM IF THEY'RE 5 WHEN THEIR 1100 00:48:07,960 --> 00:48:09,320 SIBLING IS STILLBORN WHAT'S IT 1101 00:48:09,320 --> 00:48:10,920 MEAN TO THEM WHEN THEY'RE 18 OR 1102 00:48:10,920 --> 00:48:13,320 30 OR HAVE THEIR OWN CHILD? 1103 00:48:13,320 --> 00:48:16,400 I HAVE WORKED WITH PEOPLE WHO AS 1104 00:48:16,400 --> 00:48:17,760 A YOUNG CHILD EXPERIENCED THE 1105 00:48:17,760 --> 00:48:19,400 DEATH OF A SIBLING TO STILLBIRTH 1106 00:48:19,400 --> 00:48:24,240 AND I CAN TELL YOU IT ABSOLUTELY 1107 00:48:24,240 --> 00:48:26,720 AFFECTS THEIR SOCIAL, EMOTIONAL 1108 00:48:26,720 --> 00:48:27,920 STATE EVEN 30 YEARS LATER. 1109 00:48:27,920 --> 00:48:30,160 THEN THE RISKS OF SOCIAL 1110 00:48:30,160 --> 00:48:31,040 CONSTRAINTS AND SOCIAL 1111 00:48:31,040 --> 00:48:32,280 WITHDRAWAL WHICH I'LL TALK A 1112 00:48:32,280 --> 00:48:34,360 LITTLE BIT MORE IN A MINUTE. 1113 00:48:34,360 --> 00:48:35,320 BUT ONE OF THE INTERESTING 1114 00:48:35,320 --> 00:48:40,120 STUDIES I WANT TO TELL BUT IS 1115 00:48:40,120 --> 00:48:46,480 ONE BY VANESSA JUTH IS POOR 1116 00:48:46,480 --> 00:48:49,120 PHYSICAL OUTCOMES IN BEREAVEMENT 1117 00:48:49,120 --> 00:48:52,360 WERE THE MOST SALIENT PREDICTORS 1118 00:48:52,360 --> 00:48:55,640 SOCIAL CONSTRAINT THE MOST -- 1119 00:48:55,640 --> 00:48:57,520 EXCUSE ME, POOR PHYSICAL AND 1120 00:48:57,520 --> 00:48:58,240 PSYCHOLOGICAL OUTCOMES. 1121 00:48:58,240 --> 00:49:00,480 SOCIAL CONSTRAINTS BEING, AREN'T 1122 00:49:00,480 --> 00:49:02,160 YOU OVER IT YET, PRESSURE TO 1123 00:49:02,160 --> 00:49:03,840 MOVE ON AND PRESSURE TO FORGET. 1124 00:49:03,840 --> 00:49:05,680 IT BECOMES A CYCLE BECAUSE 1125 00:49:05,680 --> 00:49:09,720 BRIEFING PARENTS GO OUT IN THE 1126 00:49:09,720 --> 00:49:10,920 WORLD AND THEY'RE TRYING TO 1127 00:49:10,920 --> 00:49:11,800 INTEGRATE THEIR LOSS AND TRYING 1128 00:49:11,800 --> 00:49:13,240 TO TALK ABOUT IT BUT PEOPLE ARE 1129 00:49:13,240 --> 00:49:15,080 SAYING AREN'T YOU OVER IT YET? 1130 00:49:15,080 --> 00:49:18,200 YOU SHOULD FEEL BETTER BY NOW, 1131 00:49:18,200 --> 00:49:19,600 YOU'RE GOING TO HURT YOUR OTHER 1132 00:49:19,600 --> 00:49:19,960 CHILDREN. 1133 00:49:19,960 --> 00:49:22,200 YOU'RE GOING TO LOSE YOUR JOB AT 1134 00:49:22,200 --> 00:49:24,200 WORK AND SOME OF THESE THINGS 1135 00:49:24,200 --> 00:49:25,000 MAY BE TRUE. 1136 00:49:25,000 --> 00:49:26,800 THE PROBLEM IS THESE KINDS OF 1137 00:49:26,800 --> 00:49:30,840 SOCIAL CONSTRAINTS BY OTHERS 1138 00:49:30,840 --> 00:49:33,280 RESULTED IN POORER PSYCHOLOGICAL 1139 00:49:33,280 --> 00:49:34,440 AND PHYSICAL HEALTH OUTCOMES 1140 00:49:34,440 --> 00:49:36,720 WHICH IS SIGNIFICANT. 1141 00:49:36,720 --> 00:49:42,000 AND OF COURSE MY VANTAGE POINT 1142 00:49:42,000 --> 00:49:45,600 IS WE NEED BETTER PEDAGOGICAL 1143 00:49:45,600 --> 00:49:46,720 MODELS TO TEACH SCHOOLS AND 1144 00:49:46,720 --> 00:49:50,640 CHURCHES AND NEIGHBORHOODS AND 1145 00:49:50,640 --> 00:49:51,360 COMMUNITIES BETTER GRIEF SUPPORT 1146 00:49:51,360 --> 00:49:59,360 STRATEGIES WE'LL GET TO LATER. 1147 00:49:59,360 --> 00:50:01,000 THIS IS THE LONG-TERM 1148 00:50:01,000 --> 00:50:02,080 PSYCHOLOGICAL AN 1149 00:50:02,080 --> 00:50:03,120 INTERGENERATIONAL AFFECTS. 1150 00:50:03,120 --> 00:50:06,240 10% OF PEOPLE REMAIN OFF WORK 1151 00:50:06,240 --> 00:50:11,680 FOR 6 MONTHS AFTER STILLBIRTH 1152 00:50:11,680 --> 00:50:13,480 FROM THE LANCET SERIES AND 1153 00:50:13,480 --> 00:50:17,320 ECONOMISTS AND I DID AN ANALYSIS 1154 00:50:17,320 --> 00:50:20,360 OWN THE ECONOMIC BURDEN OF CHILD 1155 00:50:20,360 --> 00:50:22,120 DEATH AND THIS WAS CONSERVATIVE 1156 00:50:22,120 --> 00:50:27,000 NUMBERS WE FOUND $1.6 BILLION. 1157 00:50:27,000 --> 00:50:28,960 WE USED EVERY MOST CONSERVATIVE 1158 00:50:28,960 --> 00:50:30,600 NUMBER, $1.6 BILLION PER YEAR 1159 00:50:30,600 --> 00:50:34,280 AND I WOULD VENTURE TO GUESS IF 1160 00:50:34,280 --> 00:50:36,040 WE USED MODERATE ECONOMIC 1161 00:50:36,040 --> 00:50:37,600 NUMBERS IT WOULD HAVE BEEN 1162 00:50:37,600 --> 00:50:39,240 SIGNIFICANTLY, SIGNIFICANTLY 1163 00:50:39,240 --> 00:50:41,240 HIGHER THAN THAT. 1164 00:50:41,240 --> 00:50:42,320 WE KNOW THERE ARE ECONOMIC 1165 00:50:42,320 --> 00:50:43,000 IMPACTS AS WELL. 1166 00:50:43,000 --> 00:50:48,320 THE ECONOMIC IMPACTS AREN'T JUST 1167 00:50:48,320 --> 00:50:50,920 IN CAREER AND JOB PLACEMENT, 1168 00:50:50,920 --> 00:50:52,800 IT'S IN PSYCHOLOGICAL, EMOTIONAL 1169 00:50:52,800 --> 00:50:54,160 AND MENTAL HEALTH. 1170 00:50:54,160 --> 00:50:58,080 IN TERMS OF EXISTENTIAL AND 1171 00:50:58,080 --> 00:51:00,800 SPIRITUAL, FIRST THE DEATH OF A 1172 00:51:00,800 --> 00:51:02,920 BABY, ESPECIALLY SO EARLY LIKE 1173 00:51:02,920 --> 00:51:04,600 GOING BACK TO THE ADRIAN RICH 1174 00:51:04,600 --> 00:51:08,600 QUOTE THE MATERIALS ARE HERE FOR 1175 00:51:08,600 --> 00:51:14,760 THE DEEPEST MUTUALITY AND A PART 1176 00:51:14,760 --> 00:51:17,680 OF YOU DIES AND EVERYTHING IN 1177 00:51:17,680 --> 00:51:20,480 YOUR BODY IS WIRED TO NURTURE 1178 00:51:20,480 --> 00:51:22,640 AND CARE FOR THIS BABY WHO HAS 1179 00:51:22,640 --> 00:51:26,520 NOW DIED AND WHERE DO YOU PUT 1180 00:51:26,520 --> 00:51:28,240 ALL THAT MATERNAL, PATERNAL 1181 00:51:28,240 --> 00:51:28,520 ENERGY? 1182 00:51:28,520 --> 00:51:30,960 YOU HAVE NOWHERE TO PUT THIS. 1183 00:51:30,960 --> 00:51:33,240 IT'S AN INCREDIBLE CHALLENGE TO 1184 00:51:33,240 --> 00:51:34,040 OUR EXISTENTIAL STATE. 1185 00:51:34,040 --> 00:51:35,800 IT CAN CREATE CHALLENGES TO 1186 00:51:35,800 --> 00:51:36,640 FAITH STRUCTURE. 1187 00:51:36,640 --> 00:51:40,160 IN ONE STUDY THE VAST MAJORITY 1188 00:51:40,160 --> 00:51:43,320 OF PEOPLE LEFT THEIR CHURCH HOME 1189 00:51:43,320 --> 00:51:45,880 BECAUSE OF A LACK OF 1190 00:51:45,880 --> 00:51:46,880 RESPONSIVENESS FROM THEIR 1191 00:51:46,880 --> 00:51:47,280 SPIRITUAL. 1192 00:51:47,280 --> 00:51:49,280 THERE CAN BE A COLLAPSED SENSE 1193 00:51:49,280 --> 00:51:52,040 OF THE TRUST IN THEMSELVES 1194 00:51:52,040 --> 00:51:55,880 PARTICULARLY I HEAR THIS IN 1195 00:51:55,880 --> 00:51:57,400 MOTHERS IN PEOPLE WHO GIVE BIRTH 1196 00:51:57,400 --> 00:51:58,760 TO BABIES BECAUSE THEY TRUSTED 1197 00:51:58,760 --> 00:52:00,960 THEIR BODY TO DO THE RIGHT THING 1198 00:52:00,960 --> 00:52:03,760 AND CREATES AN ACRIMONIOUS 1199 00:52:03,760 --> 00:52:04,360 RELATIONSHIP LIKE WHAT DID MY 1200 00:52:04,360 --> 00:52:08,040 BODY DO WRONG. 1201 00:52:08,040 --> 00:52:10,080 AS A THERAPIST AND COUNSELOR 1202 00:52:10,080 --> 00:52:12,400 IT'S IMPORTANT FOR PEOPLE TO 1203 00:52:12,400 --> 00:52:14,000 PROVIDE THAT KIND OF SUPPORT 1204 00:52:14,000 --> 00:52:15,360 WHERE THEY FEEL SAFE TO TALK 1205 00:52:15,360 --> 00:52:16,840 ABOUT THAT WITHOUT IT BEING 1206 00:52:16,840 --> 00:52:21,560 DISMISSED AS IT WASN'T YOUR 1207 00:52:21,560 --> 00:52:24,960 FAULT FLIPPANTLY AND IT'S LIKELY 1208 00:52:24,960 --> 00:52:27,240 IT'S NOT SOMETHING MOTHER DID 1209 00:52:27,240 --> 00:52:28,320 AND WE KNOW THAT AND IT'S 1210 00:52:28,320 --> 00:52:30,080 IMPORTANT TO TALK ABOUT THEM IN 1211 00:52:30,080 --> 00:52:31,760 A SAFE WAY OTHERWISE SHE HAS 1212 00:52:31,760 --> 00:52:37,120 THEM AND CAN'T SPEAK THEM. 1213 00:52:37,120 --> 00:52:43,320 IT'S A UNIQUE MOMENT WITH BIRTH 1214 00:52:43,320 --> 00:52:44,880 AND DEATH COALESCING TO ONE 1215 00:52:44,880 --> 00:52:47,560 MOMENT AND THERE'S THE 1216 00:52:47,560 --> 00:52:49,520 RELATIONSHIP I SPOKE ABOUT WITH 1217 00:52:49,520 --> 00:52:51,360 HER BODY AND THE IMAGE OF A 1218 00:52:51,360 --> 00:52:53,280 WOMAN REACHING DOWN TO BRING HER 1219 00:52:53,280 --> 00:52:55,080 BABY ON HER BREAST AT THE MOMENT 1220 00:52:55,080 --> 00:52:58,040 OF BIRTH IS A POWERFUL ONE. 1221 00:52:58,040 --> 00:53:00,080 IT REALLY TRULY IS. 1222 00:53:00,080 --> 00:53:03,000 IT'S ONE OF THE MOST SEMINOLE 1223 00:53:03,000 --> 00:53:05,320 EXPERIENCES OF A HUMAN BEINGS 1224 00:53:05,320 --> 00:53:09,480 LIFE, ANY MAMMAL, REALLY, THE 1225 00:53:09,480 --> 00:53:14,440 DAY SHE GAVE BIRTH AND EVERY 1226 00:53:14,440 --> 00:53:15,840 CELL OF HERS KNOWS AND PAIN 1227 00:53:15,840 --> 00:53:23,280 KNOWN MORE INTENSELY SHE'S 1228 00:53:23,280 --> 00:53:24,680 EXULTANT AND KNOWS THE 1229 00:53:24,680 --> 00:53:27,480 EXPERIENCE OF GIVING BIRTH IS 1230 00:53:27,480 --> 00:53:29,600 EMPOWERING AND NOW IMAGINE DEATH 1231 00:53:29,600 --> 00:53:34,400 ENTERS HERE AND WE GET THE 1232 00:53:34,400 --> 00:53:35,600 EXISTENTIAL CONUNDRUM PARENTS 1233 00:53:35,600 --> 00:53:38,520 FACE AFTER THE DEATH OF THEIR 1234 00:53:38,520 --> 00:53:38,760 BABY. 1235 00:53:38,760 --> 00:53:42,320 THIS IS FROM A BOOK CALLED TOUCH 1236 00:53:42,320 --> 00:53:52,840 BY ASHLEY MONTEGUE AND THERE'S A 1237 00:53:53,440 --> 00:53:54,360 REASSURANCE FROM THE MOTHER LIES 1238 00:53:54,360 --> 00:53:56,400 IN THE SIGHT OF THE BABY AND ITS 1239 00:53:56,400 --> 00:54:00,760 FIRST CRY AND CLOSENESS TO HER 1240 00:54:00,760 --> 00:54:01,200 BODY. 1241 00:54:01,200 --> 00:54:06,880 THERE'S BIRTH BY ITSELF IS SUCH 1242 00:54:06,880 --> 00:54:11,480 A BIOLOGICAL PHYSICAL EXPERIENCE 1243 00:54:11,480 --> 00:54:14,880 NOT JUST SPIRITUAL BUT PHYSICAL. 1244 00:54:14,880 --> 00:54:17,160 ALL EYES ARE TURNED TOWARDS HER 1245 00:54:17,160 --> 00:54:18,720 WAITING FOR THAT BABY. 1246 00:54:18,720 --> 00:54:20,320 THERE ARE A SERIES OF COMPLEX 1247 00:54:20,320 --> 00:54:22,360 BIOLOGICAL THINGS THAT HAPPEN 1248 00:54:22,360 --> 00:54:25,240 AFTER BIRTH WHETHER OR NOT THE 1249 00:54:25,240 --> 00:54:26,360 BABY LIVES. 1250 00:54:26,360 --> 00:54:29,360 THIS CAN BRING FEAR AND NEGATIVE 1251 00:54:29,360 --> 00:54:30,440 COGNITION AS WELL AS A STATE OF 1252 00:54:30,440 --> 00:54:31,240 PAIN. 1253 00:54:31,240 --> 00:54:34,960 BOTH OF WHICH PREDICT 1254 00:54:34,960 --> 00:54:35,480 POSTTRAUMATIC STRESS. 1255 00:54:35,480 --> 00:54:39,400 IMAGINE WHEN THE BABY DIES THAT 1256 00:54:39,400 --> 00:54:42,520 THAT FEAR AND NEGATIVE COGNITION 1257 00:54:42,520 --> 00:54:44,200 AND THE PAIN COMBINED INCREASE 1258 00:54:44,200 --> 00:54:46,640 THE RISK OF TRAUMATIC STRESS 1259 00:54:46,640 --> 00:54:46,920 SYMPTOMS. 1260 00:54:46,920 --> 00:54:49,440 THE MATERNAL HORMONES ARE 1261 00:54:49,440 --> 00:54:52,040 PUMPING THROUGH HER BLOODSTREAM 1262 00:54:52,040 --> 00:54:54,040 TELLING HER FEED YOUR BABY, 1263 00:54:54,040 --> 00:54:57,240 NURTURE YOUR BABY AND YET 1264 00:54:57,240 --> 00:54:59,640 THERE'S NO BABY TO CARE FOR. 1265 00:54:59,640 --> 00:55:02,560 FOR MANY WOMEN BREAST MILK AND 1266 00:55:02,560 --> 00:55:04,280 THE HOME MILIEU HAS BEEN SET UP 1267 00:55:04,280 --> 00:55:05,680 TO WELCOME A BABY. 1268 00:55:05,680 --> 00:55:12,000 YOU HAVE A NURSERY, PEOPLE GO TO 1269 00:55:12,000 --> 00:55:13,120 THE HOSPITAL SOMETIMES ANTE 1270 00:55:13,120 --> 00:55:15,280 PARTUM AND GO TO THE HOSPITAL 1271 00:55:15,280 --> 00:55:16,800 WITH A CAR SEAT IN THEIR CAR AND 1272 00:55:16,800 --> 00:55:19,160 PEOPLE ARE WAITING FOR THEM TO 1273 00:55:19,160 --> 00:55:21,400 MAKE THE BIRTH ANNOUNCEMENT, 1274 00:55:21,400 --> 00:55:23,640 INSTEAD THEY HAVE TO TELL PEOPLE 1275 00:55:23,640 --> 00:55:24,480 THEIR BABY DIED. 1276 00:55:24,480 --> 00:55:25,640 THIS BRINGS A PHYSICAL PAIN FROM 1277 00:55:25,640 --> 00:55:28,440 THE EMOTIONAL PAIN. 1278 00:55:28,440 --> 00:55:30,080 LITERALLY YOU CAN FEEL -- MANY 1279 00:55:30,080 --> 00:55:33,320 ON THE CALL PROBABLY HAD OR HAVE 1280 00:55:33,320 --> 00:55:36,160 PERHAPS HAD SOME TRAUMATIC GRIEF 1281 00:55:36,160 --> 00:55:37,840 LOSS AND REMEMBER TRAUMATIC 1282 00:55:37,840 --> 00:55:40,160 GRIEVING IS A PHYSICAL 1283 00:55:40,160 --> 00:55:40,440 EXPERIENCE. 1284 00:55:40,440 --> 00:55:41,920 YOU CAN FEEL THE PAIN. 1285 00:55:41,920 --> 00:55:46,520 I USED TO SAY AFTER MY DAUGHTER 1286 00:55:46,520 --> 00:55:52,480 DIED I USED TO SAY MY BODY HURTS 1287 00:55:52,480 --> 00:55:56,760 FROM THE TIP OF MY HAIR TO MY 1288 00:55:56,760 --> 00:55:59,360 TOES AND WHERE THEY OVERLAP IT'S 1289 00:55:59,360 --> 00:56:00,160 MORE INTENSE. 1290 00:56:00,160 --> 00:56:02,160 SO LET'S TALK FOR A FEW MINUTES 1291 00:56:02,160 --> 00:56:03,440 ABOUT WHAT HELPS AND WHAT 1292 00:56:03,440 --> 00:56:04,160 DOESN'T HELP. 1293 00:56:04,160 --> 00:56:07,280 LET'S TALK ABOUT WHAT DOESN'T 1294 00:56:07,280 --> 00:56:09,480 HELP FIRST. 1295 00:56:09,480 --> 00:56:11,440 INSENSITIVITY, OBVIOUSLY AND 1296 00:56:11,440 --> 00:56:12,440 LACK OF COMPASSION AND CARE. 1297 00:56:12,440 --> 00:56:14,280 I SEE THIS ALL THE TIME. 1298 00:56:14,280 --> 00:56:18,400 I SEE IT FROM THE CRISIS CARE IN 1299 00:56:18,400 --> 00:56:20,160 THE HOSPITAL AND HEAR IT FROM 1300 00:56:20,160 --> 00:56:22,440 FAMILIES IN THERAPY WHO HAVE 1301 00:56:22,440 --> 00:56:27,400 TRIED MANY THERAPISTS AND THE 1302 00:56:27,400 --> 00:56:28,960 THERAPISTS DO NOT UNDERSTAND 1303 00:56:28,960 --> 00:56:29,760 TRAUMATIC GRIEF. 1304 00:56:29,760 --> 00:56:35,000 THE WOMAN I WAS TELLING WHO I'M 1305 00:56:35,000 --> 00:56:39,880 WORKING WITH RECENTLY WHOSE BABY 1306 00:56:39,880 --> 00:56:41,640 DIED AT TERM HER THERAPIST 1307 00:56:41,640 --> 00:56:45,440 SUGGESTED HE ADOPT A CHILD. 1308 00:56:45,440 --> 00:56:47,720 THERE'S A LACK OF UNDERSTANDING 1309 00:56:47,720 --> 00:56:48,560 ABOUT TRAUMATIC GRIEF. 1310 00:56:48,560 --> 00:56:51,720 THE VERNACULAR THE WAY WE DON'T 1311 00:56:51,720 --> 00:56:53,520 TOUCH A PREGNANT WOMAN'S BODY 1312 00:56:53,520 --> 00:56:57,440 AND ASK WHEN HER FETUS IS DUE IS 1313 00:56:57,440 --> 00:56:59,720 BECAUSE IT SOUNDS LIKE AN 1314 00:56:59,720 --> 00:57:00,120 INSENSITIVE WORD. 1315 00:57:00,120 --> 00:57:07,960 WHEN A NURSE AT HAY DID THE -- 1316 00:57:07,960 --> 00:57:10,800 AT A HOSPITAL SAYS DO YOU WANT 1317 00:57:10,800 --> 00:57:13,840 TO HOLD YOUR FETUS AND IT'S 1318 00:57:13,840 --> 00:57:18,560 INCENSENSITIVE AND PEOPLE WANT 1319 00:57:18,560 --> 00:57:22,000 PEOPLE TO TALK TO THEM IN A WAY 1320 00:57:22,000 --> 00:57:25,480 THAT'S SENSITIVE AND GENTLE AND 1321 00:57:25,480 --> 00:57:26,600 WE NEED BETTER PEDAGOGICAL 1322 00:57:26,600 --> 00:57:27,000 MODELS. 1323 00:57:27,000 --> 00:57:30,280 THERE'S A FAILURE TO ACKNOWLEDGE 1324 00:57:30,280 --> 00:57:33,680 THE BABY'S DEATH AS WORTHY. 1325 00:57:33,680 --> 00:57:36,480 IT'S CONSISTENT. 1326 00:57:36,480 --> 00:57:43,800 IN THE RESEARCH IN THE '70s AND 1327 00:57:43,800 --> 00:57:46,400 '80s STILLBIRTH WAS IN ABORTION 1328 00:57:46,400 --> 00:57:48,160 AND MISCARRIAGE AND STILLBIRTH. 1329 00:57:48,160 --> 00:57:50,440 WHAT I FOUND IN MY PRACTICE IN 1330 00:57:50,440 --> 00:57:52,040 WORKING WITH BRIEFING PARENTS 1331 00:57:52,040 --> 00:57:53,560 THEY GENERALLY IT'S NOT THEIR 1332 00:57:53,560 --> 00:57:56,840 VIEW OF THEIR BABY AND THEY 1333 00:57:56,840 --> 00:58:00,920 DON'T APPRECIATE BEING LUMPED IN 1334 00:58:00,920 --> 00:58:02,560 WITH ABORTION FOR EXAMPLE. 1335 00:58:02,560 --> 00:58:03,440 WHATEVER POLITICAL POSITION 1336 00:58:03,440 --> 00:58:05,520 DOESN'T SEEM TO MATTER IN MY 1337 00:58:05,520 --> 00:58:05,920 CLINICAL WORK. 1338 00:58:05,920 --> 00:58:09,320 THE DEATH OF A BABY DURING OR 1339 00:58:09,320 --> 00:58:10,960 BEFORE BIRTH CAN BE AS IMPACTFUL 1340 00:58:10,960 --> 00:58:13,120 FOR MANY FAMILIES AS THE DEATH 1341 00:58:13,120 --> 00:58:14,360 OF AN OLDER CHILD. 1342 00:58:14,360 --> 00:58:20,000 THEY WANT PEOPLE TO ACKNOWLEDGE 1343 00:58:20,000 --> 00:58:22,240 THIS CHILD'S LIFE IS AS WORTHY 1344 00:58:22,240 --> 00:58:25,440 OF GRIEF AS ANY CHILD'S DEATH. 1345 00:58:25,440 --> 00:58:27,320 THEN THERE'S GENERAL GRIEF THAT 1346 00:58:27,320 --> 00:58:29,520 AFFECTS US ALL BECAUSE IF WE 1347 00:58:29,520 --> 00:58:31,040 LOVE AT SOME POINT WE'LL 1348 00:58:31,040 --> 00:58:32,120 EXPERIENCE GRIEF IF WE HAVEN'T 1349 00:58:32,120 --> 00:58:40,720 YET AND THERE ARE PLENTY OF 1350 00:58:40,720 --> 00:58:43,520 GOING AROUND AND SOCIAL 1351 00:58:43,520 --> 00:58:48,000 PLATITUDES AND THE MARGINALIZED 1352 00:58:48,000 --> 00:58:50,040 AND DISENFRANCHISED KIND OF 1353 00:58:50,040 --> 00:58:52,200 GRIEF ARE MET WITH PLATITUDES. 1354 00:58:52,200 --> 00:58:55,720 AT LEAST YOUR CHILD OLDER. 1355 00:58:55,720 --> 00:58:58,240 AT LEAST YOU DIDN'T BRING HER 1356 00:58:58,240 --> 00:58:58,520 HOME. 1357 00:58:58,520 --> 00:59:02,000 AREN'T YOU GLAD SHE DIED AS A 1358 00:59:02,000 --> 00:59:02,480 BABY. 1359 00:59:02,480 --> 00:59:07,680 GOD NEEDED AN ANGEL TO TEND. 1360 00:59:07,680 --> 00:59:10,280 THAT MAKES MOMENT ANGRY ABOUT 1361 00:59:10,280 --> 00:59:12,120 GOD ANYTHING AND THIS DOESN'T 1362 00:59:12,120 --> 00:59:12,920 HELP. 1363 00:59:12,920 --> 00:59:15,320 PRESSURE TO MOVE ON DOESN'T HELP 1364 00:59:15,320 --> 00:59:16,680 WHICH ALL GRIEVING PEOPLE GET. 1365 00:59:16,680 --> 00:59:17,760 IT'S PART OF MY IMPORTANT WORK 1366 00:59:17,760 --> 00:59:19,760 IN THE WORLD IS TRYING TO TEACH 1367 00:59:19,760 --> 00:59:22,280 THE GENERAL PUBLIC ABOUT GRIEF. 1368 00:59:22,280 --> 00:59:23,640 OTHERS ATTEMPTING TO FIND 1369 00:59:23,640 --> 00:59:26,520 MEANING IN THEIR LOSS. 1370 00:59:26,520 --> 00:59:28,200 THIS COMES WITH HELPFUL 1371 00:59:28,200 --> 00:59:30,160 RESPONSES AND ONE OF THE MOST 1372 00:59:30,160 --> 00:59:32,200 UNHELPFUL THINGS IS WHEN THEIR 1373 00:59:32,200 --> 00:59:33,240 COUNSELORS TRIED TO FIND MEANING 1374 00:59:33,240 --> 00:59:36,280 IN THEIR LOSS. 1375 00:59:36,280 --> 00:59:42,360 PARENTS THEMSELVES MIGHT TRY 1376 00:59:42,360 --> 00:59:43,920 THAT BUT DON'T LIKE OTHERS DO 1377 00:59:43,920 --> 00:59:46,200 THAT FOR THEM AND WE LOOKED AT 1378 00:59:46,200 --> 00:59:47,840 LONG COMPLICATED GRIEF DISORDER 1379 00:59:47,840 --> 00:59:51,280 AND WE FOUND THE MAJORITY OF 1380 00:59:51,280 --> 00:59:53,800 BRIEFING PARENTS DOES NOT 1381 00:59:53,800 --> 00:59:56,200 APPRECIATE WHEN PEOPLE DIAGNOSED 1382 00:59:56,200 --> 00:59:59,640 THEIR GRIEF AS PATHOLOGICAL. 1383 00:59:59,640 --> 01:00:03,000 WE KNOW PARENTS FACE ENDURING 1384 01:00:03,000 --> 01:00:06,640 AND LASTING SYMPTOMS AND TO 1385 01:00:06,640 --> 01:00:07,840 PATHOLOGIZE THAT WAS NOT 1386 01:00:07,840 --> 01:00:09,320 EXPERIENCED AS HELPFUL. 1387 01:00:09,320 --> 01:00:10,560 WHAT DOES HELP? 1388 01:00:10,560 --> 01:00:15,880 THIS IS NOT AN EXHAUSTIVE LIST 1389 01:00:15,880 --> 01:00:18,840 HAVING UNRUSHED TIME WITH THEIR 1390 01:00:18,840 --> 01:00:19,040 BABY. 1391 01:00:19,040 --> 01:00:20,720 SOME STATES ALSO ALLOW AND 1392 01:00:20,720 --> 01:00:22,200 ENCOURAGE FAMILIES TO TAKE THEIR 1393 01:00:22,200 --> 01:00:24,200 BABIES HOME ESPECIALLY IF THEY 1394 01:00:24,200 --> 01:00:27,760 CAN HAVE HOME FUNERALS AND 1395 01:00:27,760 --> 01:00:30,960 THERE'S NOW DEATH DOULAS AND 1396 01:00:30,960 --> 01:00:34,280 MOST STATES ALLOW THIS. 1397 01:00:34,280 --> 01:00:37,720 EMOTIONAL ARTIFACTS HELP AND 1398 01:00:37,720 --> 01:00:39,280 COMPASSIONATE AND WARM HOSPITAL 1399 01:00:39,280 --> 01:00:41,720 PROVIDER NEAR THEIR SIDE. 1400 01:00:41,720 --> 01:00:43,880 I ALSO ENCOURAGE AND TEACHING IN 1401 01:00:43,880 --> 01:00:45,680 ROUNDS I ENCOURAGE HAVING A 1402 01:00:45,680 --> 01:00:49,160 SINGLE POINT OF CONTACT FOR THE 1403 01:00:49,160 --> 01:00:52,000 PARENTS FOR POST CARE AND 1404 01:00:52,000 --> 01:00:54,120 ENSURING STAFF AT THE HOSPITAL 1405 01:00:54,120 --> 01:00:56,160 KNOW HOW TO CARE FOR PEOPLE 1406 01:00:56,160 --> 01:00:58,480 WHO'S BABY HAS JUST DIED MAKING 1407 01:00:58,480 --> 01:00:59,760 SURE ANYONE WHO GOES IN THE 1408 01:00:59,760 --> 01:01:01,520 ROOM, HOSPITALS ARE DOING THIS 1409 01:01:01,520 --> 01:01:02,520 NOW AND PUTTING NOTES ON THE 1410 01:01:02,520 --> 01:01:02,720 DOORS. 1411 01:01:02,720 --> 01:01:09,040 THIS IS HELPFUL. 1412 01:01:09,040 --> 01:01:14,240 OFFERING IN HOME RITUAL AND THE 1413 01:01:14,240 --> 01:01:16,920 TRADITIONAL RITUAL OF FUNERAL 1414 01:01:16,920 --> 01:01:20,160 CAN BE HELP FUL AND COLLECTING 1415 01:01:20,160 --> 01:01:21,680 THE WRISTBAND OR ANYTHING THEY 1416 01:01:21,680 --> 01:01:23,160 CAN ASSOCIATE WITH THE BABY ARE 1417 01:01:23,160 --> 01:01:26,360 ALL IMPORTANT BUT IN THE ABSENCE 1418 01:01:26,360 --> 01:01:29,360 OF A WARM PRESENCE OF A LOVING 1419 01:01:29,360 --> 01:01:31,040 PROVIDER, IT CAN FEEL VERY 1420 01:01:31,040 --> 01:01:32,560 LONELY AND TERRIFYING AND PEOPLE 1421 01:01:32,560 --> 01:01:34,280 DON'T ALWAYS MAKE DECISIONS 1422 01:01:34,280 --> 01:01:36,480 BASED IN LOVE WHEN THEY'RE SO 1423 01:01:36,480 --> 01:01:42,440 AFRAID AND ENCUMBERED BY FEAR OR 1424 01:01:42,440 --> 01:01:44,240 TERROR AND THE ACCOMPANIMENT OF 1425 01:01:44,240 --> 01:01:46,040 ONE CONTACT CAN HELP. 1426 01:01:46,040 --> 01:01:50,280 I OFTEN TEACH HOSPITAL TO SEND 1427 01:01:50,280 --> 01:01:54,680 CARDS CARDS ARE TANGIBLE. 1428 01:01:54,680 --> 01:01:56,080 ENSURING A GOOD COMMUNICATION 1429 01:01:56,080 --> 01:02:00,080 WITH SENSITIVE LANGUAGE AND GOOD 1430 01:02:00,080 --> 01:02:01,200 TRAUMATIC GRIEF-INFORMED 1431 01:02:01,200 --> 01:02:01,720 COUNSELLING. 1432 01:02:01,720 --> 01:02:05,520 THIS IS NOT EASY TO FIND BECAUSE 1433 01:02:05,520 --> 01:02:07,480 THERE AREN'T I'M A PROFESSOR IN 1434 01:02:07,480 --> 01:02:08,600 SCHOOL SOCIAL WORK AND A LOT OF 1435 01:02:08,600 --> 01:02:11,000 STUDENTS COME TO MY TRAUMATIC 1436 01:02:11,000 --> 01:02:13,200 GRIEF CLASS NOT KNOWING THE 1437 01:02:13,200 --> 01:02:15,200 FIRST THING ABOUT KNOWING HOW TO 1438 01:02:15,200 --> 01:02:17,000 COUNSEL IN TRAUMATIC GRIEF. 1439 01:02:17,000 --> 01:02:19,640 HAVING A GOOD LIST IS HELPFUL. 1440 01:02:19,640 --> 01:02:21,320 SUPPORT GROUPS IN THE RESEARCH 1441 01:02:21,320 --> 01:02:25,720 CAN BE HELPFUL. 1442 01:02:25,720 --> 01:02:28,440 MINDFULNESS-BASED INTERVENTIONS 1443 01:02:28,440 --> 01:02:29,800 AND MINDFUL WALKING AND 1444 01:02:29,800 --> 01:02:31,360 MEDICATION WHEN PEOPLE ARE READY 1445 01:02:31,360 --> 01:02:33,200 FOR IT AND YOGA. 1446 01:02:33,200 --> 01:02:35,160 THIS CAME FROM AN NIH GRANT WE 1447 01:02:35,160 --> 01:02:37,720 FOUND YOGA CAN BE A VERY 1448 01:02:37,720 --> 01:02:39,720 EFFECTIVE INTERVENTION FOR 1449 01:02:39,720 --> 01:02:40,200 STILLBIRTH. 1450 01:02:40,200 --> 01:02:42,640 AND FINALLY EMOTIONAL SUPPORT 1451 01:02:42,640 --> 01:02:43,360 FROM MULTIPLE SOURCE. 1452 01:02:43,360 --> 01:02:45,000 I'LL TELL YOU ABOUT A STUDY WE 1453 01:02:45,000 --> 01:02:48,480 DID AND WE LOOKED AT A LARGE 1454 01:02:48,480 --> 01:02:49,240 SAMPLE. 1455 01:02:49,240 --> 01:02:50,840 WE LOOKED AT WHAT GOOD GRIEF 1456 01:02:50,840 --> 01:02:54,520 SUPPORT WAS AND OVERWHELMINGLY 1457 01:02:54,520 --> 01:02:57,440 BASED ON HOUSES, FOUR TYPES OF 1458 01:02:57,440 --> 01:02:58,480 SOCIAL SUPPORT. 1459 01:02:58,480 --> 01:03:02,440 WE CATEGORIZED THE RESPONSES 1460 01:03:02,440 --> 01:03:05,520 INTO ONE OF THE FOUR CATEGORIES 1461 01:03:05,520 --> 01:03:08,160 OF HOW'S THE SOCIAL SUPPORT AND 1462 01:03:08,160 --> 01:03:10,160 OVERWHELMINGLY EMOTIONAL SUPPORT 1463 01:03:10,160 --> 01:03:11,920 AND ACTS OF EMOTIONAL CARES WERE 1464 01:03:11,920 --> 01:03:13,760 THE MOST DOMINANT THEMES. 1465 01:03:13,760 --> 01:03:16,720 REMEMBERING THE PERSON WHO DIED, 1466 01:03:16,720 --> 01:03:21,760 SAYING THEIR NAME, EMOTIONALLY 1467 01:03:21,760 --> 01:03:23,440 SUPPORTIVE COMMUNICATION AND 1468 01:03:23,440 --> 01:03:25,000 BEING AVAILABLE AND GIVING TIME 1469 01:03:25,000 --> 01:03:27,480 AND BEING OPEN TO HEARING ABOUT 1470 01:03:27,480 --> 01:03:29,440 PEOPLE'S GRIEF, NOT TRYING TO 1471 01:03:29,440 --> 01:03:30,720 FIX OR RUSH AND INSTRUMENTAL 1472 01:03:30,720 --> 01:03:32,400 SUPPORT CAME IN AT HIGH AND 1473 01:03:32,400 --> 01:03:34,120 APPRAISAL SUPPORT BUT EMOTIONAL 1474 01:03:34,120 --> 01:03:35,960 SUPPORT OVERWHELMINGLY. 1475 01:03:35,960 --> 01:03:38,960 INSTRUMENTAL SUPPORT IS LIKE 1476 01:03:38,960 --> 01:03:40,320 ASSISTANCE WITH CHILDCARE AND 1477 01:03:40,320 --> 01:03:42,280 MEALS AND FINANCIAL SUPPORT AND 1478 01:03:42,280 --> 01:03:44,160 APPRAISAL SUPPORT IS SIMILAR TO 1479 01:03:44,160 --> 01:03:45,800 WHAT PARENTS GET IN SUPPORT 1480 01:03:45,800 --> 01:03:48,120 GROUPS AND EXTENDED COMMUNITIES 1481 01:03:48,120 --> 01:03:49,520 WHICH IS CONNECTION WITH LIKE 1482 01:03:49,520 --> 01:03:49,800 OTHERS. 1483 01:03:49,800 --> 01:03:51,440 WE WANTED TO KNOW WHAT WERE THE 1484 01:03:51,440 --> 01:03:52,560 ACTIONS OF GOOD GRIEF SUPPORT 1485 01:03:52,560 --> 01:03:58,640 FROM GRIEVERS AND WHO WERE THE 1486 01:03:58,640 --> 01:03:59,920 ACTORS. 1487 01:03:59,920 --> 01:04:04,040 WE KNOW THE ACTIONS AND FOCUS ON 1488 01:04:04,040 --> 01:04:05,400 GRIEF SUPPORT THROUGH EMOTIONAL 1489 01:04:05,400 --> 01:04:05,680 SUPPORT. 1490 01:04:05,680 --> 01:04:09,320 THE BEST SOURCES ACCORDING TO 1491 01:04:09,320 --> 01:04:12,560 GRIEVERS, ANIMALS CAME IN AT 1492 01:04:12,560 --> 01:04:12,960 89%. 1493 01:04:12,960 --> 01:04:16,160 AND THIS IS COMPLETELY WITHOUT 1494 01:04:16,160 --> 01:04:16,360 WORDS. 1495 01:04:16,360 --> 01:04:18,920 I THINK THIS HAS TO DO WITH 1496 01:04:18,920 --> 01:04:20,680 PEOPLE PREFERRING EMOTIONAL 1497 01:04:20,680 --> 01:04:21,200 SUPPORT. 1498 01:04:21,200 --> 01:04:22,680 NEIGHBORS AND COMMUNITY CAME IN 1499 01:04:22,680 --> 01:04:24,400 AT 31% AND COLLEAGUES CAME IN 1500 01:04:24,400 --> 01:04:27,520 LOW AT 32% AND FAITH LEADERS AT 1501 01:04:27,520 --> 01:04:28,960 40%. 1502 01:04:28,960 --> 01:04:33,120 FAMILY AT 41% AND COUNSELORS AT 1503 01:04:33,120 --> 01:04:34,480 UNDER 60% WHICH IS DISAPPOINTING 1504 01:04:34,480 --> 01:04:37,320 FOR ME SINCE I WORK IN A SCHOOL 1505 01:04:37,320 --> 01:04:39,280 OF SOCIAL WORK AND GRIEF SUPPORT 1506 01:04:39,280 --> 01:04:42,920 GROUPS CAME IN BELOW PETS AND 1507 01:04:42,920 --> 01:04:43,160 ANIMALS. 1508 01:04:43,160 --> 01:04:45,600 I NEEDED TO UNDERSTAND WHY THIS 1509 01:04:45,600 --> 01:04:48,160 WAS SO WE EXTENDED OUR IRB AND 1510 01:04:48,160 --> 01:04:50,480 ASKED THE PEOPLE WHO RATED 1511 01:04:50,480 --> 01:04:51,280 ANIMALS SO HIGH WHY. 1512 01:04:51,280 --> 01:04:53,360 AND THIS IS WHAT WE FOUND. 1513 01:04:53,360 --> 01:05:00,800 THE NATURE OF THEIR RESPONSE WAS 1514 01:05:00,800 --> 01:05:03,280 NON-JUDGMENTAL AND THEY DID NOT 1515 01:05:03,280 --> 01:05:06,760 NEED TO TALK OR EXPRESS 1516 01:05:06,760 --> 01:05:09,320 PLATITUDE OR MAKING PEOPLE FEEL 1517 01:05:09,320 --> 01:05:12,680 BETTER TELLING THEM IT WAS GOD'S 1518 01:05:12,680 --> 01:05:12,880 WILL. 1519 01:05:12,880 --> 01:05:14,440 THEY APPROACHED THE GRIEVING 1520 01:05:14,440 --> 01:05:16,000 PERSON AND PROVIDED TACTILE 1521 01:05:16,000 --> 01:05:18,200 COMFORT AND WERE WITNESSES OF 1522 01:05:18,200 --> 01:05:19,760 THEIR GRIEF AND PROVIDED REFUGE 1523 01:05:19,760 --> 01:05:21,320 FROM LONELINESS AND ISOLATION. 1524 01:05:21,320 --> 01:05:25,080 I SEE THIS IN TRAUMATIC GRIEF. 1525 01:05:25,080 --> 01:05:27,720 TWO OF THE MOST COMMON 1526 01:05:27,720 --> 01:05:28,320 EXPERIENCES, DIFFICULT 1527 01:05:28,320 --> 01:05:30,440 EXPERIENCES WITH A FAMILIES IN 1528 01:05:30,440 --> 01:05:32,600 TERMS OF THE SOCIAL INTERACTION 1529 01:05:32,600 --> 01:05:36,800 IS FEELING OF LONELINESS AND 1530 01:05:36,800 --> 01:05:38,400 FEAR OF OTHERS AND FEAR OF WHAT 1531 01:05:38,400 --> 01:05:40,680 OTHERS WILL SAY OR TREAT THEM OR 1532 01:05:40,680 --> 01:05:41,480 THEIR GRIEF. 1533 01:05:41,480 --> 01:05:46,440 AND THAT ANIMALS PROVIDE A 1534 01:05:46,440 --> 01:05:51,160 REFUGE FROM THAT. 1535 01:05:51,160 --> 01:05:52,440 MUTUALITY AND CONNECTION AND 1536 01:05:52,440 --> 01:05:57,120 HAVING A CARE GIVING IDENTITY. 1537 01:05:57,120 --> 01:05:58,560 THIS WAS INTERESTING TO ME. 1538 01:05:58,560 --> 01:06:01,760 I DID NOT EXPECT THESE RESULTS 1539 01:06:01,760 --> 01:06:06,440 AND I DID NOT EXPECT THEM BUT IT 1540 01:06:06,440 --> 01:06:08,200 SHOWED ME HOW IMPORTANT BRIEF 1541 01:06:08,200 --> 01:06:10,080 SUPPORT IS IN JUST BEING THERE. 1542 01:06:10,080 --> 01:06:12,160 AND THAT THERE IS NO FIX. 1543 01:06:12,160 --> 01:06:13,240 ANIMALS DON'T TRY TO FIX 1544 01:06:13,240 --> 01:06:13,640 ANYTHING. 1545 01:06:13,640 --> 01:06:15,400 OVER AND OVER AND OVER AGAIN 1546 01:06:15,400 --> 01:06:17,600 PEOPLE TOLD STORIES ABOUT THEIR 1547 01:06:17,600 --> 01:06:20,000 DOGS OR THEIR CATS AND IN SOME 1548 01:06:20,000 --> 01:06:21,560 CASES THEIR HORSES JUST STANDING 1549 01:06:21,560 --> 01:06:23,760 WITH THEM, SITTING WITH THEM, 1550 01:06:23,760 --> 01:06:25,600 LAYING WITH THEM WHEN THEY WERE 1551 01:06:25,600 --> 01:06:28,600 CRYING AND JUST BEING THERE. 1552 01:06:28,600 --> 01:06:30,680 VERY POWERFUL. 1553 01:06:30,680 --> 01:06:33,160 SO FOR MORE INFORMATION THERE'S 1554 01:06:33,160 --> 01:06:36,720 WEBSITES AND I WANTED TO 1555 01:06:36,720 --> 01:06:37,400 DEDICATE THIS PRESENTATION TO 1556 01:06:37,400 --> 01:06:42,480 ALL THE BABIES AND CHILDREN GONE 1557 01:06:42,480 --> 01:06:42,960 TOO SOON. 1558 01:06:42,960 --> 01:06:47,800 THIS IS MY DAUGHTER WHO DIED IN 1559 01:06:47,800 --> 01:06:48,160 1994. 1560 01:06:48,160 --> 01:06:50,680 I WANT TO THANK THE NIH BECAUSE 1561 01:06:50,680 --> 01:06:52,240 28 1/2 YEARS AGO THERE WEREN'T 1562 01:06:52,240 --> 01:06:54,680 THESE DISCUSSIONS HAPPENING 1563 01:06:54,680 --> 01:06:56,040 ABOUT TRAUMATIC GRIEF AND THE 1564 01:06:56,040 --> 01:06:58,080 DEATH OF A BABY TO STILLBIRTH. 1565 01:06:58,080 --> 01:07:00,200 IT WAS NOT TALKED ABOUT AND I 1566 01:07:00,200 --> 01:07:02,360 HONOR ALL OF YOU FOR BEING HERE 1567 01:07:02,360 --> 01:07:04,160 AND WITH TREMENDOUS GRATITUDE 1568 01:07:04,160 --> 01:07:14,560 THANK YOU. 1569 01:07:14,560 --> 01:07:18,680 >>THANK YOU. 1570 01:07:18,680 --> 01:07:21,480 I APPRECIATE YOUR SHARED YOUR 1571 01:07:21,480 --> 01:07:22,480 EXPERTISE AND EXPERIENCE WITH US 1572 01:07:22,480 --> 01:07:30,880 TO HELP US MOVE FORWARD AND 1573 01:07:30,880 --> 01:07:32,560 IMPROVE. 1574 01:07:32,560 --> 01:07:36,720 YOU TOUCHED ON THE WORK AND 1575 01:07:36,720 --> 01:07:38,840 CREATE A BETTER MODEL. 1576 01:07:38,840 --> 01:07:42,160 PLEASE STAY WITH US BECAUSE 1577 01:07:42,160 --> 01:07:47,760 WE'LL HAVE QUESTIONS. 1578 01:07:47,760 --> 01:07:48,200 >>A QUICK COMMENT. 1579 01:07:48,200 --> 01:07:50,840 OF COURSE. 1580 01:07:50,840 --> 01:07:53,280 >>WHAT A POWERFUL TALK THAT YOU 1581 01:07:53,280 --> 01:07:57,080 JUST GAVE US. 1582 01:07:57,080 --> 01:08:00,280 NOT JUST IMPACTFUL -- I HAVE A 1583 01:08:00,280 --> 01:08:05,640 LUMP IN MY THROAT LISTENING TO 1584 01:08:05,640 --> 01:08:07,320 EVERYTHING THAT YOU SAID ABOUT 1585 01:08:07,320 --> 01:08:08,360 THE GRIEF THAT MOTHERS FACE AT 1586 01:08:08,360 --> 01:08:10,600 THE LOSS OF THEIR BABY AND HOW 1587 01:08:10,600 --> 01:08:15,600 YOU ACTUALLY CONNECTED WITH 1588 01:08:15,600 --> 01:08:15,840 EVERYONE. 1589 01:08:15,840 --> 01:08:17,000 THANK YOU VERY MUCH. 1590 01:08:17,000 --> 01:08:19,080 THIS IS REALLY PHENOMENAL. 1591 01:08:19,080 --> 01:08:19,600 >>THANK YOU. 1592 01:08:19,600 --> 01:08:20,400 THANK YOU VERY MUCH. 1593 01:08:20,400 --> 01:08:24,360 I APPRECIATE IT VERY MUCH. 1594 01:08:24,360 --> 01:08:29,280 THANK YOU EVERYONE 1595 01:08:29,280 --> 01:08:30,840 >>THANK YOU. 1596 01:08:30,840 --> 01:08:35,640 >>SO LET'S TAKE A BREAK FOR A 1597 01:08:35,640 --> 01:08:36,040 MOMENT. 1598 01:08:36,040 --> 01:08:37,080 IT'S POWERFUL PRESENTATION WE 1599 01:08:37,080 --> 01:08:41,360 WANT TO PAUSE ON IT. 1600 01:08:41,360 --> 01:08:45,000 THE NEXT PRESENTER IS 1601 01:08:45,000 --> 01:08:47,760 DR. KATHERINE GOLD AN ASSOCIATE 1602 01:08:47,760 --> 01:08:52,200 PROFESSOR OF FAMILY MEDICINE AND 1603 01:08:52,200 --> 01:08:53,520 OBSTETRIC GYNECOLOGY AT THE 1604 01:08:53,520 --> 01:08:55,400 UNIVERSITY OF MICHIGAN. 1605 01:08:55,400 --> 01:08:56,960 SHE WILL CONTINUE TO WORK WITH 1606 01:08:56,960 --> 01:09:00,040 US ON PSYCHOLOGICAL IMPACT AND 1607 01:09:00,040 --> 01:09:05,760 TREATMENT OF FAMILY AND WOMEN 1608 01:09:05,760 --> 01:09:07,760 SUFFERING THIS TRAGIC EVENT. 1609 01:09:07,760 --> 01:09:12,400 THANK YOU FOR ACCEPTING OUR 1610 01:09:12,400 --> 01:09:12,720 INVITATION. 1611 01:09:12,720 --> 01:09:14,240 >>THANK YOU. 1612 01:09:14,240 --> 01:09:16,960 I WANT TO THANK DR. CACCIATORE 1613 01:09:16,960 --> 01:09:17,960 FOR A LOVELY TALK. 1614 01:09:17,960 --> 01:09:19,600 IT'S A BEAUTIFUL INTRODUCTION TO 1615 01:09:19,600 --> 01:09:22,400 GRIEF IN ALL THE WAYS IT 1616 01:09:22,400 --> 01:09:24,280 INFILTRATES OUR LIVES. 1617 01:09:24,280 --> 01:09:26,160 I WAS HOPING SHE'D DO EXACTLY 1618 01:09:26,160 --> 01:09:28,000 THAT AND DECIDED TO TAKE A 1619 01:09:28,000 --> 01:09:31,840 DIFFERENT SPIN ON MY TALK SO WE 1620 01:09:31,840 --> 01:09:32,600 DIDN'T PRESENT THE SAME 1621 01:09:32,600 --> 01:09:33,160 INFORMATION. 1622 01:09:33,160 --> 01:09:36,160 I WANT IT TALK ABOUT WHEN GRIEF 1623 01:09:36,160 --> 01:09:38,160 DOESN'T GO WELL AND TALK A 1624 01:09:38,160 --> 01:09:39,680 LITTLE BIT ABOUT WHERE I SEE THE 1625 01:09:39,680 --> 01:09:42,800 RESEARCH NEEDS BEING IN THE 1626 01:09:42,800 --> 01:09:43,320 BEREAVEMENT FIELD. 1627 01:09:43,320 --> 01:09:50,560 I DO LOW-RISK OBSTETRICS AND 1628 01:09:50,560 --> 01:09:53,560 PART OF A PRENATAL CENTER IN 1629 01:09:53,560 --> 01:09:56,200 DETROIT AND HAVE SEEN BAD 1630 01:09:56,200 --> 01:09:59,000 OUTCOMES FOR HIGH-RISK MOMS AND 1631 01:09:59,000 --> 01:10:01,640 IT'S A PERSONAL THING FOR ME. 1632 01:10:01,640 --> 01:10:04,200 I HAVE NO DISCLOSURES. 1633 01:10:04,200 --> 01:10:09,320 SEVERAL PEOPLE TALKED HOW 1634 01:10:09,320 --> 01:10:12,160 STILLBIRTH IS SUCH SO MUCH MORE 1635 01:10:12,160 --> 01:10:12,920 PREVALENT THAN THE MATERNAL 1636 01:10:12,920 --> 01:10:14,480 HEALTH OUTCOMES WE WORRY ABOUT 1637 01:10:14,480 --> 01:10:18,800 AND I WANT TO REINFORCE WE HAVE 1638 01:10:18,800 --> 01:10:21,720 SO MANY STILLBIRTHS WITH THE 1639 01:10:21,720 --> 01:10:22,960 UNEXPLAINED INFANT DEATHS AND 1640 01:10:22,960 --> 01:10:23,960 MATERNAL DEATHS AND IT'S 1641 01:10:23,960 --> 01:10:26,600 IMPORTANT WE CONTINUE TO LOOK AT 1642 01:10:26,600 --> 01:10:27,160 STILLBIRTH AS A CRITICAL 1643 01:10:27,160 --> 01:10:32,920 COMPONENT. 1644 01:10:32,920 --> 01:10:35,480 STILLBIRTH IS A VERY UNIQUE 1645 01:10:35,480 --> 01:10:35,720 LOSS. 1646 01:10:35,720 --> 01:10:41,240 IT'S TYPICALLY UNEXPECTED. 1647 01:10:41,240 --> 01:10:44,080 MY FAVORITE ARTICLE WAS PARENTS 1648 01:10:44,080 --> 01:10:47,760 EXPERIENCING TWO LIFE-CHANGING 1649 01:10:47,760 --> 01:10:53,200 EVENTS AT THE STATEMENT TIME. 1650 01:10:53,200 --> 01:10:54,960 THERE'S RELATIVELY SHORT TIME 1651 01:10:54,960 --> 01:10:56,960 FOR GRIEF AND A SHORT TIME FRAME 1652 01:10:56,960 --> 01:10:58,560 FROM DIAGNOSIS TO LOSING A BABY. 1653 01:10:58,560 --> 01:11:00,520 IT'S TRAUMATIC FOR FAMILIES AND 1654 01:11:00,520 --> 01:11:01,040 MEDICAL STAFF. 1655 01:11:01,040 --> 01:11:01,840 THAT'S IMPORTANT TO THINK ABOUT 1656 01:11:01,840 --> 01:11:10,720 AS WE MOVE FORWARD. 1657 01:11:10,720 --> 01:11:13,040 BEREAVEMENT IS NORMAL AND THE 1658 01:11:13,040 --> 01:11:16,680 MODEL OF GRIEF SUGGESTS WE GO 1659 01:11:16,680 --> 01:11:20,480 BACK AND FORTH AND FOLK FOCUS ON 1660 01:11:20,480 --> 01:11:21,920 RESTORING OUR LIVES AND WE'RE 1661 01:11:21,920 --> 01:11:25,360 OFTEN GOING BACK AND FORTH 1662 01:11:25,360 --> 01:11:26,720 BETWEEN THE TWO STATES. 1663 01:11:26,720 --> 01:11:28,280 BEREAVEMENT IS NORMAL. 1664 01:11:28,280 --> 01:11:33,760 THE PROBLEM IS THERE ARE CERTAIN 1665 01:11:33,760 --> 01:11:34,480 SITUATI 1666 01:11:34,480 --> 01:11:36,800 SITUATIONS WHY WHERE MOMS 1667 01:11:36,800 --> 01:11:37,880 STRUGGLE MORE THAN OTHERS AND 1668 01:11:37,880 --> 01:11:40,400 CERTAIN MOMS WE NEED TO GET 1669 01:11:40,400 --> 01:11:44,160 AUTOPSIES AND SIMILARLY, MANY 1670 01:11:44,160 --> 01:11:47,040 MOMS AND FAMILIES DO FINE AND 1671 01:11:47,040 --> 01:11:48,160 RECOVER AFTER STILLBIRTH BUT 1672 01:11:48,160 --> 01:11:50,560 SOME ARE AT HIGH RISK FOR WORSE 1673 01:11:50,560 --> 01:11:52,160 OUTCOMES AND THOSE THE ONES WE 1674 01:11:52,160 --> 01:12:02,480 NEED TO FOCUS ON. 1675 01:12:15,440 --> 01:12:22,680 THERE'S RISKS AND THINGS 1676 01:12:22,680 --> 01:12:23,760 UNEXPECTED 1 AND POOR CARE 1677 01:12:23,760 --> 01:12:25,000 AROUND THE TIME OF LOSS CAN 1678 01:12:25,000 --> 01:12:26,280 INCREASE THE TRAUMATIC NATURE. 1679 01:12:26,280 --> 01:12:28,960 I WAS STARTING OUT AS A 1680 01:12:28,960 --> 01:12:32,040 RESEARCHER WHEN THE STILLBIRTH 1681 01:12:32,040 --> 01:12:34,320 COLLABORATIVE RESEARCH NETWORK 1682 01:12:34,320 --> 01:12:36,880 WAS GOING I WASN'T AWARE OF 1683 01:12:36,880 --> 01:12:38,360 THEIR PRESENCE UNTIL I GOT INTO 1684 01:12:38,360 --> 01:12:39,880 MY OWN STUDY. 1685 01:12:39,880 --> 01:12:42,200 I TRIED SERVING MOMS IN MICHIGAN 1686 01:12:42,200 --> 01:12:44,000 OVER A TWO-YEAR PERIOD ON A 1687 01:12:44,000 --> 01:12:46,400 POPULATION LEVEL SO WE WORKED 1688 01:12:46,400 --> 01:12:49,920 WITH THE STATE OF MICHIGAN AND 1689 01:12:49,920 --> 01:12:55,880 REACHED OUT USING INFORMATION 1690 01:12:55,880 --> 01:12:58,320 AND MATCHED THEM WITH A MOM WHO 1691 01:12:58,320 --> 01:13:00,480 HAD A LIVE BIRTH DURING THE SAME 1692 01:13:00,480 --> 01:13:01,280 TIME PERIOD. 1693 01:13:01,280 --> 01:13:02,600 I PURPOSELY FOCUSSED ON BOTH 1694 01:13:02,600 --> 01:13:05,200 MOMS WHO HAD A STILLBIRTH AND 1695 01:13:05,200 --> 01:13:06,640 MOTHERS WHO HAD INFANTS DIE IN 1696 01:13:06,640 --> 01:13:08,960 THE FIRST 28 DAYS OF LIFE. 1697 01:13:08,960 --> 01:13:11,760 TYPICALLY IF A CHILD DIES IN 1698 01:13:11,760 --> 01:13:13,560 THIS TIME PERIOD THEY HAVEN'T 1699 01:13:13,560 --> 01:13:15,520 LEFT THE HOSPITAL THEY'RE 1700 01:13:15,520 --> 01:13:16,520 USUALLY PREMATURE OR SICK. 1701 01:13:16,520 --> 01:13:20,200 WHAT WE HAD KNOWN TO THIS POINT 1702 01:13:20,200 --> 01:13:24,200 IS OUTCOMES IN TERMS OF 1703 01:13:24,200 --> 01:13:25,720 BEREAVEMENT AND TO INCREASE THE 1704 01:13:25,720 --> 01:13:28,640 SAMPLE SIZE I WANTED TO LOOK AT 1705 01:13:28,640 --> 01:13:28,840 BOTH. 1706 01:13:28,840 --> 01:13:30,920 I WAS ABLE TO CONTROL FOR OTHER 1707 01:13:30,920 --> 01:13:33,880 THINGS THAT MAY HAVE AFFECTED 1708 01:13:33,880 --> 01:13:36,200 MENTAL HEALTH OUTCOMES, 1709 01:13:36,200 --> 01:13:37,840 PSYCHIATRIC HISTORY, VIOLENCE 1710 01:13:37,840 --> 01:13:39,280 AND SOCIAL SUPPORT BECAUSE THERE 1711 01:13:39,280 --> 01:13:40,360 COULD BE OTHER THINGS THAT 1712 01:13:40,360 --> 01:13:43,680 AFFECT HOW MOMS DO AFTER 1713 01:13:43,680 --> 01:13:44,080 DELIVERY. 1714 01:13:44,080 --> 01:13:46,240 I THINK THIS THE MOST IMPORTANT 1715 01:13:46,240 --> 01:13:47,760 SLIDE. 1716 01:13:47,760 --> 01:13:49,080 THERE WAS A HIGHER RISK FOR 1717 01:13:49,080 --> 01:13:52,000 MEETING CRITERIA FOR MENTAL 1718 01:13:52,000 --> 01:13:53,200 HEALTH DISORDERS NINE MONTHS 1719 01:13:53,200 --> 01:13:54,520 AFTER THE LOSS FOR EVERY MEASURE 1720 01:13:54,520 --> 01:13:59,320 WE LOOKED AT FOR DEPRESSION, 1721 01:13:59,320 --> 01:14:00,240 POSTTRAUMATIC STRESS DISORDER 1722 01:14:00,240 --> 01:14:02,440 AND ANXIETY AND SOCIAL PHOBIA. 1723 01:14:02,440 --> 01:14:04,160 THIS IS CONTROLLING FOR ALL THE 1724 01:14:04,160 --> 01:14:05,280 OTHER FACTORS THAT MIGHT AFFECT 1725 01:14:05,280 --> 01:14:06,560 YOUR OUTCOMES. 1726 01:14:06,560 --> 01:14:09,920 SO THIS REALLY TELLS US THAT 1727 01:14:09,920 --> 01:14:11,480 MENTAL HEALTH IS A CRITICALLY 1728 01:14:11,480 --> 01:14:15,560 HIGH RISK AREA FOR FAMILIES 1729 01:14:15,560 --> 01:14:17,480 AFTER A LOSS AND ALSO THAT THE 1730 01:14:17,480 --> 01:14:18,920 OUTCOMES FOR MOMS WITH 1731 01:14:18,920 --> 01:14:20,160 STILLBIRTH AND THOSE MOMS WITH 1732 01:14:20,160 --> 01:14:23,960 EARLY INFANT DEATHS WERE VERY 1733 01:14:23,960 --> 01:14:24,480 SIMILAR. 1734 01:14:24,480 --> 01:14:26,800 THERE WERE NO STATISTICAL 1735 01:14:26,800 --> 01:14:28,800 DIFFERENCES AND THERE WAS NO 1736 01:14:28,800 --> 01:14:30,080 DIFFERENCES IN RACE FOR THE 1737 01:14:30,080 --> 01:14:31,640 MENTAL HEALTH DISORDERS. 1738 01:14:31,640 --> 01:14:34,440 WHY DOES MENTAL HEALTH MATTER? 1739 01:14:34,440 --> 01:14:37,720 IT'S NOT A FLIPPANT QUESTION? 1740 01:14:37,720 --> 01:14:40,080 NOT JUST DAILY FUNCTION OR 1741 01:14:40,080 --> 01:14:41,640 PHYSICAL HEALTH IT'S ALSO FUTURE 1742 01:14:41,640 --> 01:14:42,920 REPRODUCTIVE HEALTH. 1743 01:14:42,920 --> 01:14:44,760 WE TYPICALLY THINK IF SOMEONE 1744 01:14:44,760 --> 01:14:47,600 HAS A STILLBIRTH THERE COULD BE 1745 01:14:47,600 --> 01:14:48,760 MENTAL HEALTH CONSEQUENCES DOWN 1746 01:14:48,760 --> 01:14:50,520 THE READY FOR THE MOM. 1747 01:14:50,520 --> 01:14:52,080 THERE'S ALSO SIGNIFICANT 1748 01:14:52,080 --> 01:14:57,240 EVIDENCE IN ENDOCRINOLOGY, 1749 01:14:57,240 --> 01:14:58,840 NEUROBIOLOGY THAT SUGGESTS THIS 1750 01:14:58,840 --> 01:15:00,200 MAY BE A TWO-WAY STREET. 1751 01:15:00,200 --> 01:15:02,600 IN SOME RESEARCH I DID EARLY ON 1752 01:15:02,600 --> 01:15:07,560 USED A LONGITUDINAL COHORT TO 1753 01:15:07,560 --> 01:15:10,560 LOOK AT MOMS WITH A MENTAL 1754 01:15:10,560 --> 01:15:11,800 HEALTH DIAGNOSIS AND SUBSEQUENT 1755 01:15:11,800 --> 01:15:13,240 BIRTH OUTCOMES AND COMBINED 1756 01:15:13,240 --> 01:15:16,320 STILLBIRTH AND MISSCARRIAGES AND 1757 01:15:16,320 --> 01:15:21,200 HAVING A MENTAL HEALTH DIAGNOSIS 1758 01:15:21,200 --> 01:15:26,960 INCREASED THE RISK WHICH FOR ME 1759 01:15:26,960 --> 01:15:28,280 IS IMPORTANT BECAUSE IT MAY 1760 01:15:28,280 --> 01:15:30,680 AFFECT SUBSEQUENT PREGNANCIES. 1761 01:15:30,680 --> 01:15:34,080 STILLBIRTH ALSO IMPACTS SOCIAL 1762 01:15:34,080 --> 01:15:34,320 SUPPORT. 1763 01:15:34,320 --> 01:15:36,360 I SAID POOR SOCIAL SUPPORT WAS A 1764 01:15:36,360 --> 01:15:38,840 FACTOR THAT CAN INCREASE RISK 1765 01:15:38,840 --> 01:15:40,120 FOR STRUGGLING AFTER A 1766 01:15:40,120 --> 01:15:41,200 STILLBIRTH. 1767 01:15:41,200 --> 01:15:42,360 IT GOES BOTH WAYS. 1768 01:15:42,360 --> 01:15:44,040 JOANNE REFERENCED THIS. 1769 01:15:44,040 --> 01:15:47,040 I DID A STUDY SIMILAR TO HERS. 1770 01:15:47,040 --> 01:15:49,080 WE LOOKED NOT JUST AT MARRIAGES 1771 01:15:49,080 --> 01:15:51,120 BUT ANY PARTNERSHIPS WHETHER 1772 01:15:51,120 --> 01:15:53,160 SOMEONE WAS MARRIED OR NOT AND 1773 01:15:53,160 --> 01:15:55,960 LOOKING AT LONGITUDINAL DATA AND 1774 01:15:55,960 --> 01:16:00,000 LOOKED AT WITH A LIVE BIRTH OR 1775 01:16:00,000 --> 01:16:02,240 MISCARRIAGE OR STILLBIRTH AND 1776 01:16:02,240 --> 01:16:04,200 FOLLOWED THAT RELATIONSHIP 1777 01:16:04,200 --> 01:16:06,360 OVERTIME TO SEE WHAT HAPPENED. 1778 01:16:06,360 --> 01:16:08,840 WE THEN DID SURVIVAL ANALYSIS 1779 01:16:08,840 --> 01:16:11,760 AND SOME MAY BE FAMILIAR WITH 1780 01:16:11,760 --> 01:16:17,320 SURVIVAL ANALYSES AND SOME LESS. 1781 01:16:17,320 --> 01:16:19,280 BASICALLY IF YOU LOOK AT WHAT 1782 01:16:19,280 --> 01:16:20,320 HAPPENS TO THE RELATIONSHIPS. 1783 01:16:20,320 --> 01:16:23,440 AT THE TOP WE HAVE LIVE BIRTHS. 1784 01:16:23,440 --> 01:16:24,320 IT GOES FROM EVERYBODY BEING 1785 01:16:24,320 --> 01:16:26,040 TOGETHER AT THE TIME THE BABY IS 1786 01:16:26,040 --> 01:16:28,160 BORN WE EXCLUDED PEOPLE WHO 1787 01:16:28,160 --> 01:16:30,360 WEREN'T WITH A PARTNER AT THE 1788 01:16:30,360 --> 01:16:32,240 TIME THE BABY WAS BORN AND HALF 1789 01:16:32,240 --> 01:16:34,040 THE FAMILIES ARE STILL TOGETHER 1790 01:16:34,040 --> 01:16:35,600 AT THE END OF 15 YEARS. 1791 01:16:35,600 --> 01:16:39,280 THE BLUE LINE IS MISCARRIAGE. 1792 01:16:39,280 --> 01:16:41,960 WHAT WE'RE INTERESTED IN IS THE 1793 01:16:41,960 --> 01:16:43,960 PERIOD IN THE FIRST 1-2 YEARS 1794 01:16:43,960 --> 01:16:46,600 WHERE THE BLUE AND BLACK LINE 1795 01:16:46,600 --> 01:16:47,800 SEPARATE BECAUSE THERE'S 1796 01:16:47,800 --> 01:16:49,480 SUDDENLY INCREASED RISK IN TERMS 1797 01:16:49,480 --> 01:16:51,600 OF SEPARATION OF THE 1798 01:16:51,600 --> 01:16:53,480 RELATIONSHIP AND IN FACT THE 1799 01:16:53,480 --> 01:16:58,400 HAZARD RATIO OF 1.22 A 22% 1800 01:16:58,400 --> 01:17:00,160 HIGHER RISK OF SEPARATING WITH A 1801 01:17:00,160 --> 01:17:02,640 PARTNER AFTER A MISCARRIAGE. 1802 01:17:02,640 --> 01:17:04,960 THE PINK LINE WAS STILLBIRTH 40% 1803 01:17:04,960 --> 01:17:06,760 HIGHER AND THAT RISK PERSISTED 1804 01:17:06,760 --> 01:17:08,160 OVER THE FIRST 10 YEARS. 1805 01:17:08,160 --> 01:17:09,440 IT DOESN'T MEAN SOMEONE WHO'S 1806 01:17:09,440 --> 01:17:11,800 HAD A LOSS IS DOOMED TO HAVE 1807 01:17:11,800 --> 01:17:13,040 THEIR RELATIONSHIP FAIL. 1808 01:17:13,040 --> 01:17:15,360 WHAT I THINK TYPICALLY IS GOING 1809 01:17:15,360 --> 01:17:17,800 ON IS THAT RELATIONSHIPS 1810 01:17:17,800 --> 01:17:19,320 STRUGGLING BEFORE A BIRTH ARE 1811 01:17:19,320 --> 01:17:20,960 MORE LIKELY TO BE AT RISK IF 1812 01:17:20,960 --> 01:17:23,080 THERE'S A BAD OUTCOME WITH THAT 1813 01:17:23,080 --> 01:17:23,280 BIRTH. 1814 01:17:23,280 --> 01:17:25,800 SO THOSE FAMILIES WHO MAY 1815 01:17:25,800 --> 01:17:26,880 ALREADY STRUGGLE WITH SOCIAL 1816 01:17:26,880 --> 01:17:28,160 SUPPORT MAY HAVE FURTHER 1817 01:17:28,160 --> 01:17:35,360 STRUGGLES DOWN THE ROAD. 1818 01:17:35,360 --> 01:17:36,960 I'LL TALK A LITTLE BIT ABOUT 1819 01:17:36,960 --> 01:17:37,600 TREATMENT. 1820 01:17:37,600 --> 01:17:41,600 DESPITE MOMS HAVING HIGH RATES 1821 01:17:41,600 --> 01:17:44,600 OF SYMPTOMOLOGY FEW SOUGHT 1822 01:17:44,600 --> 01:17:46,200 TREATMENT OF THE MOMS WITH 1823 01:17:46,200 --> 01:17:47,760 POSITIVE SCREENS FOR ANY OF 1824 01:17:47,760 --> 01:17:49,720 THESE DISORDERS, ONLY 42% OF 1825 01:17:49,720 --> 01:17:51,600 THOSE WITH DEPRESSION AND A 1826 01:17:51,600 --> 01:17:54,200 THIRD OF THOSE MOMS WITH PTSD 1827 01:17:54,200 --> 01:17:55,880 REPORTED ANY TYPE OF TREATMENT. 1828 01:17:55,880 --> 01:17:57,680 WE WERE BROAD IN OUR DEFINITIONS 1829 01:17:57,680 --> 01:17:59,120 OF WHAT CONSTITUTED TREATMENT. 1830 01:17:59,120 --> 01:18:04,160 PEOPLE ARE NOT SEEKING HELP FOR 1831 01:18:04,160 --> 01:18:09,400 THIS. 1832 01:18:09,400 --> 01:18:10,760 THERE WAS NO DIFFERENCE AND 1833 01:18:10,760 --> 01:18:13,240 THERE WAS A DIFFERENCE BY 1834 01:18:13,240 --> 01:18:13,520 TREATMENT. 1835 01:18:13,520 --> 01:18:15,760 WHITE WOMAN WERE TWICE AS LIKELY 1836 01:18:15,760 --> 01:18:16,400 AS AFRICAN AMERICAN WOMEN TO GET 1837 01:18:16,400 --> 01:18:24,960 TREATMENT. 1838 01:18:24,960 --> 01:18:29,680 THERE'S BEEN TALK ABOUT THE HIGH 1839 01:18:29,680 --> 01:18:31,560 RATES OF AFRICAN AMERICAN WOMEN 1840 01:18:31,560 --> 01:18:32,200 HAVING STILLBIRTHS AND THEY'RE 1841 01:18:32,200 --> 01:18:33,880 ALSO LESS LIKELY TO GET 1842 01:18:33,880 --> 01:18:34,640 TREATMENT. 1843 01:18:34,640 --> 01:18:38,400 WE KNOW THE MENTAL HEALTH 1844 01:18:38,400 --> 01:18:41,320 LITERATURE THAT BLACK WOMEN HAVE 1845 01:18:41,320 --> 01:18:45,080 BEEN LESS LIKELY TO SEEK 1846 01:18:45,080 --> 01:18:45,760 TRADITIONAL HEALTH CARE WHETHER 1847 01:18:45,760 --> 01:18:47,880 SEEING PHYSICIANS LIKE ME OR 1848 01:18:47,880 --> 01:18:49,600 PSYCHIATRISTS OR BEING ON 1849 01:18:49,600 --> 01:18:50,840 MEDICATIONS AND WE ALSO KNOW 1850 01:18:50,840 --> 01:18:52,120 THERE ARE A LOT BARRIERS TO 1851 01:18:52,120 --> 01:18:52,760 MENTAL HEALTH TREATMENT IN THIS 1852 01:18:52,760 --> 01:18:56,200 COUNTRY. 1853 01:18:56,200 --> 01:18:58,440 WE HAVE 42% OF BIRTHS ARE 1854 01:18:58,440 --> 01:18:59,920 MEDICAID FUND AND MANY OF THOSE 1855 01:18:59,920 --> 01:19:01,800 MOMS WILL LOSE THEIR MEDICAID 1856 01:19:01,800 --> 01:19:04,480 INSURANCE AFTER DELIVERY. 1857 01:19:04,480 --> 01:19:05,520 IF YOU HAVE A STILLBIRTH YOU'RE 1858 01:19:05,520 --> 01:19:09,040 NOT TAKING YOUR BABY TO A 1859 01:19:09,040 --> 01:19:10,840 PEDIATRICIAN TO WATCH THE MOM'S 1860 01:19:10,840 --> 01:19:14,120 MENTAL HEALTH AFTER DELIVERY OR 1861 01:19:14,120 --> 01:19:15,560 TO A PHYSICIAN WATCHING FOR THE 1862 01:19:15,560 --> 01:19:16,640 MENTAL HEALTH OUTCOMES. 1863 01:19:16,640 --> 01:19:17,760 PEOPLE LOSE THEIR INSURANCE. 1864 01:19:17,760 --> 01:19:20,080 THEY MAY NOT HAVE TIME TO ATTEND 1865 01:19:20,080 --> 01:19:20,360 TREATMENT. 1866 01:19:20,360 --> 01:19:21,760 THEY MAY HAVE CHILDCARE BARRIERS 1867 01:19:21,760 --> 01:19:23,800 AND THEN YOU HAVE TRANSPORTATION 1868 01:19:23,800 --> 01:19:24,080 BARRIERS. 1869 01:19:24,080 --> 01:19:26,720 THESE ARE ALL SERIOUS BARRIERS. 1870 01:19:26,720 --> 01:19:29,000 IN TERMS OF BEING ABLE TO HAVE 1871 01:19:29,000 --> 01:19:30,400 HEALTH EQUITY. 1872 01:19:30,400 --> 01:19:31,880 I'VE BEEN INTERESTED IN TWO VERY 1873 01:19:31,880 --> 01:19:35,760 SPECIFIC AREAS OF MENTAL HEALTH 1874 01:19:35,760 --> 01:19:36,800 TREATMENT. 1875 01:19:36,800 --> 01:19:37,920 ONE IS THINKING ABOUT THE TYPE 1876 01:19:37,920 --> 01:19:40,000 OF CARE THAT HAPPENS WHEN 1877 01:19:40,000 --> 01:19:41,240 SOMEONE IS IN THE HOSPITAL AND 1878 01:19:41,240 --> 01:19:43,080 DELIVERING A STILLBIRTH BABY AND 1879 01:19:43,080 --> 01:19:47,440 THE SECOND IS ONLINE PEER 1880 01:19:47,440 --> 01:19:47,680 SUPPORT. 1881 01:19:47,680 --> 01:19:50,000 I THINK ABOUT A STILLBIRTH AS 1882 01:19:50,000 --> 01:19:52,000 BEING A TRAUMA MUCH LIKE JOANNE 1883 01:19:52,000 --> 01:19:54,480 TALKED ABOUT AND WHEN A MOM IS 1884 01:19:54,480 --> 01:19:57,240 TOLD HER BABY HAS DIED THIS 1885 01:19:57,240 --> 01:19:58,400 COMES OFTEN AS A COMPLETE SHOCK. 1886 01:19:58,400 --> 01:20:01,080 IT'S ALMOST AS IF A CAMERA 1887 01:20:01,080 --> 01:20:02,000 STARTS ROLLING THAT THE MOMENT 1888 01:20:02,000 --> 01:20:03,920 AND RECORDING WHAT IS HAPPENING 1889 01:20:03,920 --> 01:20:08,160 AND THOSE ARE MEMORIES THAT PLAY 1890 01:20:08,160 --> 01:20:09,520 OVER AND OVER AND PART OF WHAT 1891 01:20:09,520 --> 01:20:10,080 CONTRIBUTE TO THE TRAUMA OF 1892 01:20:10,080 --> 01:20:14,320 THIS. 1893 01:20:14,320 --> 01:20:16,320 IN MY MICHIGAN MOTHER STUDY WE 1894 01:20:16,320 --> 01:20:17,720 ASKED MOMS ABOUT THEIR 1895 01:20:17,720 --> 01:20:20,160 EXPERIENCE AND GOT HUNDREDS OF 1896 01:20:20,160 --> 01:20:24,520 COMMENTS AND I'LL SHARE THREE. 1897 01:20:24,520 --> 01:20:29,200 DR. X WAS AWFUL. 1898 01:20:29,200 --> 01:20:32,200 SHE TOLD ME I WAS FAT AND 1899 01:20:32,200 --> 01:20:34,640 BECAUSE I HAD MEDICAID AND THE 1900 01:20:34,640 --> 01:20:36,600 NURSES WERE AWESOME. 1901 01:20:36,600 --> 01:20:39,600 THE TRIAGE PEOPLE WERE THE WORSE 1902 01:20:39,600 --> 01:20:39,920 PEOPLE. 1903 01:20:39,920 --> 01:20:41,440 I ALMOST PUNCHED BOTH. 1904 01:20:41,440 --> 01:20:43,080 THEY MADE ME FEEL LIKE IT'S MY 1905 01:20:43,080 --> 01:20:43,280 FAULT. 1906 01:20:43,280 --> 01:20:45,320 I THINK I LIKE HOW THE DOCTOR 1907 01:20:45,320 --> 01:20:48,600 TOLD ME, NURSE, I'M NOT GOOD AT 1908 01:20:48,600 --> 01:20:49,760 FINDING THE HEARTBEAT, LET ME 1909 01:20:49,760 --> 01:20:53,760 FIND THE DOCTOR AND A LADY WITH 1910 01:20:53,760 --> 01:20:58,320 AN ULTRASOUND MACHINE CAME IN 1911 01:20:58,320 --> 01:21:01,920 AND THEN THE DOCTOR CAME IN AND 1912 01:21:01,920 --> 01:21:03,880 SAID I'M SORRY, I SAID FOR WHAT 1913 01:21:03,880 --> 01:21:06,560 AND HE SAID YOUR BABY'S DEAD. 1914 01:21:06,560 --> 01:21:10,520 I THOUGHT THEY TOLD YOU. 1915 01:21:10,520 --> 01:21:12,840 THIS WILL REPLAY OVER AND OVER 1916 01:21:12,840 --> 01:21:14,640 FOR MOMS FOR YEARS AND WE NEED 1917 01:21:14,640 --> 01:21:15,680 TO DO IT RIGHT. 1918 01:21:15,680 --> 01:21:17,120 WE DON'T HAVE A LOT OF DATA HOW 1919 01:21:17,120 --> 01:21:19,280 IT AFFECTS OUTCOMES. 1920 01:21:19,280 --> 01:21:21,640 CLINICALLY DO WE KNOW HOW IT 1921 01:21:21,640 --> 01:21:21,880 MATTERS? 1922 01:21:21,880 --> 01:21:23,520 PARENTS TELL US IT MATTERS A LOT 1923 01:21:23,520 --> 01:21:25,120 BUT THERE'S LIMITED 1924 01:21:25,120 --> 01:21:26,120 UNDERSTANDING WHAT KINDS OF CARE 1925 01:21:26,120 --> 01:21:27,920 IS OFFERED IN HOSPITALS ACROSS 1926 01:21:27,920 --> 01:21:29,600 THE COUNTRY. 1927 01:21:29,600 --> 01:21:31,200 THERE'S LITTLE DATA SPECIFICALLY 1928 01:21:31,200 --> 01:21:33,120 TIMED TO THE KIND OF CARE GIVEN 1929 01:21:33,120 --> 01:21:38,640 TO THE SPECIFIC OUTCOMES FOR 1930 01:21:38,640 --> 01:21:48,840 FAMILIES. 1931 01:22:00,960 --> 01:22:04,360 I LOVE THIS PICTURE. 1932 01:22:04,360 --> 01:22:06,480 THE NEXT PICTURE APPEARED ON THE 1933 01:22:06,480 --> 01:22:07,480 STACK OF PHOTOGRAPHS FROM THE 1934 01:22:07,480 --> 01:22:10,720 HOSPITAL PROVIDED TO THE HOME. 1935 01:22:10,720 --> 01:22:12,640 YOU'LL SEE HERE'S THE MOM'S BABY 1936 01:22:12,640 --> 01:22:15,120 IN A METAL SINK AND THE PIECE OF 1937 01:22:15,120 --> 01:22:17,960 PAPER HAD THE MOM'S NAME AND 1938 01:22:17,960 --> 01:22:19,280 MEDICAL RECORD WHICH I COVERED 1939 01:22:19,280 --> 01:22:22,760 IN THE PHOTO BUT YOU CAN IMAGINE 1940 01:22:22,760 --> 01:22:28,280 SEEING YOUR BABY IN A METAL SINK 1941 01:22:28,280 --> 01:22:29,560 WILL BE SOMETHING THAT NEVER 1942 01:22:29,560 --> 01:22:32,080 GOES AWAY FROM THAT MOM AND 1943 01:22:32,080 --> 01:22:33,600 PROBABLY A MINOR TRANSGRESSION 1944 01:22:33,600 --> 01:22:35,320 PROBABLY THE NURSE WAS NOT 1945 01:22:35,320 --> 01:22:37,560 THINKING OF THE IMPACT BUT THOSE 1946 01:22:37,560 --> 01:22:40,160 MINOR MISSTEPS HAPPEN ALL THE 1947 01:22:40,160 --> 01:22:43,480 TIME AND CAN ADD UP AND HAVE 1948 01:22:43,480 --> 01:22:44,560 PROFOUND AFFECTS ON FAMILIES. 1949 01:22:44,560 --> 01:22:47,280 CURRENTLY I'VE BEEN WORKING ON A 1950 01:22:47,280 --> 01:22:49,960 STUDY TO TRY TO UNDERSTAND WHAT 1951 01:22:49,960 --> 01:22:50,680 IS ACTUALLY HAPPENING IN 1952 01:22:50,680 --> 01:22:52,040 HOSPITAL CAN CARE. 1953 01:22:52,040 --> 01:22:53,680 THIS WAS A NATIONAL SAMPLE. 1954 01:22:53,680 --> 01:22:56,280 I TOOK DATA FROM THE AMERICAN 1955 01:22:56,280 --> 01:22:57,320 HOSPITAL ASSOCIATION AND LIMITED 1956 01:22:57,320 --> 01:23:01,000 IT TO HOSPITALS WITH AT LEAST 1957 01:23:01,000 --> 01:23:03,280 100 DELIVERIES PER YEAR AND SAID 1958 01:23:03,280 --> 01:23:06,520 LET'S SAMPLE 10% AND THROUGH A 1959 01:23:06,520 --> 01:23:08,120 SAMPLING PROCESS WE IDENTIFIED 1960 01:23:08,120 --> 01:23:10,480 THE SAMPLE AND HOSPITALS WITHIN 1961 01:23:10,480 --> 01:23:15,600 EACH STATE AND RANKED THEM BY 1962 01:23:15,600 --> 01:23:16,960 DELIVERY VOLUME AND WHEN WE HAD 1963 01:23:16,960 --> 01:23:18,560 TO PICK HOSPITALS, SAY NEW YORK, 1964 01:23:18,560 --> 01:23:21,480 WE PICKED ONE FROM THE LARGEST 1965 01:23:21,480 --> 01:23:22,800 VOLUME OF DELIVERIES AND THE 1966 01:23:22,800 --> 01:23:26,560 NEXT AND THEN THE NEXT AND THEN 1967 01:23:26,560 --> 01:23:26,840 SMALLEST. 1968 01:23:26,840 --> 01:23:27,880 I WANTED TO JUST LOOK JUST AT 1969 01:23:27,880 --> 01:23:29,880 THE BIG HOSPITALS DOING 1970 01:23:29,880 --> 01:23:31,600 STILLBIRTH CARE BUT SMALL 1971 01:23:31,600 --> 01:23:33,120 HOSPITALS WHERE YOU STILL HAVE 1972 01:23:33,120 --> 01:23:40,040 MOMS DELIVER THE BABIES. 1973 01:23:40,040 --> 01:23:42,800 WE REACHED OUT TO A BEREAVEMENT 1974 01:23:42,800 --> 01:23:46,080 COORDINATOR USUALLY A NURSE AND 1975 01:23:46,080 --> 01:23:52,360 HAD A SURVEY OF QUESTIONS. 1976 01:23:52,360 --> 01:23:56,200 WE ASKED AND SAID WHICH TOPICS 1977 01:23:56,200 --> 01:23:59,320 ARE ROUTINELY DISCUSSED BEFORE 1978 01:23:59,320 --> 01:24:00,880 THEY GO HOME, 90% OF PEOPLE 1979 01:24:00,880 --> 01:24:02,280 TALKED ABOUT OPTIONS FOR A 1980 01:24:02,280 --> 01:24:03,400 FUNERAL AND MEMORIAL. 1981 01:24:03,400 --> 01:24:05,760 THAT FITS THE DATA JOANNE SHOWED 1982 01:24:05,760 --> 01:24:07,080 YOU. 1983 01:24:07,080 --> 01:24:10,160 75% TALKED ABOUT NORMAL GRIEVING 1984 01:24:10,160 --> 01:24:11,600 AND AT A QUARTER OF HOSPITALS 1985 01:24:11,600 --> 01:24:17,160 ARE THEY NOT TALKING TO PARENTS 1986 01:24:17,160 --> 01:24:18,560 ABOUT WHAT TO EXPECT AND WHO TO 1987 01:24:18,560 --> 01:24:20,160 CONTACT FOR FOLLOW-UP AND A 1988 01:24:20,160 --> 01:24:22,080 THIRD OF HOSPITAL PARENTS ARE 1989 01:24:22,080 --> 01:24:25,400 NOT ROUTINELY GIVEN THE NAME OF 1990 01:24:25,400 --> 01:24:25,720 FOR FOLLOW-UP. 1991 01:24:25,720 --> 01:24:27,400 ONLY HALF TALK ABOUT THE IMPACT 1992 01:24:27,400 --> 01:24:29,720 OF LOSS ON DAD. 1993 01:24:29,720 --> 01:24:30,840 ONLY HALF TALK ABOUT INTERNET 1994 01:24:30,840 --> 01:24:32,240 SUPPORT OPTIONS AND LESS THAN 1995 01:24:32,240 --> 01:24:35,280 HALF ARE TALKING ABOUT THE 1996 01:24:35,280 --> 01:24:37,120 INCREASED RISKS FOR MENTAL 1997 01:24:37,120 --> 01:24:39,120 HEALTH PROBLEMS OR SUBSTANCE 1998 01:24:39,120 --> 01:24:39,280 USE. 1999 01:24:39,280 --> 01:24:40,160 THESE ARE CONCERNING NUMBERS FOR 2000 01:24:40,160 --> 01:24:47,720 ME. 2001 01:24:47,720 --> 01:24:50,160 THE OTHER ISSUE IS BEREAVEMENT 2002 01:24:50,160 --> 01:24:51,920 TRAINING AND I'M GLAD HRSA IS ON 2003 01:24:51,920 --> 01:24:56,120 THE CALL BECAUSE IT'S ESSENTIAL. 2004 01:24:56,120 --> 01:24:59,800 I DID A STUDY OF OBSTETRICIANS 2005 01:24:59,800 --> 01:25:03,920 AND WANTED TO KNOW THE EMOTIONAL 2006 01:25:03,920 --> 01:25:05,760 IMPACT OF DELIVERING A 2007 01:25:05,760 --> 01:25:08,120 STILLBIRTH AND WHERE THERE'S 2008 01:25:08,120 --> 01:25:09,720 KNOWN CAUSE OF DEATH HOW OFTEN 2009 01:25:09,720 --> 01:25:11,800 DID YOU FEEL GUILTY. 2010 01:25:11,800 --> 01:25:13,320 NOT WHERE WE THOUGHT THE 2011 01:25:13,320 --> 01:25:15,080 PHYSICIAN HAD SOMETHING TO DO 2012 01:25:15,080 --> 01:25:17,160 WITH THE DEATH OR BLAME YOURSELF 2013 01:25:17,160 --> 01:25:20,000 AND A THIRD BLAMED THEMSELVES. 2014 01:25:20,000 --> 01:25:23,760 I ASKED HOW OFTEN DID YOU WORRY 2015 01:25:23,760 --> 01:25:24,880 ABOUT DISCIPLINARY OR LEGAL 2016 01:25:24,880 --> 01:25:26,640 ACTION AND 43% WORRIED ABOUT 2017 01:25:26,640 --> 01:25:27,320 THIS. 2018 01:25:27,320 --> 01:25:31,720 THIS IS NOT FANTASTICAL 2019 01:25:31,720 --> 01:25:32,040 THINKING. 2020 01:25:32,040 --> 01:25:34,680 AFTER POOR NEUROLOGICAL OUTCOME 2021 01:25:34,680 --> 01:25:35,440 STILLBIRTH IS THE SECOND LEADING 2022 01:25:35,440 --> 01:25:38,600 CAUSE OF LAWSUITS AGAINST 2023 01:25:38,600 --> 01:25:39,040 OBSTETRICIANS. 2024 01:25:39,040 --> 01:25:41,280 STILLBIRTHS ARE EMOTIONALLY 2025 01:25:41,280 --> 01:25:42,680 DIFFICULT FOR PHYSICIANS AND 2026 01:25:42,680 --> 01:25:48,040 BRINGS UP LOTS OF LEGAL ISSUES 2027 01:25:48,040 --> 01:25:53,520 AND FEARS AND PHYSICIANS CARRY 2028 01:25:53,520 --> 01:25:54,680 AROUND A LOT OF GUILT ABOUT 2029 01:25:54,680 --> 01:25:55,960 STILLBIRTH EVEN WHEN THERE WAS 2030 01:25:55,960 --> 01:25:58,360 NOTHING THEY COULD PREVENT. 2031 01:25:58,360 --> 01:26:00,760 WE ASKED DID YOU GET TRAINING ON 2032 01:26:00,760 --> 01:26:05,120 HOW TO COPE WITH THIS AND HALF 2033 01:26:05,120 --> 01:26:06,840 SAID YES AND ABOUT WHAT 2034 01:26:06,840 --> 01:26:08,240 COLLEAGUES DO THEY HAVE ADEQUATE 2035 01:26:08,240 --> 01:26:08,520 TRAINING. 2036 01:26:08,520 --> 01:26:10,200 THEY WERE LESS LIKELY TO THINK 2037 01:26:10,200 --> 01:26:12,120 THE PEOPLE THEY'LL WORKED WITH 2038 01:26:12,120 --> 01:26:14,240 HAD ADEQUATE TRAINING TO DEAL 2039 01:26:14,240 --> 01:26:20,160 WITH THE EMOTIONAL JIM -- 2040 01:26:20,160 --> 01:26:30,560 IMPACT OF THE LOSSES. 2041 01:26:31,640 --> 01:26:35,800 THEY SAID 43% OF HOSPITALS 2042 01:26:35,800 --> 01:26:38,800 REQUIRED TRAINING ON LOSS AND 2043 01:26:38,800 --> 01:26:40,000 HALF SAID BEREAVEMENT TRAINING 2044 01:26:40,000 --> 01:26:41,800 WAS REQUIRED FOR LABOR AND 2045 01:26:41,800 --> 01:26:45,640 DELIVERY NURSES AND 14% SAID IT 2046 01:26:45,640 --> 01:26:47,640 WAS REQUIRED FOR PHYSICIANS. 2047 01:26:47,640 --> 01:26:49,680 THIS IS A BIG GAP IN OUR 2048 01:26:49,680 --> 01:26:52,160 RESEARCH AND CLINICAL CARE WE 2049 01:26:52,160 --> 01:27:02,440 NEED TO ADDRESS. 2050 01:27:06,760 --> 01:27:07,560 MOST THE RESEARCH IS DESCRIPTIVE 2051 01:27:07,560 --> 01:27:12,600 AND QUALITATIVE. 2052 01:27:12,600 --> 01:27:17,800 I DID MY OWN SYSTEMATIC HAVE A 2053 01:27:17,800 --> 01:27:18,600 FOR BEREAVEMENT CARE AFTER 2054 01:27:18,600 --> 01:27:20,200 STILLBIRTH AND I FOUND I THINK 2055 01:27:20,200 --> 01:27:20,560 SEVEN. 2056 01:27:20,560 --> 01:27:22,680 NOT ALL ARE IN THE U.S. 2057 01:27:22,680 --> 01:27:27,720 THIS IS OVER A 30-YEAR PERIOD. 2058 01:27:27,720 --> 01:27:28,560 MOST ARE SMALL. 2059 01:27:28,560 --> 01:27:31,120 ONLY A FEW LOOK AT MENTAL HEALTH 2060 01:27:31,120 --> 01:27:31,480 SPECIFICALLY. 2061 01:27:31,480 --> 01:27:35,760 MOST LOOK AT PHYSICAL SYMPTOMS 2062 01:27:35,760 --> 01:27:37,800 OR MENTAL GRIEF SYMPTOMS. 2063 01:27:37,800 --> 01:27:45,160 ONE HAS NOT EVEN STARTED. 2064 01:27:45,160 --> 01:27:47,600 WHO IS MISSING? 2065 01:27:47,600 --> 01:27:49,000 BLACK WOMEN AND ETHNIC 2066 01:27:49,000 --> 01:27:50,360 MINORITIES BUT TO ME THE BLACK 2067 01:27:50,360 --> 01:27:52,960 WOMEN ARE THE KEY AREA BECAUSE 2068 01:27:52,960 --> 01:27:54,280 THESE ARE AT HIGHEST RISK OF THE 2069 01:27:54,280 --> 01:27:58,760 BAD OUTCOME. 2070 01:27:58,760 --> 01:28:02,080 WHEN I DID MY 5-SECOND PUB MED 2071 01:28:02,080 --> 01:28:05,120 SEARCH I FOUND 20 ARTICLES IN 2072 01:28:05,120 --> 01:28:08,040 THE LAST YEARS AND 14 ARTICLES 2073 01:28:08,040 --> 01:28:10,120 FOCUSSING ON AFRICAN AMERICAN 2074 01:28:10,120 --> 01:28:12,640 WOMEN AND GRIEF FROM STILLBIRTH 2075 01:28:12,640 --> 01:28:17,120 AND OUTCOMES. 2076 01:28:17,120 --> 01:28:18,360 AND IT'S IMPORTANT TO REMEMBER 2077 01:28:18,360 --> 01:28:20,640 HOW WE RECRUIT FAMILIES IS 2078 01:28:20,640 --> 01:28:22,000 REALLY IMPORTANT. 2079 01:28:22,000 --> 01:28:23,800 MOST OF THE WORK THAT'S OUT 2080 01:28:23,800 --> 01:28:25,200 THERE MOST THE STUDIES HAVE 2081 01:28:25,200 --> 01:28:32,120 RECRUIT FROM SUPPORT GROUPS. 2082 01:28:32,120 --> 01:28:38,520 WE ARE MOSTLY SURVEYING WHITE 2083 01:28:38,520 --> 01:28:39,720 AND UPPER MIDDLE-CLASS WOMEN AND 2084 01:28:39,720 --> 01:28:43,360 WE HAVE SMALL SAMPLE SIZES AND 2085 01:28:43,360 --> 01:28:45,960 WE'RE NOT MEASURING CONFOUNDERS 2086 01:28:45,960 --> 01:28:47,840 WHICH MIGHT AFFECT OUTCOMES. 2087 01:28:47,840 --> 01:28:50,720 IT MAY NOT JUST BE THE LOSS 2088 01:28:50,720 --> 01:28:51,800 THERE MAY BE OTHER THINGS WE 2089 01:28:51,800 --> 01:28:53,800 NEED TO STUDY. 2090 01:28:53,800 --> 01:29:03,080 WHEN WE PULL FROM SUPPORT GROUPS 2091 01:29:03,080 --> 01:29:07,120 I'VE DONE WORK AND WOMEN IN BOTH 2092 01:29:07,120 --> 01:29:09,160 SUPPORT GROUPS TEND TO BE WHITE, 2093 01:29:09,160 --> 01:29:10,720 WELL EDUCATED AND 42% OF BIRTHS 2094 01:29:10,720 --> 01:29:12,880 ARE ON PUBLIC INSURANCE, FEW 2095 01:29:12,880 --> 01:29:13,920 WERE IN THESE SUPPORT GROUPS ARE 2096 01:29:13,920 --> 01:29:18,400 WOMEN WHO HAD PUBLIC INSURANCE. 2097 01:29:18,400 --> 01:29:20,920 WHILE IT'S A CONVENIENT WAY TO 2098 01:29:20,920 --> 01:29:24,480 GET FAMILIES TO TALK ABOUT THEIR 2099 01:29:24,480 --> 01:29:25,520 EXPERIENCES IT'S NOT 2100 01:29:25,520 --> 01:29:26,400 REPRESENTATIVE OF THE FAMILIES 2101 01:29:26,400 --> 01:29:35,320 EXPERIENCES THE LOSSES. 2102 01:29:35,320 --> 01:29:38,680 WHEN I LOOK AT THE MOM WHO'S 2103 01:29:38,680 --> 01:29:40,000 PREGNANT WE WORK IN A RESEARCH 2104 01:29:40,000 --> 01:29:41,680 COMMUNITY WHERE WE SEGMENT HER. 2105 01:29:41,680 --> 01:29:44,240 WE HAVE THE PEOPLE LOOKING AT 2106 01:29:44,240 --> 01:29:47,320 MATERNAL DEATH AND LOOKING AT 2107 01:29:47,320 --> 01:29:51,160 INFANT DEATH AND LOOKING AT 2108 01:29:51,160 --> 01:29:51,920 STILLBIRTH. 2109 01:29:51,920 --> 01:29:53,680 IF WE THOUGHT HOW WE COULD GROUP 2110 01:29:53,680 --> 01:29:55,800 OUTCOMES WE COULD HAVE STRONGER 2111 01:29:55,800 --> 01:30:01,600 STUDIES WITH GREATER POWER. 2112 01:30:01,600 --> 01:30:04,480 AND WE LOOKED AT STUDIES THAT 2113 01:30:04,480 --> 01:30:06,280 MAYBE DIDN'T SEEK TO FOCUS ON 2114 01:30:06,280 --> 01:30:08,200 STILLBIRTH BUT STILL COLLECTED 2115 01:30:08,200 --> 01:30:09,280 DATA THAT WAS RELEVANT. 2116 01:30:09,280 --> 01:30:11,080 WE NEED TO THINK OF EXPANDING 2117 01:30:11,080 --> 01:30:16,160 OUR COHORTS TO COMBINE ALL THE 2118 01:30:16,160 --> 01:30:17,760 CAUSES OF DEATH. 2119 01:30:17,760 --> 01:30:20,120 WOMEN DIE IN CHILD BIRTH FOR THE 2120 01:30:20,120 --> 01:30:22,520 SAME REASONS INFANTS DIE AFTER 2121 01:30:22,520 --> 01:30:24,160 BIRTH OR THE SAME REASONS BABIES 2122 01:30:24,160 --> 01:30:25,400 DIE AFTER THEIR BORN AND NEED TO 2123 01:30:25,400 --> 01:30:30,840 LOOK AT HOW WE LOOK AT ALL THREE 2124 01:30:30,840 --> 01:30:32,320 GROUPS AT THE SAME TIME. 2125 01:30:32,320 --> 01:30:37,160 I WANT TO THINK ABOUT RETHINKING 2126 01:30:37,160 --> 01:30:38,360 OUR BEREAVEMENT COHORTS AND LOSS 2127 01:30:38,360 --> 01:30:40,840 IS A CONTINUUM AND CAN HAPPEN 2128 01:30:40,840 --> 01:30:45,880 FROM THE FIRST TRIMESTER UP 2129 01:30:45,880 --> 01:30:49,400 THROUGH THE FIRST YEAR OF LIFE. 2130 01:30:49,400 --> 01:30:51,520 FROM THE RESEARCH IT LOOKS LIKE 2131 01:30:51,520 --> 01:30:53,960 FAMILIES IN THE AREAS IN BLUE 2132 01:30:53,960 --> 01:30:55,720 HERE HAVE SIMILAR GRIEF 2133 01:30:55,720 --> 01:30:56,280 OUTCOMES. 2134 01:30:56,280 --> 01:30:59,760 SIMILAR MENTAL HEALTH OUTCOMES. 2135 01:30:59,760 --> 01:31:03,560 THEY'RE NOT EXACTLY THE SAME BUT 2136 01:31:03,560 --> 01:31:05,360 VERY SIMILAR. 2137 01:31:05,360 --> 01:31:08,200 WOMEN WITH EARLY MISCARRIAGES DO 2138 01:31:08,200 --> 01:31:11,360 BETTER LONG TERM AND THOSE WHO 2139 01:31:11,360 --> 01:31:13,640 HAVE LIKE A SIDES DEATH HAVE A 2140 01:31:13,640 --> 01:31:15,000 DIFFERENT TRAJECTORY BUT IT'S 2141 01:31:15,000 --> 01:31:16,120 LARGER THAN JUST STILLBIRTH 2142 01:31:16,120 --> 01:31:16,560 LOSS. 2143 01:31:16,560 --> 01:31:18,560 IF YOU LOSE A BABY AT 18 WEEKS 2144 01:31:18,560 --> 01:31:20,600 YOU'RE EXPERIENCE IS NOT THAT 2145 01:31:20,600 --> 01:31:22,280 DIFFERENT FROM A MOM WHO LOSES A 2146 01:31:22,280 --> 01:31:24,120 BABY AT 22 WEEKS. 2147 01:31:24,120 --> 01:31:25,520 I THINK IT'S IMPORTANT WE THINK 2148 01:31:25,520 --> 01:31:27,240 OF WAYS TO EXPAND OUR COHORTS. 2149 01:31:27,240 --> 01:31:29,320 AND FINALLY I WANT TO MAKE A 2150 01:31:29,320 --> 01:31:31,960 COMMENT ON FUNDING. 2151 01:31:31,960 --> 01:31:33,880 I APPRECIATED THE RESEARCH AND 2152 01:31:33,880 --> 01:31:35,680 THE PRESENTATION ABOUT NIH 2153 01:31:35,680 --> 01:31:36,200 FUNDING. 2154 01:31:36,200 --> 01:31:38,960 MY CONVERSATIONS HAVE BEEN 2155 01:31:38,960 --> 01:31:39,880 REALLY FRUSTRATING AT TIMES WITH 2156 01:31:39,880 --> 01:31:41,320 NIH BECAUSE I COME TO NICHD AND 2157 01:31:41,320 --> 01:31:45,280 I SAY I WANT TO DO A STUDY ON 2158 01:31:45,280 --> 01:31:46,360 MENTAL HEALTH AFTER STILLBIRTH 2159 01:31:46,360 --> 01:31:48,880 AND THEY SAY, WELL, WE DON'T 2160 01:31:48,880 --> 01:31:50,680 FUNDAMENTAL HEALTH YOU WANT TO 2161 01:31:50,680 --> 01:31:54,520 GO TO NIMH AND THEY SAY WE DON'T 2162 01:31:54,520 --> 01:31:55,280 FUND BEREAVEMENT. 2163 01:31:55,280 --> 01:31:56,720 YOU OUGHT TO GO TO THE NURSING 2164 01:31:56,720 --> 01:31:57,880 INSTITUTE AND I GO THERE AND 2165 01:31:57,880 --> 01:32:02,560 THEY SAY, OOH, WE FUND INFANT 2166 01:32:02,560 --> 01:32:03,560 DEATH BUT NOT STILLBIRTH SO YOU 2167 01:32:03,560 --> 01:32:04,560 HAVE TO GO TO NICHD. 2168 01:32:04,560 --> 01:32:06,200 AGAIN, WE NEED TO THINK IN OUR 2169 01:32:06,200 --> 01:32:09,800 RESEARCH STUDIES HOW WE'RE BEING 2170 01:32:09,800 --> 01:32:10,680 MORE INCLUSIVE AND ALWAYS 2171 01:32:10,680 --> 01:32:12,080 INCLUDING STILLBIRTH AND INFANT 2172 01:32:12,080 --> 01:32:14,640 DEATH AND MATERNAL MORTALITY AS 2173 01:32:14,640 --> 01:32:15,920 IMPORTANT OUTCOMES WITH RELATED 2174 01:32:15,920 --> 01:32:16,200 CAUSES. 2175 01:32:16,200 --> 01:32:20,000 I THINK TO DO THAT WE NEED TO 2176 01:32:20,000 --> 01:32:22,920 THINK ABOUT HOW WE QUANTIFY THE 2177 01:32:22,920 --> 01:32:24,440 COST OF STILLBIRTH. 2178 01:32:24,440 --> 01:32:34,120 WITH BABY'S IN THE NICU SOMEONE 2179 01:32:34,120 --> 01:32:36,560 NEEDS TO SAY WE NEED TO PREVENT 2180 01:32:36,560 --> 01:32:39,200 THIS BUT THERE'S COSTS NOT WELL 2181 01:32:39,200 --> 01:32:40,160 MEASURED, COSTS FOR MENTAL 2182 01:32:40,160 --> 01:32:44,520 HEALTH AND LOSS OF WORK AND 2183 01:32:44,520 --> 01:32:47,800 PRODUCTIVITY AND HEALTH CARE 2184 01:32:47,800 --> 01:32:49,760 COSTS LOST AND WE NEED TO PUT A 2185 01:32:49,760 --> 01:32:52,120 PRICE TAG ON THE COST OF FAMILY 2186 01:32:52,120 --> 01:32:54,520 AND SOCIETY WHEN A BABY DIES NOT 2187 01:32:54,520 --> 01:32:56,280 JUST AFTER IT'S BORN BUT BEFORE 2188 01:32:56,280 --> 01:32:57,080 IT'S BORN. 2189 01:32:57,080 --> 01:33:07,560 I'LL STOP THERE, THANK YOU. 2190 01:33:09,120 --> 01:33:12,400 >>THANK YOU, DR. GOLD ANOTHER 2191 01:33:12,400 --> 01:33:16,200 VERY POWERFUL PRESENTATION. 2192 01:33:16,200 --> 01:33:20,200 AGAIN, IT'S A WONDERFUL STUDY 2193 01:33:20,200 --> 01:33:23,120 AND LOOKING HOW WE CAN BE BETTER 2194 01:33:23,120 --> 01:33:26,280 PREPARED AS A PHYSICIAN AND 2195 01:33:26,280 --> 01:33:31,160 HOSPITAL AND NICHD. 2196 01:33:31,160 --> 01:33:39,040 THANK YOU VERY MUCH I HOPE YOU 2197 01:33:39,040 --> 01:33:40,160 CAN STAY FOR THE PANEL BECAUSE 2198 01:33:40,160 --> 01:33:49,960 WE HAVE QUESTIONS COMING IN. 2199 01:33:49,960 --> 01:33:51,400 I APPRECIATE YOU SHARING THIS 2200 01:33:51,400 --> 01:33:56,000 WITH US. 2201 01:33:56,000 --> 01:34:03,000 THE NEXT PRESENTATION IS FROM 2202 01:34:03,000 --> 01:34:05,360 DR. JOANNE STONE THE PRESIDENT 2203 01:34:05,360 --> 01:34:08,160 OF THE SOCIETY FOR MATERNAL 2204 01:34:08,160 --> 01:34:09,360 FETAL MEDICINE. 2205 01:34:09,360 --> 01:34:17,120 THE CHAIR OF THE RA QUELL 2206 01:34:17,120 --> 01:34:21,680 ANDHAMMEE GILLINSKI DEPARTMENT 2207 01:34:21,680 --> 01:34:24,200 OF OBSTETRICS GYNECOLOGY AND 2208 01:34:24,200 --> 01:34:26,040 TALK ABOUT THE RAINBOW CLINIC. 2209 01:34:26,040 --> 01:34:27,720 THANK YOU FOR ACCEPTING THE 2210 01:34:27,720 --> 01:34:28,000 INVITATION. 2211 01:34:28,000 --> 01:34:29,840 >>THANK YOU FOR INVITING ME TO 2212 01:34:29,840 --> 01:34:34,760 SPEAK ABOUT THIS. 2213 01:34:34,760 --> 01:34:37,120 I WANT TO TALK ABOUT HOW WE 2214 01:34:37,120 --> 01:34:37,880 STARTED THIS AND THE CURRENT 2215 01:34:37,880 --> 01:34:48,280 STATUS OF WHERE WE ARE. 2216 01:34:57,720 --> 01:35:02,240 YOU KNOW THE STATISTICS AND IN 2217 01:35:02,240 --> 01:35:02,920 NEW YORK CITY IT'S ABOUT 700 2218 01:35:02,920 --> 01:35:13,360 STILLBIRTHS IN EACH YEAR. 2219 01:35:13,360 --> 01:35:17,520 THESE THE RISK FACTORS PA THAT 2220 01:35:17,520 --> 01:35:20,440 PUT PATIENTS AT HIGHER RISK AND 2221 01:35:20,440 --> 01:35:23,080 SMOKING, MEDICAL CONDITIONS, 2222 01:35:23,080 --> 01:35:25,000 MULTIPLE GESTATIONS AND A PRIOR 2223 01:35:25,000 --> 01:35:30,720 PREGNANCY OR LOSS OR STILLBIRTH. 2224 01:35:30,720 --> 01:35:39,120 THAT'S THE REAL MOTIVATION IN 2225 01:35:39,120 --> 01:35:42,240 TRYING TO PREVENT ANY 2226 01:35:42,240 --> 01:35:47,680 PREVENTABLE STILLBIRTHS. 2227 01:35:47,680 --> 01:35:53,440 THIS IS SHOWING THE RATE BY RACE 2228 01:35:53,440 --> 01:35:54,800 AND ETHNICITY AND IN NEW YORK 2229 01:35:54,800 --> 01:35:56,600 CITY IT'S A DIVERSE PATIENT 2230 01:35:56,600 --> 01:35:56,920 POPULATION. 2231 01:35:56,920 --> 01:35:59,080 WE HAVE A LOT OF PATIENTS THAT 2232 01:35:59,080 --> 01:35:59,760 ARE AT THE HIGHER RISK FOR 2233 01:35:59,760 --> 01:36:07,640 STILLBIRTH. 2234 01:36:07,640 --> 01:36:09,800 THIS ALSO SHOWS THE INCREASED 2235 01:36:09,800 --> 01:36:12,960 RISK OF STILLBIRTH BY MATERNAL 2236 01:36:12,960 --> 01:36:13,240 AGE. 2237 01:36:13,240 --> 01:36:18,840 NEW YORK IS LIKE MANY OF THE 2238 01:36:18,840 --> 01:36:25,840 LOWER CITIES AND IT PUTS THEM AT 2239 01:36:25,840 --> 01:36:27,920 A HIGHER RISK MAKING OUR 2240 01:36:27,920 --> 01:36:29,760 POPULATION CERTAINLY A LITTLE 2241 01:36:29,760 --> 01:36:35,160 BIT UNIQUE. 2242 01:36:35,160 --> 01:36:36,920 THIS IS SHOWING STILLBIRTH RATE 2243 01:36:36,920 --> 01:36:37,640 OVER TIME. 2244 01:36:37,640 --> 01:36:38,840 WHILE THERE'S SOME CHANGE THAT 2245 01:36:38,840 --> 01:36:40,200 HAVE OCCURRED YOU CAN SEE HOW 2246 01:36:40,200 --> 01:36:45,600 FLAT IT IS. 2247 01:36:45,600 --> 01:36:47,640 TRYING TO DO WHATEVER WE CAN TO 2248 01:36:47,640 --> 01:36:49,880 REDUCE THE STILLBIRTH RATE IS 2249 01:36:49,880 --> 01:36:52,160 WHAT WE'RE ALL HERE FOR AND PLAN 2250 01:36:52,160 --> 01:37:00,520 TO HIGHLIGHT THAT. 2251 01:37:00,520 --> 01:37:05,360 THE GOAL IS TO SUPPORT WOMEN AND 2252 01:37:05,360 --> 01:37:06,640 FAMILIES THROUGHOUT THEIR 2253 01:37:06,640 --> 01:37:10,400 DIFFICULT JOURNEY ON A FUTURE 2254 01:37:10,400 --> 01:37:12,200 PREGNANCY WITH ENHANCED CLINICAL 2255 01:37:12,200 --> 01:37:14,840 CARE AND SUPPORT AN REDUCE 2256 01:37:14,840 --> 01:37:17,440 ANXIETY FOR FAMILIES AND 2257 01:37:17,440 --> 01:37:18,640 DECREASE THE HIGH RISK FOR THE 2258 01:37:18,640 --> 01:37:25,280 NEXT PREGNANCY. 2259 01:37:25,280 --> 01:37:27,160 IT STARTED AND WE'VE BEEN TAKING 2260 01:37:27,160 --> 01:37:29,720 CARE OF PATIENTS MY ENTIRE 2261 01:37:29,720 --> 01:37:34,320 CAREER WHO HAD A STILLBIRTH BUT 2262 01:37:34,320 --> 01:37:37,560 SEVERAL OF THE PATIENTS CAME 2263 01:37:37,560 --> 01:37:39,360 TOGETHER AND GOT INVOLVED WITH 2264 01:37:39,360 --> 01:37:40,520 AN ORGANIZATION WHICH I'LL 2265 01:37:40,520 --> 01:37:45,920 MENTION LATER AND REALLY WANTED 2266 01:37:45,920 --> 01:37:52,200 TO CREATE A MODEL AFTER THE 2267 01:37:52,200 --> 01:37:54,200 RAINBOW CLINICS IN THE U.K. 2268 01:37:54,200 --> 01:37:59,800 A RAINBOW BABY IS A BABY YOU 2269 01:37:59,800 --> 01:38:04,160 CARRY AFTER HAVING SUFFERED A 2270 01:38:04,160 --> 01:38:09,120 STILLBIRTH IN THE PAST. 2271 01:38:09,120 --> 01:38:13,280 WHEN THIS ALL STARTED WE HAD 2272 01:38:13,280 --> 01:38:17,800 SEVERAL CONVERSATIONS ABOUT HOW 2273 01:38:17,800 --> 01:38:22,960 WE CKCAN MODEL OUR RAINBOW CLIN 2274 01:38:22,960 --> 01:38:24,640 AFTER THEIRS AND HAVE A SHARED 2275 01:38:24,640 --> 01:38:34,480 IRB TO COLLECT DATA ON OUTCOMES. 2276 01:38:34,480 --> 01:38:36,240 IT PATIENTS WHO HAVE HAD A 2277 01:38:36,240 --> 01:38:39,920 STILLBIRTH THE NEXT PREGNANCY 2278 01:38:39,920 --> 01:38:41,760 THEY'RE AT THIS HEIGHTENED LEVEL 2279 01:38:41,760 --> 01:38:43,920 OF ANXIETY THAT JUST NEEDS 2280 01:38:43,920 --> 01:38:47,760 REALLY SPECIAL ATTENTION. 2281 01:38:47,760 --> 01:38:52,960 WE MEET THEIR NEEDS BY PROVIDING 2282 01:38:52,960 --> 01:38:53,800 APPOINTMENTS AND TECHNOLOGY 2283 01:38:53,800 --> 01:38:56,080 SURVEILLANCE BY ULTRASOUND 2284 01:38:56,080 --> 01:38:59,800 NON-STRESS TESTS AND PROFILES. 2285 01:38:59,800 --> 01:39:08,160 WHATEVER THEY NEED. 2286 01:39:08,160 --> 01:39:09,960 THE PROVIDERS AND STAFF ARE 2287 01:39:09,960 --> 01:39:11,760 TRAINED AND THERE'S SO MANY 2288 01:39:11,760 --> 01:39:15,560 THINGS THAT CAN BE TRIGGERS. 2289 01:39:15,560 --> 01:39:17,640 FOR EXAMPLE, IT'S COMMON TO WALK 2290 01:39:17,640 --> 01:39:20,160 INTO A ROOM AND ULTRA SOUND ROOM 2291 01:39:20,160 --> 01:39:23,080 AND SAY IS THIS YOUR FIRST 2292 01:39:23,080 --> 01:39:24,200 PREGNANCY AND THAT'S SO 2293 01:39:24,200 --> 01:39:24,960 TRIGGERING BECAUSE THEY DON'T 2294 01:39:24,960 --> 01:39:28,160 KNOW HOW TO BEGIN TO ANSWER THAT 2295 01:39:28,160 --> 01:39:29,600 QUESTION. 2296 01:39:29,600 --> 01:39:34,440 OR IF THEY'RE SCHEDULING WEEKLY 2297 01:39:34,440 --> 01:39:36,480 APPOINTMENTS FOR SURVEILLANCE, 2298 01:39:36,480 --> 01:39:38,120 HAVING THE FRONT DESK WHO 2299 01:39:38,120 --> 01:39:38,840 SCHEDULED THE APPOINTMENT SAYING 2300 01:39:38,840 --> 01:39:40,440 WHY DO YOU NEED SO MANY 2301 01:39:40,440 --> 01:39:42,960 APPOINTMENTS AND THINGS LIKE 2302 01:39:42,960 --> 01:39:43,200 THAT. 2303 01:39:43,200 --> 01:39:45,600 THESE ARE ALL THE THINGS THAT 2304 01:39:45,600 --> 01:39:49,480 PEOPLE DON'T REALLY REALIZE CAN 2305 01:39:49,480 --> 01:39:51,840 BE QUITE ANXIETY PROVOKING FOR 2306 01:39:51,840 --> 01:39:56,920 THE PATIENTS IN ADDITION, WE 2307 01:39:56,920 --> 01:40:00,600 HAVE SOCIAL WORK SUPPORT WHO 2308 01:40:00,600 --> 01:40:06,880 FOLLOWED THEM AND HAVE 2309 01:40:06,880 --> 01:40:11,520 NUTRITIONAL SUPPORT AND THERE'S 2310 01:40:11,520 --> 01:40:12,640 A COMPREHENSIVE APPROACH FOR 2311 01:40:12,640 --> 01:40:17,400 CARRYING FOR THE PATIENTS. 2312 01:40:17,400 --> 01:40:19,680 THIS THE ROAD MAP WE HAD WHERE 2313 01:40:19,680 --> 01:40:21,600 WE STARTED OFF BUILDING THE 2314 01:40:21,600 --> 01:40:22,160 RAINBOW CLINIC. 2315 01:40:22,160 --> 01:40:25,080 IF YOU JUST HIT ENTER, SOMETHING 2316 01:40:25,080 --> 01:40:26,200 WILL POP UP. 2317 01:40:26,200 --> 01:40:29,640 THIS STARTED FEBRUARY 1, 2021 WE 2318 01:40:29,640 --> 01:40:31,520 HAD A MEETING TO TALK ABOUT HOW 2319 01:40:31,520 --> 01:40:34,160 WE CAN DO THIS WHERE IT WILL BE 2320 01:40:34,160 --> 01:40:40,200 AND HOW WE CAN AFFECT THE 2321 01:40:40,200 --> 01:40:50,720 TRAINING AND WE CAME UP WITH THE 2322 01:40:53,160 --> 01:41:00,560 PROPOSAL THE NEXT DAY MARCH AND 2323 01:41:00,560 --> 01:41:02,640 APRIL WE MET WITH THE 2324 01:41:02,640 --> 01:41:03,880 ADMINISTRATIVE LEADERSHIP TO 2325 01:41:03,880 --> 01:41:05,440 PROPOSE THIS AND DISCUSS THE 2326 01:41:05,440 --> 01:41:08,320 LOGISTICS BEHIND THIS AND HOW IT 2327 01:41:08,320 --> 01:41:12,200 CAN BE SUPPORTED. 2328 01:41:12,200 --> 01:41:15,240 AND WE FORMALIZED THE STRATEGY 2329 01:41:15,240 --> 01:41:16,160 AND IDENTIFIED A FUNDING SOURCE 2330 01:41:16,160 --> 01:41:19,760 FOR THIS. 2331 01:41:19,760 --> 01:41:23,800 THE IDEA IS IT WAS OPEN TO 2332 01:41:23,800 --> 01:41:31,440 ANYBODY WHETHER THEY WERE 2333 01:41:31,440 --> 01:41:33,080 INSURANCE IT DIDN'T MATTER. 2334 01:41:33,080 --> 01:41:36,520 THIS GIVES AN EXAMPLE OF OUR 2335 01:41:36,520 --> 01:41:37,640 FUNDING. 2336 01:41:37,640 --> 01:41:38,840 THE DIFFERENT THE REALITY BEHIND 2337 01:41:38,840 --> 01:41:41,800 STARTING THIS IS IT DOES REQUIRE 2338 01:41:41,800 --> 01:41:44,200 FUNDING SUPPORT SO FUNDING 2339 01:41:44,200 --> 01:41:46,800 SOCIAL WORKER, THE EXCLUSIVE 2340 01:41:46,800 --> 01:41:49,560 FRONT DESK SCHEDULING AND A 2341 01:41:49,560 --> 01:41:53,800 COORDINATOR COORDINATING ALL THE 2342 01:41:53,800 --> 01:41:56,560 APPOINTMENTS FOR THEM. 2343 01:41:56,560 --> 01:41:58,920 WE LOOKED AT THE PROJECTED 2344 01:41:58,920 --> 01:42:03,880 PATIENTS FOR YEAR ONE AND YEAR 2345 01:42:03,880 --> 01:42:08,280 TWO AND THREE. 2346 01:42:08,280 --> 01:42:13,920 WE HAD PATIENTS PER SESSION AND 2347 01:42:13,920 --> 01:42:17,040 THE TRUTH IS THE FIRST CONSULTS 2348 01:42:17,040 --> 01:42:19,080 TAKE -- I BLOCK OFF AN HOUR AND 2349 01:42:19,080 --> 01:42:21,440 ALWAYS RUNNING LATE BECAUSE IT 2350 01:42:21,440 --> 01:42:23,240 TAKES AN HOUR AND A HALF BY THE 2351 01:42:23,240 --> 01:42:24,400 TIME WE GO THROUGH ALL THE 2352 01:42:24,400 --> 01:42:26,840 RECORDS AND IT GIVES AN IDEA OF 2353 01:42:26,840 --> 01:42:28,560 OVERHEAD AND BILLING AND ALL THE 2354 01:42:28,560 --> 01:42:29,120 OTHER STUFF. 2355 01:42:29,120 --> 01:42:35,760 THIS WAS THE SUPPORT WE FELT WE 2356 01:42:35,760 --> 01:42:38,560 NEEDED. 2357 01:42:38,560 --> 01:42:40,360 FORTUNATELY A PUSH FOR EMPOWER 2358 01:42:40,360 --> 01:42:46,240 PREGNANCY IS A PHILANTHROPIC 2359 01:42:46,240 --> 01:42:47,440 ORGANIZATION FOCUSSED ON 2360 01:42:47,440 --> 01:42:51,120 PREVENTING STILLBIRTHS AND THEY 2361 01:42:51,120 --> 01:42:53,680 FUNDED US FOR THREE YEARS. 2362 01:42:53,680 --> 01:42:55,560 WE'RE HOPING TO BE SUSTAINABLE 2363 01:42:55,560 --> 01:42:58,200 PARTLY AFTER THIS BUT WE'LL SEE 2364 01:42:58,200 --> 01:43:01,440 HOW IT'S GOING. 2365 01:43:01,440 --> 01:43:05,720 THEY'VE BEEN INCREDIBLE IN TERMS 2366 01:43:05,720 --> 01:43:10,960 OF DEVELOPING MODULES FOR 2367 01:43:10,960 --> 01:43:15,280 TRAINING FOR THE STAFF AND SO 2368 01:43:15,280 --> 01:43:19,400 THIS IS ACTUALLY THE BUILDING 2369 01:43:19,400 --> 01:43:20,920 THAT WE WORK IN AND PRACTICES. 2370 01:43:20,920 --> 01:43:25,080 WE HAVE A MULTI-DISCIPLINARY 2371 01:43:25,080 --> 01:43:25,400 CLINIC. 2372 01:43:25,400 --> 01:43:27,640 WE HAVE MEDICINE SPECIALISTS. 2373 01:43:27,640 --> 01:43:32,080 IT'S CURRENTLY ME DOING IT BUT 2374 01:43:32,080 --> 01:43:35,280 MY COLLEAGUES AND OTHER MFMs ARE 2375 01:43:35,280 --> 01:43:38,080 STARTING TO NOW SEE RAINBOW 2376 01:43:38,080 --> 01:43:40,120 PATIENTS FOR CONSULTATION AS 2377 01:43:40,120 --> 01:43:41,800 WELL AS TAKING SEEING THEM FOR 2378 01:43:41,800 --> 01:43:43,320 THEIR OBSTETRICAL CARE. 2379 01:43:43,320 --> 01:43:45,160 THE WAY WE FUNCTION IS TYPICALLY 2380 01:43:45,160 --> 01:43:47,560 WE START WITH THE 2381 01:43:47,560 --> 01:43:48,560 PRECONCEPTIONAL CONSULTATION AND 2382 01:43:48,560 --> 01:43:51,400 IF THEY WANT TO STAY WITH US FOR 2383 01:43:51,400 --> 01:43:52,600 DELIVERY, THEY STAY WITH US BUT 2384 01:43:52,600 --> 01:43:54,360 WE ALSO KNOW THAT SOME PATIENTS 2385 01:43:54,360 --> 01:44:00,320 WANT HAVE A PLAN OF ACTION AND 2386 01:44:00,320 --> 01:44:03,560 THEN GO BACK TO THEIR OB 2387 01:44:03,560 --> 01:44:04,880 PROVIDER. 2388 01:44:04,880 --> 01:44:09,640 AGAIN, THE SOCIAL WORKER WHO 2389 01:44:09,640 --> 01:44:10,520 SPECIALIZES IN THISES 2390 01:44:10,520 --> 01:44:11,640 PSYCHOLOGICAL SUPPORT FROM THE 2391 01:44:11,640 --> 01:44:14,080 BEGINNING AND SHE HAS A LIST OF 2392 01:44:14,080 --> 01:44:15,720 THE RAINBOW CLINIC PATIENTS 2393 01:44:15,720 --> 01:44:18,480 COMING IN FOR CONSULTATION AND 2394 01:44:18,480 --> 01:44:21,080 ALSO FOR FIRST OB VISIT AND ASKS 2395 01:44:21,080 --> 01:44:23,320 IF THEY WANT TO BE FOLLOWED 2396 01:44:23,320 --> 01:44:25,400 THROUGHOUT AND SHE FOLLOWS UP 2397 01:44:25,400 --> 01:44:26,000 WITH THEM. 2398 01:44:26,000 --> 01:44:28,400 WE SOMEWHERE THEM MEET WITH A 2399 01:44:28,400 --> 01:44:29,800 NUTRITIONIST AND THE STAFF ARE 2400 01:44:29,800 --> 01:44:30,840 TRAINED AND I'LL GET INTO THAT 2401 01:44:30,840 --> 01:44:32,760 IN MORE DETAIL. 2402 01:44:32,760 --> 01:44:35,800 A CHALLENGE HAS BEEN THE -- I 2403 01:44:35,800 --> 01:44:38,360 DON'T KNOW HOW MANY HAVE EPIC OR 2404 01:44:38,360 --> 01:44:40,160 ANOTHER EMR BUT THE EPIC 2405 01:44:40,160 --> 01:44:41,680 INTERFACE TO IDENTIFY PATIENTS 2406 01:44:41,680 --> 01:44:45,760 AS PART OF THE MAYO CLINIC HAS 2407 01:44:45,760 --> 01:44:46,400 BEEN CHALLENGING. 2408 01:44:46,400 --> 01:44:50,560 WE'VE PUT IN A PROBLEM LIST AND 2409 01:44:50,560 --> 01:44:57,160 COMING UP WITH A FLAG THAT CAN 2410 01:44:57,160 --> 01:44:59,240 BE ON THERE AND WE'VE BEEN 2411 01:44:59,240 --> 01:45:00,680 WORKING FOR A YEAR AND A HALF ON 2412 01:45:00,680 --> 01:45:01,000 THIS. 2413 01:45:01,000 --> 01:45:03,680 IT'S PROBABLY BEEN THE HARDEST 2414 01:45:03,680 --> 01:45:08,880 THING TO FIGURE OUT. 2415 01:45:08,880 --> 01:45:11,800 WE WANT SOMEBODY TO BE ABLE TO 2416 01:45:11,800 --> 01:45:12,840 SEE THAT. 2417 01:45:12,840 --> 01:45:16,160 THE WAY THAT THESE PATIENTS ARE 2418 01:45:16,160 --> 01:45:21,720 APPROACHED AND THE WAY THE STAFF 2419 01:45:21,720 --> 01:45:23,120 IS IMPORTANT TO KNOW THEY'RE 2420 01:45:23,120 --> 01:45:24,080 PART OF THE RAINBOW CLINIC. 2421 01:45:24,080 --> 01:45:32,200 WE STARTED WITH THE HALF DAY 2422 01:45:32,200 --> 01:45:36,960 WEEK WE'RE SEEING PATIENTS WITH 2423 01:45:36,960 --> 01:45:39,840 CONSULTATION AND WHEN THEY GET 2424 01:45:39,840 --> 01:45:42,240 PREGNANT THEY COME FOR THEIR 2425 01:45:42,240 --> 01:45:44,880 FIRST O.B. VISIT WITH A PLAN IN 2426 01:45:44,880 --> 01:45:46,360 PLACE THEY KNOW AND THE 2427 01:45:46,360 --> 01:45:47,360 SUBSEQUENT VISITS ARE 2428 01:45:47,360 --> 01:45:49,600 INCORPORATED INTO MY SCHEDULE 2429 01:45:49,600 --> 01:45:50,920 AND SOME OF MY COLLEAGUES' 2430 01:45:50,920 --> 01:45:53,280 SCHEDULES AS WELL AND WORKING ON 2431 01:45:53,280 --> 01:45:55,120 CONNECTING THE PATIENTS FOR A 2432 01:45:55,120 --> 01:45:55,720 SUPPORT GROUP. 2433 01:45:55,720 --> 01:45:56,320 THAT HASN'T HAPPENED YET BUT 2434 01:45:56,320 --> 01:46:05,000 WE'RE WORKING ON THAT. 2435 01:46:05,000 --> 01:46:09,360 THIS IS THE CURRICULUM. 2436 01:46:09,360 --> 01:46:11,040 THEY GO THROUGH DIFFERENT 2437 01:46:11,040 --> 01:46:12,280 MODULES AND IT'S ABOUT ACTUALLY 2438 01:46:12,280 --> 01:46:17,680 THE TRAINING IS ABOUT SIX HOURS. 2439 01:46:17,680 --> 01:46:20,600 AND WE HAD EVERY ONE OF OUR 2440 01:46:20,600 --> 01:46:24,160 FRONT DESK STAFF AND BILLERS AND 2441 01:46:24,160 --> 01:46:29,600 DOCTORS AND STENOGRAPHERS, 2442 01:46:29,600 --> 01:46:32,440 ANYBODY WHO INTERACTS IN THE 2443 01:46:32,440 --> 01:46:34,680 OFFICE AND CALL CENTER DID THE 2444 01:46:34,680 --> 01:46:34,960 TRAINING. 2445 01:46:34,960 --> 01:46:40,200 MANY TOLD US THEY GOD EMOTIONAL 2446 01:46:40,200 --> 01:46:41,680 AND HAD TO STOP AFTER A LITTLE 2447 01:46:41,680 --> 01:46:43,200 WHILE AND THEN COME BACK TO IT 2448 01:46:43,200 --> 01:46:50,720 BECAUSE IT WAS SO EMOTIONAL. 2449 01:46:50,720 --> 01:46:51,880 THEY DID THE TRAINING. 2450 01:46:51,880 --> 01:46:54,040 IT'S BEEN EIGHT MONTHS AND WE'RE 2451 01:46:54,040 --> 01:46:59,720 WORKING ON REPEATING THE 2452 01:46:59,720 --> 01:47:02,680 TRAINING AGAIN TO MAKE SURE 2453 01:47:02,680 --> 01:47:07,680 STAFF THAT HADN'T BEEN TRAINED 2454 01:47:07,680 --> 01:47:13,480 ARE BEING TRAINED AND THE WHOLE 2455 01:47:13,480 --> 01:47:17,480 IDEA IS THIS COURSE CURRICULUM 2456 01:47:17,480 --> 01:47:19,280 THEY'LL MAKE FREE OF CHARGE FOR 2457 01:47:19,280 --> 01:47:23,800 ANY PLACE THAT'S STARTING A 2458 01:47:23,800 --> 01:47:33,200 RAINBOW CLINIC. 2459 01:47:33,200 --> 01:47:35,600 WE'RE GETTING TO THE WORKUP THAT 2460 01:47:35,600 --> 01:47:39,440 WAS DONE OR GROWTH RESTRICTION 2461 01:47:39,440 --> 01:47:42,680 AND WE'LL WAS THERE EFFORTS OF 2462 01:47:42,680 --> 01:47:47,640 AN ACCIDENT WITH UNDERLYING 2463 01:47:47,640 --> 01:47:49,120 MEDICAL CONDITIONS WE NEED TO 2464 01:47:49,120 --> 01:47:52,240 OPTIMIZE PRIOR TO THE NEXT 2465 01:47:52,240 --> 01:47:52,520 PREGNANCY. 2466 01:47:52,520 --> 01:47:55,600 AND ANY SMOKING CESSATION OR 2467 01:47:55,600 --> 01:47:56,040 WEIGHT REDUCTION. 2468 01:47:56,040 --> 01:47:58,120 THE WEIGHT REDUCTION IS 2469 01:47:58,120 --> 01:47:59,080 DIFFICULT BECAUSE MOST THE 2470 01:47:59,080 --> 01:48:04,040 PATIENTS WHEN THEY COME FOR A 2471 01:48:04,040 --> 01:48:05,400 CONSULT AFTER HAVING A 2472 01:48:05,400 --> 01:48:09,520 STILLBIRTH WANT TO GET PREGNANT 2473 01:48:09,520 --> 01:48:12,160 AS SOON AS POSSIBLE SO I FOUND 2474 01:48:12,160 --> 01:48:12,960 THIS TO BE CHALLENGING. 2475 01:48:12,960 --> 01:48:14,880 IT TAKES A LONG TIME TO 2476 01:48:14,880 --> 01:48:17,800 ACCOMPLISH THAT AND THEY'RE NOT 2477 01:48:17,800 --> 01:48:19,000 WILLING TO WAIT A YEAR AND A 2478 01:48:19,000 --> 01:48:21,760 HALF UNTIL THEY CAN LOSE WEIGHT. 2479 01:48:21,760 --> 01:48:28,160 AND POTENTIAL THERAPIES AS 2480 01:48:28,160 --> 01:48:33,760 APPROPRIATE. 2481 01:48:33,760 --> 01:48:35,080 AND IF THERE'S DIABETES 2482 01:48:35,080 --> 01:48:35,800 OPTIMIZATION AND THINGS LIKE 2483 01:48:35,800 --> 01:48:37,440 THAT AND TALK ABOUT MONITORING 2484 01:48:37,440 --> 01:48:39,400 OF THE PREGNANCY. 2485 01:48:39,400 --> 01:48:41,760 WE'LL USUALLY SEE THEM EVERY 2486 01:48:41,760 --> 01:48:48,160 WEEK STARTING IN 28 WEEKS FOR 2487 01:48:48,160 --> 01:48:48,760 SURVEILLANCE AND COUNSELLING OF 2488 01:48:48,760 --> 01:48:59,040 FETAL MOVEMENT. 2489 01:49:03,960 --> 01:49:06,040 WE START WITH THE 2490 01:49:06,040 --> 01:49:08,160 PRECONCEPTIONAL HISTORY AND TRY 2491 01:49:08,160 --> 01:49:11,760 TO OBTAIN THE PLACENTAL 2492 01:49:11,760 --> 01:49:21,240 PATHOLOGY. 2493 01:49:21,240 --> 01:49:23,800 ULTRASOUND VIABILITY. 2494 01:49:23,800 --> 01:49:28,760 NOT SURE WHAT THAT SAYS. 2495 01:49:28,760 --> 01:49:32,320 WE TALK ABOUT DOING GENETIC 2496 01:49:32,320 --> 01:49:37,960 TESTING BECAUSE WON'T HAVE HAD 2497 01:49:37,960 --> 01:49:40,320 GENETIC TESTING DONE ON 2498 01:49:40,320 --> 01:49:42,200 STILLBIRTHS AND TALK ABOUT IT 2499 01:49:42,200 --> 01:49:47,760 AND MOST PATIENTS SEEM TO WANT 2500 01:49:47,760 --> 01:49:52,360 THAT IT GIVES A BIT OF PIECE OF 2501 01:49:52,360 --> 01:49:53,760 MIND AND MOST PATIENTS WILL DO 2502 01:49:53,760 --> 01:49:57,160 THAT. 2503 01:49:57,160 --> 01:49:59,800 FREQUENT ULTRA SOUNDS. 2504 01:49:59,800 --> 01:50:04,160 I HAVE TO SAY A LOT OF THE 2505 01:50:04,160 --> 01:50:08,160 PATIENTS WANT TO HAVE THE 2506 01:50:08,160 --> 01:50:15,040 ESTIMATED PLACENTAL VOLUME AND 2507 01:50:15,040 --> 01:50:16,480 WE'RE COLLECTING THE DATA TO SEE 2508 01:50:16,480 --> 01:50:19,120 IF IT CORRELATES WITH THE 2509 01:50:19,120 --> 01:50:29,560 PLACENTAL VOLUME AFTER DELIVERY. 2510 01:50:29,560 --> 01:50:31,920 FREQUENT ULTRA SOUNDS AND 2511 01:50:31,920 --> 01:50:32,480 ESTIMATED PLACENTAL VOLUME 2512 01:50:32,480 --> 01:50:42,680 ASSESSMENT. 2513 01:50:43,080 --> 01:50:49,600 THEN WE PLAN FOR DELIVERY. 2514 01:50:49,600 --> 01:50:56,160 OUR RECOMMENDATION IS 39 WEEKS 2515 01:50:56,160 --> 01:51:05,200 AND I AGREE THAT WITH THE 2516 01:51:05,200 --> 01:51:06,480 RATIONALE BUT IT'S HARD FOR 2517 01:51:06,480 --> 01:51:09,240 PATIENTS TO MAKE IT TO 39 WEEKS. 2518 01:51:09,240 --> 01:51:11,440 OFTEN THERE'S AN INDICATION FOR 2519 01:51:11,440 --> 01:51:13,840 SLIGHTLY EARLIER DELIVERY. 2520 01:51:13,840 --> 01:51:17,320 WE TRY TO PUSH IT TO 39 BUT IF 2521 01:51:17,320 --> 01:51:23,760 THEIR ANXIETY LEVEL YOU HAVE TO 2522 01:51:23,760 --> 01:51:28,160 BALANCE THAT WITH WHAT IS THE 2523 01:51:28,160 --> 01:51:29,880 BEST OUTCOME FOR THE PATIENT. 2524 01:51:29,880 --> 01:51:31,280 AND SUPPORT AROUND BIRTH AND THE 2525 01:51:31,280 --> 01:51:33,360 POSTPARTUM PERIOD. 2526 01:51:33,360 --> 01:51:36,440 I WANT TO GET MORE INTO THAT IN 2527 01:51:36,440 --> 01:51:36,760 A SECOND. 2528 01:51:36,760 --> 01:51:40,160 I THINK I HAVE THAT ON A FUTURE 2529 01:51:40,160 --> 01:51:48,280 SLIDE. 2530 01:51:48,280 --> 01:51:52,160 AS THE WORD GOT OUT OF THE 2531 01:51:52,160 --> 01:51:56,680 RAINBOW CLINIC AND WHILE WE 2532 01:51:56,680 --> 01:52:02,120 DON'T PUT THEM IN OUR STUDY WE 2533 01:52:02,120 --> 01:52:03,880 TAKE CARE OF THEM. 2534 01:52:03,880 --> 01:52:06,840 THESE PATIENTS HAVE HAD 2535 01:52:06,840 --> 01:52:12,080 RECURRENT MISCARRIAGES WERE 2536 01:52:12,080 --> 01:52:13,800 DISTRAUGHT OR HAD PRETERM 2537 01:52:13,800 --> 01:52:14,320 DELIVERY. 2538 01:52:14,320 --> 01:52:23,800 THEY WANT THE SAME KIND OF PAIR 2539 01:52:23,800 --> 01:52:29,440 WHERE PEOPLE KNOW THEM AND FEEL 2540 01:52:29,440 --> 01:52:31,600 THEY HAVE EXTRA ATTENTION AND 2541 01:52:31,600 --> 01:52:33,720 THEY'LL NEED A MORE FREQUENT 2542 01:52:33,720 --> 01:52:35,760 ASSESSMENT FOR RISK OF PRETERM 2543 01:52:35,760 --> 01:52:40,160 DELIVERY WE SEE THEM IN THE 2544 01:52:40,160 --> 01:52:44,120 CLINIC AS WELL. 2545 01:52:44,120 --> 01:52:46,000 OUR PHONE NUMBER AND WE TRY TO 2546 01:52:46,000 --> 01:52:49,200 GET SOMETHING WITH RAINBOW. 2547 01:52:49,200 --> 01:52:53,800 THE BEST WE COULD DO IS 824 ARBO 2548 01:52:53,800 --> 01:53:01,160 AND THAT OUR SIGN. 2549 01:53:01,160 --> 01:53:06,120 WE HAVE OUR IRB TO TRACK OUR 2550 01:53:06,120 --> 01:53:08,120 OUTCOMES WE'LL ALSO BE ABLE TO 2551 01:53:08,120 --> 01:53:12,520 GET DATA IF IT WAS AN INDICATED 2552 01:53:12,520 --> 01:53:15,160 CAUSE FOR THE PRETERM BIRTH. 2553 01:53:15,160 --> 01:53:17,800 WE STARTED SEEING PATIENTS IN 2554 01:53:17,800 --> 01:53:19,640 APRIL 2022. 2555 01:53:19,640 --> 01:53:21,040 STARTING WITH HALF DAYS A WEEK 2556 01:53:21,040 --> 01:53:23,800 AND NOW IT'S TWO. 2557 01:53:23,800 --> 01:53:25,520 MOSTLY STARTING WITH 2558 01:53:25,520 --> 01:53:28,160 PRECONCEPTIONAL CONSULTATIONS. 2559 01:53:28,160 --> 01:53:32,080 WE'VE SEEN OVER 80 PATIENTS 2560 01:53:32,080 --> 01:53:38,320 SINCE THEM AND 40 OB APPRECIATES 2561 01:53:38,320 --> 01:53:48,800 AND THREE DELIVERIES SO FAR. 2562 01:53:54,440 --> 01:53:55,960 WE WANT TO KNOW WHAT WE'RE DOING 2563 01:53:55,960 --> 01:53:59,000 RIGHT AND WRONG AND HOW TO 2564 01:53:59,000 --> 01:53:59,360 IMPROVE. 2565 01:53:59,360 --> 01:54:00,680 WE HAVE TO ENSURE REPEAT 2566 01:54:00,680 --> 01:54:03,840 TRAINING AND I HAD A STENOGRAPHY 2567 01:54:03,840 --> 01:54:05,800 WHO RECENTLY WE'RE TRAINING HER 2568 01:54:05,800 --> 01:54:10,800 TO WORK IN A LOCATION AND NEVER 2569 01:54:10,800 --> 01:54:13,040 UNDERWENT THE TRAINING AND TOOK 2570 01:54:13,040 --> 01:54:15,240 A RAINBOW PATIENT IN AND WAS 2571 01:54:15,240 --> 01:54:20,320 ASKING HER ALL THE THINGS SHE 2572 01:54:20,320 --> 01:54:22,920 SHOULD BE ASKING SO WE NEED TO 2573 01:54:22,920 --> 01:54:24,040 MAKE SURE WE'RE TRAINING NEW 2574 01:54:24,040 --> 01:54:27,000 STAFF AND FOUND MOST THE 2575 01:54:27,000 --> 01:54:30,800 PATIENTS WANT TO SEE THE SAME 2576 01:54:30,800 --> 01:54:32,000 STENOGRAPHY AS MUCH AS POSSIBLE 2577 01:54:32,000 --> 01:54:34,640 AND WE HAVE THEM SEE THE SAME 2578 01:54:34,640 --> 01:54:36,480 STENOGRAPHY OR ONE OF TWO 2579 01:54:36,480 --> 01:54:40,160 BECAUSE THEY'RE THERE SO 2580 01:54:40,160 --> 01:54:45,640 FREQUENTLY. 2581 01:54:45,640 --> 01:54:47,920 WE HAVE TO TRAIN WHAT WE'RE 2582 01:54:47,920 --> 01:54:51,000 DOING ANTEPARTUM TO POSTPARTUM 2583 01:54:51,000 --> 01:54:53,760 AND THIS CAME AS FEEDBACK FROM 2584 01:54:53,760 --> 01:54:55,800 THE FIRST PATIENT THAT DELIVERED 2585 01:54:55,800 --> 01:54:57,800 BECAUSE THERE WASN'T THE SAME 2586 01:54:57,800 --> 01:55:06,480 ATTENTION THAT WAS GIVEN 2587 01:55:06,480 --> 01:55:09,560 ANTEPARTUM AND WE HAVE FOOT WE 2588 01:55:09,560 --> 01:55:12,480 PUT OWN THE BOARD AND WE MOVED 2589 01:55:12,480 --> 01:55:14,680 TO AN ELECTRONIC BOARD IF 2590 01:55:14,680 --> 01:55:18,920 THEY'RE A RAINBOW PATIENT. 2591 01:55:18,920 --> 01:55:22,400 EVERYBODY'S GETTING TRAINED. 2592 01:55:22,400 --> 01:55:23,720 WE'RE PRIORITIZING PRIVATE ROOMS 2593 01:55:23,720 --> 01:55:26,440 AND WE DON'T HAVE FIVE ROOMS FOR 2594 01:55:26,440 --> 01:55:28,160 EVERY PATIENT BUT THEY KNOW THE 2595 01:55:28,160 --> 01:55:29,760 RAINBOW CLINIC PATIENTS GET 2596 01:55:29,760 --> 01:55:34,800 PRIORITY. 2597 01:55:34,800 --> 01:55:43,160 AND FOLLOW-UP WITH THE 2598 01:55:43,160 --> 01:55:43,480 PHYSICIAN. 2599 01:55:43,480 --> 01:55:46,960 WHAT CAME UP IS YOU THINK YOU'RE 2600 01:55:46,960 --> 01:55:48,600 HANDING THEM THIS HEALTHY BABY 2601 01:55:48,600 --> 01:55:52,160 AND ALL THE PROBLEMS GO AWAY BUT 2602 01:55:52,160 --> 01:55:57,840 IT'S NOT. 2603 01:55:57,840 --> 01:55:59,760 THERE'S A LOT OF EMOTION AND 2604 01:55:59,760 --> 01:56:02,080 THEY'RE HOLDING THIS HEALTHY 2605 01:56:02,080 --> 01:56:03,360 LIVING CHILD BUT THEN BRINGING 2606 01:56:03,360 --> 01:56:05,520 UP EMOTIONS OF WHAT THEY LOST. 2607 01:56:05,520 --> 01:56:07,760 THIS IS WHAT THEY SHOULD HAVE -- 2608 01:56:07,760 --> 01:56:09,360 THIS IS A CHILD THEY SHOULD HAVE 2609 01:56:09,360 --> 01:56:10,880 HELD TWO YEARS AGO. 2610 01:56:10,880 --> 01:56:16,160 THERE'S A LOT OF MIXED EMOTIONS 2611 01:56:16,160 --> 01:56:21,440 OVER THAT WE FOLLOW-UP WITH THEM 2612 01:56:21,440 --> 01:56:22,960 IMMEDIATELY WITH A SOCIAL WORKER 2613 01:56:22,960 --> 01:56:27,640 OR TALK TO THEM WITHIN A WEEK. 2614 01:56:27,640 --> 01:56:30,400 AND ELICITING THE FEEDBACK FROM 2615 01:56:30,400 --> 01:56:32,920 PATIENTS IS A WAY OF CHANGING 2616 01:56:32,920 --> 01:56:33,840 THINGS. 2617 01:56:33,840 --> 01:56:35,760 IT STRUCK ME WHEN DR. GOLD WAS 2618 01:56:35,760 --> 01:56:38,760 SHOWING THE PICTURE AND THE 2619 01:56:38,760 --> 01:56:41,520 PHOTOGRAPHY OF THE STILLBIRTHS 2620 01:56:41,520 --> 01:56:44,160 AND THE PHOTOGRAPH OF THE 2621 01:56:44,160 --> 01:56:48,840 STILLBORN BABY PUT IN A -- LIKE 2622 01:56:48,840 --> 01:56:50,880 IN A MAILBOX OR SOMETHING LIKE 2623 01:56:50,880 --> 01:56:54,440 THAT AND I HAD A PATIENT THAT 2624 01:56:54,440 --> 01:56:58,520 SHOWED ME THE PICTURE OF HER 2625 01:56:58,520 --> 01:56:59,120 STILLBORN BABY. 2626 01:56:59,120 --> 01:57:03,320 SO WE'RE ALSO WE HAVE A WHOLE 2627 01:57:03,320 --> 01:57:04,960 BEREAVEMENT KIT BUT WE'RE ALSO 2628 01:57:04,960 --> 01:57:06,240 WORKING TO IMPROVE THAT AS WELL 2629 01:57:06,240 --> 01:57:12,600 MAKING SURE THAT IF PATIENTS ARE 2630 01:57:12,600 --> 01:57:13,760 HAVING A STILLBIRTH DON'T HAVE 2631 01:57:13,760 --> 01:57:15,840 THAT KIND OF EXPERIENCE. 2632 01:57:15,840 --> 01:57:21,360 WE HAD ONE PATIENT WHO WAS PUT 2633 01:57:21,360 --> 01:57:23,760 IN THE LABOR ROOM AND COULD HEAR 2634 01:57:23,760 --> 01:57:25,720 BABIES BEING BORN AND TRYING TO 2635 01:57:25,720 --> 01:57:27,720 WORK ON HAVING THEM AS FAR AS 2636 01:57:27,720 --> 01:57:28,000 POSSIBLE. 2637 01:57:28,000 --> 01:57:29,160 LITTLE THINGS LIKE THAT THAT ARE 2638 01:57:29,160 --> 01:57:39,600 BIG DEAL TO OUR PATIENTS. 2639 01:57:40,920 --> 01:57:42,720 WE'RE FOCUSSED ON IMPROVING THE 2640 01:57:42,720 --> 01:57:43,200 PATIENT EXPERIENCE. 2641 01:57:43,200 --> 01:57:49,320 REDUCING THE FEAR AND ANXIETY 2642 01:57:49,320 --> 01:57:50,320 ADDING TO THE BODY OF RESEARCH 2643 01:57:50,320 --> 01:57:55,000 OUT THERE AND HOPEFULLY 2644 01:57:55,000 --> 01:57:56,080 IMPROVING OUTCOMES IN REDUCING 2645 01:57:56,080 --> 01:57:56,400 STILLBIRTHS. 2646 01:57:56,400 --> 01:57:57,520 ONCE WE HAVE A REASONABLE NUMBER 2647 01:57:57,520 --> 01:57:59,320 OF PATIENTS WE'LL BE ABLE TO 2648 01:57:59,320 --> 01:58:03,520 COMPARE OUR OUTCOMES WITH THE 2649 01:58:03,520 --> 01:58:05,920 OUTCOMES THAT DR. HAZEL HAS 2650 01:58:05,920 --> 01:58:06,160 PUBLISHED. 2651 01:58:06,160 --> 01:58:07,240 THANK YOU SO MUCH FOR THE 2652 01:58:07,240 --> 01:58:17,720 OPPORTUNITY TO SPEAK TODAY. 2653 01:58:23,360 --> 01:58:29,480 >>THANK YOU SO MUCH AND NOW 2654 01:58:29,480 --> 01:58:31,280 WE'RE ADDING TO OUR OPEN PANEL 2655 01:58:31,280 --> 01:58:34,280 FOR THE DISCUSSION IN THE 2656 01:58:34,280 --> 01:58:35,200 INSIGHTFUL PRESENTATION. 2657 01:58:35,200 --> 01:58:40,320 BURY START I WOULD LIKE KNOW IF 2658 01:58:40,320 --> 01:58:49,320 OUR CHAIR DR. JAIN OR REDDY 2659 01:58:49,320 --> 01:58:59,800 WOULD LIKE TO ADD SOMETHING. 2660 01:59:00,040 --> 01:59:02,400 >>THANK YOU, DR. LONGO. 2661 01:59:02,400 --> 01:59:03,440 THESE WERE AMAZING PRESENTATIONS 2662 01:59:03,440 --> 01:59:04,440 AND LOOK FORWARD TO THE 2663 01:59:04,440 --> 01:59:09,320 DISCUSSION WITH THE PANEL 2664 01:59:09,320 --> 01:59:09,560 MEMBERS. 2665 01:59:09,560 --> 01:59:12,160 PERHAPS, MONICA, IF I CAN GET 2666 01:59:12,160 --> 01:59:17,320 THE DISCUSSION STARTED. 2667 01:59:17,320 --> 01:59:23,640 I HAVE A QUESTION FOR 2668 01:59:23,640 --> 01:59:28,160 DR. BARFIELD AND ADDA REGARDING 2669 01:59:28,160 --> 01:59:33,640 PRAMS AND SOARS. 2670 01:59:33,640 --> 01:59:37,720 WHAT WOULD IT TAKE TO IMPLEMENT 2671 01:59:37,720 --> 01:59:39,280 SOARS FOR THE ENTIRE COUNTRY? 2672 01:59:39,280 --> 01:59:41,320 AND PARTICULARLY DR. BARFIELD 2673 01:59:41,320 --> 01:59:45,360 SAID SHE MAY HAVE THE HISTORICAL 2674 01:59:45,360 --> 01:59:45,680 PERSPECTIVE. 2675 01:59:45,680 --> 01:59:47,800 WHY WASN'T STILLBIRTH INCLUDING 2676 01:59:47,800 --> 01:59:51,920 OF INCLUDED IN THE PRAMS 2677 01:59:51,920 --> 01:59:54,360 DATABASE FROM EARLY ONSET OF THE 2678 01:59:54,360 --> 01:59:55,320 PROGRAM BECAUSE THAT WOULD HAVE 2679 01:59:55,320 --> 01:59:57,880 SET THE STAGE FOR ALL THIS VITAL 2680 01:59:57,880 --> 02:00:01,920 INFORMATION TO BE CAPTURED. 2681 02:00:01,920 --> 02:00:03,960 >>THAT'S A REALLY IMPORTANT 2682 02:00:03,960 --> 02:00:05,840 QUESTION AND I WILL HAVE 2683 02:00:05,840 --> 02:00:08,160 DR. DIEKE ANSWER THE FIRST SO 2684 02:00:08,160 --> 02:00:11,480 I'LL ANSWER THE SECOND. 2685 02:00:11,480 --> 02:00:13,040 IN TERMS OF UNDERSTANDING PRAMS 2686 02:00:13,040 --> 02:00:17,400 AND THE PARTICIPATION RATE IN 2687 02:00:17,400 --> 02:00:19,880 GENERAL PRAMS IS A HIGH 2688 02:00:19,880 --> 02:00:20,440 PARTICIPATION RATE. 2689 02:00:20,440 --> 02:00:22,000 WOMEN AND BIRTHING PEOPLE WANT 2690 02:00:22,000 --> 02:00:24,640 TO SHARE THEIR EXPERIENCES. 2691 02:00:24,640 --> 02:00:26,040 IF YOU CAN FIND THEM. 2692 02:00:26,040 --> 02:00:28,040 IF THEY'RE NOT BACK AT WORK OR 2693 02:00:28,040 --> 02:00:29,000 OTHER AREAS, THEIR RESPONSE IS 2694 02:00:29,000 --> 02:00:34,480 REALLY VERY GOOD. 2695 02:00:34,480 --> 02:00:38,160 AT THE TIME WE DID NOT 2696 02:00:38,160 --> 02:00:38,840 UNDERSTAND WHAT WOULD BE THE 2697 02:00:38,840 --> 02:00:45,240 RESPONSE AND WHAT WOULD BE THE 2698 02:00:45,240 --> 02:00:46,440 APPROPRIATE SENSITIVITY FOR 2699 02:00:46,440 --> 02:00:49,400 ASKING QUESTIONS AMONGST 2700 02:00:49,400 --> 02:00:50,880 BIRTHING PEOPLE WHO HAVE 2701 02:00:50,880 --> 02:00:55,720 EXPERIENCED AN INSTANT LOSS IN 2702 02:00:55,720 --> 02:00:57,120 THE FIRST CASE AS WELL AS A 2703 02:00:57,120 --> 02:00:57,920 STILLBIRTH. 2704 02:00:57,920 --> 02:00:59,880 WE NEEDED TO EXPLORE THAT. 2705 02:00:59,880 --> 02:01:02,800 PRAMS FROM THE INCEPTION HAS 2706 02:01:02,800 --> 02:01:05,840 BEEN INCREDIBLY SENSITIVE TO 2707 02:01:05,840 --> 02:01:09,200 INFANT DEATHS AS THEY'RE 2708 02:01:09,200 --> 02:01:10,000 SAMPLING AND GATHER THE 2709 02:01:10,000 --> 02:01:12,520 INFORMATION WHETHER IT'S FINDING 2710 02:01:12,520 --> 02:01:17,640 IT FROM HOSPITAL RECORDS OR 2711 02:01:17,640 --> 02:01:19,200 REPORTS OR FROM INFORMATION THAT 2712 02:01:19,200 --> 02:01:22,720 MAY BE SHARED PUBLICLY AND SHARE 2713 02:01:22,720 --> 02:01:25,840 APPROPRIATE CARDS, CONDOLENCES, 2714 02:01:25,840 --> 02:01:27,960 INCENTIVES AND ASK RESPONDENTS 2715 02:01:27,960 --> 02:01:29,800 IF THEY'RE STILL INTERESTED IN 2716 02:01:29,800 --> 02:01:37,840 PARTICIPATING IN THE SURVEY. 2717 02:01:37,840 --> 02:01:39,000 WE HAVEN'T MADE MUCH TRACTION IN 2718 02:01:39,000 --> 02:01:41,400 TERMS OF STILLBIRTH. 2719 02:01:41,400 --> 02:01:44,000 IT SEEMED LIKE AN IMPORTANT 2720 02:01:44,000 --> 02:01:44,440 QUESTION. 2721 02:01:44,440 --> 02:01:52,080 THAT'S THE OPPORTUNITY DR. DIEE 2722 02:01:52,080 --> 02:01:53,200 KE EXPLAINED. 2723 02:01:53,200 --> 02:01:58,560 WE'RE ALL BETTER TRYING TO 2724 02:01:58,560 --> 02:02:08,160 UNDERSTAND AND WHY IS IT THESE 2725 02:02:08,160 --> 02:02:09,680 COMPONENTS THEY'RE INTERRELATED. 2726 02:02:09,680 --> 02:02:12,360 WE DO DO SURVEILLANCE ON 2727 02:02:12,360 --> 02:02:16,160 MATERNAL MORTALITY AND SUDDEN 2728 02:02:16,160 --> 02:02:21,240 UNEXPECTED INFANT DEATH. 2729 02:02:21,240 --> 02:02:25,920 HOW CAN WE THINK ABOUT THESE 2730 02:02:25,920 --> 02:02:27,360 CONTINUOUSLY BUT NEED TO 2731 02:02:27,360 --> 02:02:28,320 ACKNOWLEDGE THERE MAY BE 2732 02:02:28,320 --> 02:02:31,120 DIFFERENT SKILL SETS NEEDED IN 2733 02:02:31,120 --> 02:02:32,520 TERMS OF THE EXPERTISE AND 2734 02:02:32,520 --> 02:02:41,560 INVOLVEMENT OF REVIEW PANELS. 2735 02:02:41,560 --> 02:02:47,080 THE APPROPRIATE DIAGNOSIS AND 2736 02:02:47,080 --> 02:02:50,600 THE RESEARCH TO UNDERSTAND THE 2737 02:02:50,600 --> 02:02:51,240 UNDERLYING ISSUES. 2738 02:02:51,240 --> 02:02:54,240 IN TERMS OF THE COST DR. DIEKE 2739 02:02:54,240 --> 02:02:56,160 MAY WANT TO TALK ABOUT THAT AS 2740 02:02:56,160 --> 02:02:56,360 WELL. 2741 02:02:56,360 --> 02:03:04,720 I'LL HAND IT TO YOU. 2742 02:03:04,720 --> 02:03:06,080 WITH THE STILL BIRTH FUNDING 2743 02:03:06,080 --> 02:03:08,160 IT'S BEEN LIMITED IN TERMS OF 2744 02:03:08,160 --> 02:03:14,280 OUR ABILITY TO FUND THE PILOT. 2745 02:03:14,280 --> 02:03:19,320 I BELIEVE THE FIRST PILOT WAS 2746 02:03:19,320 --> 02:03:21,120 AROUND $100,000 OR LESS TO GET 2747 02:03:21,120 --> 02:03:23,440 THE PARTNERS AND SYSTEMS ARE 2748 02:03:23,440 --> 02:03:28,160 READY TO COLLECT THIS 2749 02:03:28,160 --> 02:03:29,800 INFORMATION. 2750 02:03:29,800 --> 02:03:34,840 AND WE WERE ABLE TO FUND 2751 02:03:34,840 --> 02:03:36,680 STILLBIRTH LONGER BUT I WANT TO 2752 02:03:36,680 --> 02:03:39,480 MAKE A CLARIFICATION IT'S FOR 2753 02:03:39,480 --> 02:03:41,800 THREE YEARS OF FUNDING DURING 2754 02:03:41,800 --> 02:03:43,920 OUR FIVE-YEAR NOTICE OF FUNDING 2755 02:03:43,920 --> 02:03:46,520 AWARD OPPORTUNITY. 2756 02:03:46,520 --> 02:03:49,800 BUT STILL, WE HAD ONE APPLICANT. 2757 02:03:49,800 --> 02:03:53,160 WE JUST HAD ONE STATE APPLY. 2758 02:03:53,160 --> 02:03:58,400 THAT IS SOMETHING THAT WE'RE 2759 02:03:58,400 --> 02:04:00,240 ALSO TRYING TO UNDERSTAND FROM 2760 02:04:00,240 --> 02:04:01,240 THE SITE PERSPECTIVE. 2761 02:04:01,240 --> 02:04:03,080 THERE'S SOME SITES THAT HAVE 2762 02:04:03,080 --> 02:04:03,480 GREAT COMMITTEES. 2763 02:04:03,480 --> 02:04:05,560 I LEARNED THIS THROUGH THE 2764 02:04:05,560 --> 02:04:06,320 STILLBIRTH COUNCIL MEETING. 2765 02:04:06,320 --> 02:04:11,640 THERE WERE OTHER STATES THAT HAD 2766 02:04:11,640 --> 02:04:12,960 STRONG STILLBIRTH COMMITTEES. 2767 02:04:12,960 --> 02:04:17,040 I THINK IT WILL BE A PARTNERSHIP 2768 02:04:17,040 --> 02:04:18,320 TO CONSIDER WHETHER THOSE 2769 02:04:18,320 --> 02:04:20,320 STILLBIRTH COMMITTEES IN THOSE 2770 02:04:20,320 --> 02:04:22,360 STATES ARE ALSO OPEN TO CONSIDER 2771 02:04:22,360 --> 02:04:24,360 APPLYING TO THE LIMITED CDC 2772 02:04:24,360 --> 02:04:25,040 FUNDING. 2773 02:04:25,040 --> 02:04:30,680 OF COURSE, IF WE COULD GET 2774 02:04:30,680 --> 02:04:34,080 ADDITIONAL FUNDING IT WILL MEAN 2775 02:04:34,080 --> 02:04:34,800 ADDITIONAL OPPORTUNITIES TO 2776 02:04:34,800 --> 02:04:35,800 EXPAND STILLBIRTH STUDIES FROM 2777 02:04:35,800 --> 02:04:37,040 OUR END. 2778 02:04:37,040 --> 02:04:39,040 >>ONE THING TO NOTICE, WE HAVE 2779 02:04:39,040 --> 02:04:41,800 TO BE COGNIZANT OF WHAT RECENT 2780 02:04:41,800 --> 02:04:46,520 YEARS HAVE DONE IN TERMS OF 2781 02:04:46,520 --> 02:04:47,800 IMPACTING CAPACITY AND I'M SURE 2782 02:04:47,800 --> 02:04:49,760 OUR COLLEAGUES FROM HRSA CAN 2783 02:04:49,760 --> 02:04:51,120 TALK TO THAT AS WELL. 2784 02:04:51,120 --> 02:04:53,320 IT'S BEEN AN ALL HANDS ON DECK 2785 02:04:53,320 --> 02:05:00,280 FOR THE MCH COMMUNITY INCLUDING 2786 02:05:00,280 --> 02:05:02,520 GRANTS. 2787 02:05:02,520 --> 02:05:03,760 SOMETIMES IN TERMS OF APPLYING 2788 02:05:03,760 --> 02:05:05,120 FOR THE OPPORTUNITIES, GROUPS 2789 02:05:05,120 --> 02:05:07,280 HAVE TO THINK ABOUT WHAT THEIR 2790 02:05:07,280 --> 02:05:08,160 CAPACITIES IS TO BE ABLE TO 2791 02:05:08,160 --> 02:05:18,320 IMPLEMENT. 2792 02:05:20,520 --> 02:05:25,120 >>I DID A QUICK CALCULATION 2793 02:05:25,120 --> 02:05:33,280 FROM DR. DIEKE'S PRESENTATION I 2794 02:05:33,280 --> 02:05:37,640 HEARD 81% OF LIVE BIRTHS ARE 2795 02:05:37,640 --> 02:05:41,240 CAPTURED IN PRAMS THAT'S 3 2796 02:05:41,240 --> 02:05:44,520 MILLION BIRTHS THAT WOULD BE 2797 02:05:44,520 --> 02:05:45,120 CAPTURED. 2798 02:05:45,120 --> 02:05:47,120 HOW MUCH WOULD IT BE TO ADD 2799 02:05:47,120 --> 02:05:49,200 24,000 STILLBIRTHS TO PRAMS? 2800 02:05:49,200 --> 02:05:51,560 WHY CAN'T WE DO IT AS A NATIONAL 2801 02:05:51,560 --> 02:05:59,800 INITIATIVE AND WE DON'T HAVE TO 2802 02:05:59,800 --> 02:06:02,120 HAVE DUPLICATIVE SERVICES. 2803 02:06:02,120 --> 02:06:06,440 I SEE KATHERINE SHAKING HER 2804 02:06:06,440 --> 02:06:07,320 HEADS WHICH ALWAYS GIVES ME 2805 02:06:07,320 --> 02:06:08,160 CONFIDENCE I'M ASKING THE RIGHT 2806 02:06:08,160 --> 02:06:16,800 QUESTION. 2807 02:06:16,800 --> 02:06:18,720 >>DO YOU WANT TO TAKE THAT? 2808 02:06:18,720 --> 02:06:22,480 I THINK HE'S PROBABLY ASKING A 2809 02:06:22,480 --> 02:06:23,320 RHETORICAL QUESTION. 2810 02:06:23,320 --> 02:06:24,960 >>THIS IS A COOPERATIVE 2811 02:06:24,960 --> 02:06:28,160 AGREEMENT BETWEEN JURISDICTIONS 2812 02:06:28,160 --> 02:06:34,040 AND CDC AND WE ALSO NEED SUPPORT 2813 02:06:34,040 --> 02:06:34,920 BECAUSE OTHER SYSTEMS INCLUDE 2814 02:06:34,920 --> 02:06:36,160 MATERNAL MORTALITY REVIEW 2815 02:06:36,160 --> 02:06:43,120 COMMITTEES ON WORK ON SUDDEN 2816 02:06:43,120 --> 02:06:44,160 UNEXPECTED DEATH AND MORTALITY 2817 02:06:44,160 --> 02:06:49,120 SURVEILLANCE AND OTHER AREAS. 2818 02:06:49,120 --> 02:06:50,480 GIVEN RESOURCES THAT COULD BE A 2819 02:06:50,480 --> 02:06:52,160 POTENTIAL OPPORTUNITY TO LOOK AT 2820 02:06:52,160 --> 02:07:01,200 THE AREA. 2821 02:07:01,200 --> 02:07:04,160 WE HAVE TO THINK THOUGHTFULLY 2822 02:07:04,160 --> 02:07:07,760 ABOUT PARTICULARLY JURISDICTIONS 2823 02:07:07,760 --> 02:07:09,120 THAT MAY HAVE LIMITED CAPACITY 2824 02:07:09,120 --> 02:07:15,880 IN TERMS OF DIVERSITY OF 2825 02:07:15,880 --> 02:07:16,400 RECIPIENTS, PARTICIPANTS. 2826 02:07:16,400 --> 02:07:19,120 THOSE ARE IMPORTANT POINTS. 2827 02:07:19,120 --> 02:07:24,240 WITHIN PRAMS, IT HAS DIVERSE 2828 02:07:24,240 --> 02:07:34,760 REPRESENTATION AND WHAT'S THE 2829 02:07:42,760 --> 02:07:44,040 CADRE OF PEOPLE TO PARTICIPATE 2830 02:07:44,040 --> 02:07:46,720 IN TERMS OF TRUST AND ACCESS AND 2831 02:07:46,720 --> 02:07:47,240 THE MODE? 2832 02:07:47,240 --> 02:07:50,560 WE NEED TO MAKE SURE WE DON'T 2833 02:07:50,560 --> 02:07:51,120 LEAVE CERTAIN GROUPS BEHIND. 2834 02:07:51,120 --> 02:07:51,800 >>GREAT. 2835 02:07:51,800 --> 02:07:56,120 I WANTED TO ALSO INVITE DR. UMA 2836 02:07:56,120 --> 02:07:58,360 REDDY BEFORE WE OPEN IT TO 2837 02:07:58,360 --> 02:08:00,840 EVERYONE ELSE TO SEE IF SHE HAD 2838 02:08:00,840 --> 02:08:01,280 QUESTIONS OR COMMENTS. 2839 02:08:01,280 --> 02:08:06,600 >>THANK YOU. 2840 02:08:06,600 --> 02:08:08,720 >>THANK YOU TO THE SPEAKERS. 2841 02:08:08,720 --> 02:08:11,840 FANTASTIC TALKS. 2842 02:08:11,840 --> 02:08:14,560 A LOT TO THINK ABOUT. 2843 02:08:14,560 --> 02:08:17,120 SOARS IS A FANTASTIC PROJECT AND 2844 02:08:17,120 --> 02:08:20,160 LINKING IT TO THE INFORMATION WE 2845 02:08:20,160 --> 02:08:23,360 HEARD AS YOU SAID ABOUT OTHER 2846 02:08:23,360 --> 02:08:25,440 STATES WITH PROJECTS, EXTENSIONS 2847 02:08:25,440 --> 02:08:28,440 OF BIRTH EFFECTS REGISTRY, IN 2848 02:08:28,440 --> 02:08:34,760 TERMS OF WE TALKED ABOUT HOW WE 2849 02:08:34,760 --> 02:08:37,440 NEEDED IN DEPTH INVESTIGATIONS 2850 02:08:37,440 --> 02:08:39,840 OF STILLBIRTHS TO MAKE PROGRESS 2851 02:08:39,840 --> 02:08:42,200 AND WE HEARD ABOUT FROM SOME 2852 02:08:42,200 --> 02:08:46,040 STATE PROJECTS AND ASKING THE 2853 02:08:46,040 --> 02:08:52,160 QUESTIONS SOARS DOES AND BEING 2854 02:08:52,160 --> 02:08:54,960 ABLE TO DO LABORATORY TESTING. 2855 02:08:54,960 --> 02:09:00,720 AND THE NETWORK WAS ABLE TO DO 2856 02:09:00,720 --> 02:09:03,480 THAT AND THERE WAS A MATERNAL 2857 02:09:03,480 --> 02:09:05,640 INTERVIEW WHICH WAS A KEY 2858 02:09:05,640 --> 02:09:08,160 COMPONENT GOING TO YOUR POINTS 2859 02:09:08,160 --> 02:09:15,520 THAT WE NEED TO TALK TO OUR 2860 02:09:15,520 --> 02:09:18,520 FAMILIES AND PREGNANT WOMEN WHO 2861 02:09:18,520 --> 02:09:20,560 SUFFERED STILLBIRTH AND TRIED TO 2862 02:09:20,560 --> 02:09:22,440 UNDERSTAND. 2863 02:09:22,440 --> 02:09:24,120 AND DR. CACCIATORE, TOO BAD SHE 2864 02:09:24,120 --> 02:09:25,280 LEFT, SHE DID FOCUS GROUPS TO 2865 02:09:25,280 --> 02:09:26,800 FORM THE MATERNAL INTERVIEW THAT 2866 02:09:26,800 --> 02:09:31,840 WAS USED FOR SCREEN. 2867 02:09:31,840 --> 02:09:42,320 THAT KEY COMPONENT -- THERE'S 2868 02:09:43,440 --> 02:09:44,600 OTHER FACTORS INFLUENCING WHY 2869 02:09:44,600 --> 02:09:45,840 STILLBIRTHS HAPPEN AND TO 2870 02:09:45,840 --> 02:09:47,200 COMBINE THAT AND TO 2871 02:09:47,200 --> 02:09:48,920 DR. BARFIELD'S POINT IT'S HARD 2872 02:09:48,920 --> 02:09:51,720 TO APPLY TO A GRANT FROM A 2873 02:09:51,720 --> 02:09:54,560 COMMUNITY ORGANIZATION OR EVEN 2874 02:09:54,560 --> 02:09:57,400 AN INSTITUTION UNDER RESOURCES 2875 02:09:57,400 --> 02:09:58,200 FOR SCREEN. 2876 02:09:58,200 --> 02:09:59,800 THE STILL BIRTH COLLABORATIVE 2877 02:09:59,800 --> 02:10:02,120 RESEARCH NETWORK IS BECAUSE THEY 2878 02:10:02,120 --> 02:10:04,080 WERE PARTNERED WITH AN ACADEMIC 2879 02:10:04,080 --> 02:10:07,200 INSTITUTION WE WERE ABLE TO DO 2880 02:10:07,200 --> 02:10:08,040 POPULATION-BASED STUDIES. 2881 02:10:08,040 --> 02:10:10,560 LIKE THE COUNTY FOR EXAMPLE, IT 2882 02:10:10,560 --> 02:10:12,880 HAD TWICE THE STILLBIRTH RATE OF 2883 02:10:12,880 --> 02:10:13,880 EVERY OTHER COUNTY IN THE 2884 02:10:13,880 --> 02:10:15,640 STILLBIRTH COLLABORATIVE 2885 02:10:15,640 --> 02:10:17,280 RESEARCH NETWORK AND REALLY 2886 02:10:17,280 --> 02:10:20,960 BECAUSE EMORY PAIRED WITH THE 2887 02:10:20,960 --> 02:10:23,800 COMMUNITY HOSPITALS IN THE 2888 02:10:23,800 --> 02:10:24,040 STUDIES. 2889 02:10:24,040 --> 02:10:25,520 THANK YOU ALL AND IF IF WE CAN 2890 02:10:25,520 --> 02:10:28,800 GET A COMBINATION OF THE FACTORS 2891 02:10:28,800 --> 02:10:32,200 FROM SOARS AND FROM THE BIRTH 2892 02:10:32,200 --> 02:10:35,800 DEFECTS REGISTRY WE WOULD MAKE 2893 02:10:35,800 --> 02:10:38,560 GOOD PROGRESS. 2894 02:10:38,560 --> 02:10:39,960 THANKS. 2895 02:10:39,960 --> 02:10:40,160 >> 2896 02:10:40,160 --> 02:10:44,160 >>THIS QUESTION IS FOR 2897 02:10:44,160 --> 02:10:51,280 DR. GOLD. 2898 02:10:51,280 --> 02:10:53,680 KATHERINE, 45 YEARS AGO IN 2899 02:10:53,680 --> 02:10:55,520 MEDICAL SCHOOL WHEN MY OLDER 2900 02:10:55,520 --> 02:11:02,760 BROTHER AND HIS WIFE LOST A BABY 2901 02:11:02,760 --> 02:11:05,520 AND I KNOW MY SISTER AND MOM 2902 02:11:05,520 --> 02:11:10,600 GRIEVED FOR A LONG TIME. 2903 02:11:10,600 --> 02:11:15,560 MY BROTHER YEARS LATER EXPRESSED 2904 02:11:15,560 --> 02:11:18,680 TO ME HOW HE WAS STILL 2905 02:11:18,680 --> 02:11:21,880 STRUGGLING WITH THAT SADNESS AND 2906 02:11:21,880 --> 02:11:22,320 SOR 2907 02:11:22,320 --> 02:11:22,560 SORROW. 2908 02:11:22,560 --> 02:11:27,000 WE SELDOM TALK ABOUT PATERNAL 2909 02:11:27,000 --> 02:11:27,840 GRIEF AFTER STILLBIRTH. 2910 02:11:27,840 --> 02:11:30,640 WOULD YOU MIND MAKING A COMMENT 2911 02:11:30,640 --> 02:11:37,360 HOW WE CAN ADDRESS THAT AS WELL? 2912 02:11:37,360 --> 02:11:39,680 >>I THINK THAT'S A GOOD 2913 02:11:39,680 --> 02:11:40,160 COMMENT. 2914 02:11:40,160 --> 02:11:41,120 WE'RE ONLY IN THE LAST FIVE OR 2915 02:11:41,120 --> 02:11:43,360 10 YEARS STARTING TO GET MORE 2916 02:11:43,360 --> 02:11:45,440 DATA ABOUT THE GRIEF OF FATHERS 2917 02:11:45,440 --> 02:11:48,320 AND THE NON-BIRTHING PARTNER IF 2918 02:11:48,320 --> 02:11:52,680 YOU HAVE A SAME-SEX COUPLE. 2919 02:11:52,680 --> 02:11:54,480 IN GENERAL AND THIS IS A 2920 02:11:54,480 --> 02:11:55,960 SWEEPING GENERALIZATION FROM THE 2921 02:11:55,960 --> 02:11:58,240 STUDIES I'VE SEEN, MEN AND WOMEN 2922 02:11:58,240 --> 02:11:59,520 HAVE DIFFERENT KINDS OF GRIEF 2923 02:11:59,520 --> 02:12:00,880 AND DIFFERENT EXPRESSIONS. 2924 02:12:00,880 --> 02:12:02,920 WOMEN TENDED TO HAVE MORE 2925 02:12:02,920 --> 02:12:06,200 PROLONGED POORER OUTCOMES AFTER 2926 02:12:06,200 --> 02:12:07,560 STILLBIRTH THAN MEN HAVE. 2927 02:12:07,560 --> 02:12:09,760 AGAIN IT'S ABOUT IDENTIFYING THE 2928 02:12:09,760 --> 02:12:11,800 FATHERS WHO ARE MOST AT RISK 2929 02:12:11,800 --> 02:12:15,640 LIKE WE'RE TRYING TO IDENTIFY 2930 02:12:15,640 --> 02:12:19,760 THE MOMS MOST AT RISK AND MY 2931 02:12:19,760 --> 02:12:22,840 GUESS IS THE FATHERS WITH PRIOR 2932 02:12:22,840 --> 02:12:24,880 TRAUMATIC LOSSES, EXPERIENCING 2933 02:12:24,880 --> 02:12:25,840 UNANTICIPATED DEATHS ARE AT 2934 02:12:25,840 --> 02:12:29,120 HIGHER RISK AND WE NEED TO 2935 02:12:29,120 --> 02:12:29,480 IDENTIFY THAT. 2936 02:12:29,480 --> 02:12:33,080 WHEN I MEET WITH FAMILIES I SAY 2937 02:12:33,080 --> 02:12:36,000 YOU'LL GRIEVE AT DIFFERENT WAYS 2938 02:12:36,000 --> 02:12:37,280 AND TIMES BUT NOT MANY HOSPITALS 2939 02:12:37,280 --> 02:12:39,720 ARE TALKING TO PARENTS ABOUT HOW 2940 02:12:39,720 --> 02:12:41,760 THEY MIGHT GRIEF DIFFERENTLY AND 2941 02:12:41,760 --> 02:12:43,600 WHAT NORMAL GRIEF LOOKS LIKE FOR 2942 02:12:43,600 --> 02:12:43,880 PEOPLE. 2943 02:12:43,880 --> 02:12:45,080 THAT'S AN IMPORTANT COMPONENT 2944 02:12:45,080 --> 02:12:45,800 THAT'S BEEN NEGLECTED. 2945 02:12:45,800 --> 02:12:50,840 IT'S NOT JUST MEN. 2946 02:12:50,840 --> 02:12:58,240 I THINK IT'S RECOGNIZING THERE'S 2947 02:12:58,240 --> 02:13:01,120 DIFFERENT BACKGROUNDS AND 2948 02:13:01,120 --> 02:13:04,880 LOOKING AT LGBT COUPLES AND 2949 02:13:04,880 --> 02:13:08,520 GROUPS WE MAY NOT HAVE PAID AS 2950 02:13:08,520 --> 02:13:09,200 MUCH ATTENTION TO IN TERMS OF 2951 02:13:09,200 --> 02:13:11,800 LOSS. 2952 02:13:11,800 --> 02:13:19,160 >>THANK YOU. 2953 02:13:19,160 --> 02:13:21,280 >>I THINK WE'VE ADDRESSED SOME 2954 02:13:21,280 --> 02:13:22,000 QUESTIONS IN THE CHAT. 2955 02:13:22,000 --> 02:13:22,800 THANK YOU. 2956 02:13:22,800 --> 02:13:27,560 IT SEEMS WE WOULD LIKE TO HEAR 2957 02:13:27,560 --> 02:13:28,400 YOUR OPINION ABOUT FETAL 2958 02:13:28,400 --> 02:13:30,440 MOVEMENT. 2959 02:13:30,440 --> 02:13:34,880 YOU PUT IN YOUR PRESENTATION AS 2960 02:13:34,880 --> 02:13:37,120 PART OF AWARENESS. 2961 02:13:37,120 --> 02:13:39,960 CAN YOU GIVE MORE HOW DEATH 2962 02:13:39,960 --> 02:13:41,840 COULD FALL INTO CONSIDERATION OF 2963 02:13:41,840 --> 02:13:43,040 THE RISK FACTOR YOU'RE 2964 02:13:43,040 --> 02:13:43,840 EVALUATING AND WHAT DO YOU THINK 2965 02:13:43,840 --> 02:13:45,200 WOULD BE THE BEST WAY? 2966 02:13:45,200 --> 02:13:47,800 AS WE KNOW THERE'S REALLY NOT A 2967 02:13:47,800 --> 02:13:52,840 GOOD EVIDENCE BASE. 2968 02:13:52,840 --> 02:13:57,440 WE DON'T HAVE CLEAR DATA BUT 2969 02:13:57,440 --> 02:13:59,040 THERE'S NOT GOOD ANALYSIS 2970 02:13:59,040 --> 02:14:01,360 SHOWING WE CAN REALLY PREVENT 2971 02:14:01,360 --> 02:14:03,040 PRENATAL DEATH UNFORTUNATELY. 2972 02:14:03,040 --> 02:14:08,520 HOW CAN YOU JOIN THE DISCUSSION 2973 02:14:08,520 --> 02:14:10,600 WITH YOUR WORK. 2974 02:14:10,600 --> 02:14:12,920 >>THE WAY WE THINK ABOUT IT IN 2975 02:14:12,920 --> 02:14:15,840 THE CONTEXT OF THE HEAR HER 2976 02:14:15,840 --> 02:14:17,560 CAMPAIGN THERE ISN'T NECESSARILY 2977 02:14:17,560 --> 02:14:20,560 ONE SINGLE FACTOR THAT'S GOING 2978 02:14:20,560 --> 02:14:25,160 TO DETERMINE DEFINITIVELY THERE 2979 02:14:25,160 --> 02:14:28,160 IS SOMETHING GOING ON WITH A 2980 02:14:28,160 --> 02:14:29,080 PREGNANCY OF CONCERN. 2981 02:14:29,080 --> 02:14:30,760 IT'S MORE ABOUT LISTENING. 2982 02:14:30,760 --> 02:14:31,880 IF SOMEONE IS CONCERNED ENOUGH 2983 02:14:31,880 --> 02:14:33,840 THEY'RE TRYING TO SEEK HELP AND 2984 02:14:33,840 --> 02:14:39,400 THEY'RE BEING TURNED AWAY OR 2985 02:14:39,400 --> 02:14:49,920 IGNORED OR SYMPTOMS AND I CAN 2986 02:14:55,960 --> 02:14:59,800 TELL YOU SEVERAL ANECDOTES AS A 2987 02:14:59,800 --> 02:15:01,160 NEONATOLOGIST WHERE WOMEN HAVE 2988 02:15:01,160 --> 02:15:03,200 COME BACK TO THE EMERGENCY ROOM 2989 02:15:03,200 --> 02:15:04,200 MORE THAN ONCE BECAUSE THEIR 2990 02:15:04,200 --> 02:15:04,760 CONCERNS ABOUT THEIR BABY'S 2991 02:15:04,760 --> 02:15:09,240 MOVEMENT. 2992 02:15:09,240 --> 02:15:13,640 >>I WILL SAY THERE'S SO MUCH 2993 02:15:13,640 --> 02:15:14,720 OUT THERE IN THE STILLBIRTH 2994 02:15:14,720 --> 02:15:18,440 COMMUNITY ABOUT FETAL MOVEMENT. 2995 02:15:18,440 --> 02:15:21,000 IT'S HARD TO TRY TO TELL THEM 2996 02:15:21,000 --> 02:15:22,520 THE SCIENCE ISN'T THERE. 2997 02:15:22,520 --> 02:15:23,600 I AGREE. 2998 02:15:23,600 --> 02:15:26,480 I THINK YOU CAN'T DISMISS IT AND 2999 02:15:26,480 --> 02:15:30,200 WE HAVE TO SAY LISTEN AND IF 3000 02:15:30,200 --> 02:15:32,120 YOU'RE CONCERNED, COME IN, GET 3001 02:15:32,120 --> 02:15:32,400 CHECKED. 3002 02:15:32,400 --> 02:15:35,800 YOU NEED TO SHOW THAT KIND OF 3003 02:15:35,800 --> 02:15:37,320 SUPPORT OTHERWISE YOU DON'T HAVE 3004 02:15:37,320 --> 02:15:38,480 THEIR TRUST. 3005 02:15:38,480 --> 02:15:39,920 AND WE DO NEED MORE. 3006 02:15:39,920 --> 02:15:43,400 WE 100% NEED MORE INFORMATION 3007 02:15:43,400 --> 02:15:45,000 ABOUT THIS. 3008 02:15:45,000 --> 02:15:46,960 RETROSPECTIVE STUDIES CAN'T DO 3009 02:15:46,960 --> 02:15:49,600 IT YOU NEED TO LOOK AT PATTERNS 3010 02:15:49,600 --> 02:15:50,680 AND THINGS LIKE THAT. 3011 02:15:50,680 --> 02:15:52,200 WE HAVE TO LISTEN TO PATIENTS. 3012 02:15:52,200 --> 02:16:02,480 I TOTALLY AGREE. 3013 02:16:06,240 --> 02:16:08,000 >>IS THERE MORE TO ADD? 3014 02:16:08,000 --> 02:16:08,960 >>NOTHING TO ADD. 3015 02:16:08,960 --> 02:16:11,320 AS YOU, WE DO HAVE A FEW 3016 02:16:11,320 --> 02:16:17,240 QUESTIONS ON THE SOURCE SURVEY 3017 02:16:17,240 --> 02:16:19,280 AROUND FETAL MOVEMENT BUT THIS 3018 02:16:19,280 --> 02:16:20,160 IS AFTER THE OUTCOME HAS 3019 02:16:20,160 --> 02:16:26,160 HAPPENED. 3020 02:16:26,160 --> 02:16:27,000 NOTHING DIFFERENT FROM WHAT HAS 3021 02:16:27,000 --> 02:16:27,400 ALREADY BEEN SAID. 3022 02:16:27,400 --> 02:16:31,760 OVER. 3023 02:16:31,760 --> 02:16:35,320 >>ANECDOTALLY FROM WORKING FROM 3024 02:16:35,320 --> 02:16:36,760 MY CLINIC IN DETROIT. 3025 02:16:36,760 --> 02:16:40,160 WE'RE WORKING WITH MOMS WITH NO 3026 02:16:40,160 --> 02:16:41,800 MONEY, NO INSURANCE, LITTLE 3027 02:16:41,800 --> 02:16:42,320 SOCIAL SUPPORT. 3028 02:16:42,320 --> 02:16:45,280 WE'VE SEEN TERRIBLE OUTCOMES AND 3029 02:16:45,280 --> 02:16:48,240 THE NUMBER OF TIMES WE SEND MOMS 3030 02:16:48,240 --> 02:16:50,400 TO THE HOSPITAL BECAUSE THEY IS 3031 02:16:50,400 --> 02:16:53,120 SOMETHING CONCERN AND GET SENT 3032 02:16:53,120 --> 02:16:55,480 AWAY BECAUSE THEY DON'T HAVE 3033 02:16:55,480 --> 02:16:57,040 THEIR INSURANCE CARD IN HAND OR 3034 02:16:57,040 --> 02:16:59,600 CHILD IN TOW IS HEARTBREAKING. 3035 02:16:59,600 --> 02:17:02,800 WE JUST A COUPLE MONTHS AGO 3036 02:17:02,800 --> 02:17:05,800 SENTMAN TO THE HOSPITAL BECAUSE 3037 02:17:05,800 --> 02:17:08,240 HER POSTPARTUM BLOOD PRESSURE 3038 02:17:08,240 --> 02:17:09,760 WAS HIGH AND SHE WAS 17 AND 3039 02:17:09,760 --> 02:17:10,960 DIDN'T HAVE A PARENT WITH HER 3040 02:17:10,960 --> 02:17:12,480 AND THEY SENT HER HOME. 3041 02:17:12,480 --> 02:17:16,160 WE SEE THAT OVER AND OVER AND 3042 02:17:16,160 --> 02:17:16,880 OVER. 3043 02:17:16,880 --> 02:17:18,000 THE HEAR CAMPAIGN IS ABOUT 3044 02:17:18,000 --> 02:17:20,440 LISTENING TO PATIENTS AND 3045 02:17:20,440 --> 02:17:22,800 EMPOWERING PATIENTS TO KEEP 3046 02:17:22,800 --> 02:17:24,200 SPEAKING UP IF THEY'RE WORRIED. 3047 02:17:24,200 --> 02:17:34,600 THAT'S A CRITICAL PIECE. 3048 02:17:35,400 --> 02:17:37,080 >>WE NEED BETTER EDUCATION. 3049 02:17:37,080 --> 02:17:44,160 WE NEED BETTER TRAINING FROM 3050 02:17:44,160 --> 02:17:52,160 BOTH PROVIDERS AND A WAY TO 3051 02:17:52,160 --> 02:17:52,680 COMPORT THE BRIEFING AND 3052 02:17:52,680 --> 02:17:54,440 SUPPORT. 3053 02:17:54,440 --> 02:17:59,520 HOW DO YOU ENVISION WE COULD ASK 3054 02:17:59,520 --> 02:18:01,720 THE TASK TO ELUCIDATE WHAT WE 3055 02:18:01,720 --> 02:18:02,480 WOULD LIKE IT IMPLEMENT YOU 3056 02:18:02,480 --> 02:18:04,160 WOULD LIKE TO SEE THAT WILL 3057 02:18:04,160 --> 02:18:14,560 ANSWER THE QUESTIONS? 3058 02:18:15,360 --> 02:18:17,080 >>ARE YOU ASKING ABOUT THE 3059 02:18:17,080 --> 02:18:17,800 KINDS OF RESEARCH THAT WOULD 3060 02:18:17,800 --> 02:18:19,360 LOOK AT TRAINING? 3061 02:18:19,360 --> 02:18:20,680 >>THE EDUCATION AND TRAINING 3062 02:18:20,680 --> 02:18:24,720 YOU WOULD LIKE IT INCLUDE THAT. 3063 02:18:24,720 --> 02:18:30,240 WA DO YOU THINK WOULD LEAD TO AN 3064 02:18:30,240 --> 02:18:33,000 OVER ALL -- 3065 02:18:33,000 --> 02:18:34,720 >>I CAN COMMENT. 3066 02:18:34,720 --> 02:18:35,480 OTHERS MAY HAVE DIFFERENT 3067 02:18:35,480 --> 02:18:35,840 PERSPECTIVES. 3068 02:18:35,840 --> 02:18:41,480 I THINK WE NEED TO USE THE 3069 02:18:41,480 --> 02:18:44,120 EXPERIENCES OF PARENTS TO TRAIN 3070 02:18:44,120 --> 02:18:45,400 HEALTH CARE PROFESSIONALS. 3071 02:18:45,400 --> 02:18:47,840 WHEN YOU HAIR WHAT WAS HELPFUL 3072 02:18:47,840 --> 02:18:50,120 AND PAINFUL, THAT'S WHAT MAKES 3073 02:18:50,120 --> 02:18:52,160 THE DIFFERENCE FOR THE HEALTH 3074 02:18:52,160 --> 02:18:53,400 CARE PROVIDERS. 3075 02:18:53,400 --> 02:18:55,000 IT'S OFTEN HARD TO REALIZE WHAT 3076 02:18:55,000 --> 02:18:56,000 DO YOU IMPACTS A FAMILY UNTIL 3077 02:18:56,000 --> 02:18:57,160 THEY COME BACK AND TELL YOU. 3078 02:18:57,160 --> 02:19:00,840 I WILL SAY I'VE BEEN IN SETTINGS 3079 02:19:00,840 --> 02:19:02,360 WHERE PARENTS HAVE COME AND 3080 02:19:02,360 --> 02:19:04,560 SPOKE TO DOCTORS AND DOCTORS ARE 3081 02:19:04,560 --> 02:19:05,360 DEFENSIVE ABOUT BEING TOLD 3082 02:19:05,360 --> 02:19:06,640 BECAUSE PATIENTS MAY NOT 3083 02:19:06,640 --> 02:19:09,200 UNDERSTAND THE OTHER SIDE BUT 3084 02:19:09,200 --> 02:19:11,480 THERE'S WAYS TO THOUGHTFULLY AND 3085 02:19:11,480 --> 02:19:12,560 SENSITIVELY BRING THE STORIES 3086 02:19:12,560 --> 02:19:15,120 FOR WARD TO NOT JUST PHYSICIANS 3087 02:19:15,120 --> 02:19:23,800 AND MIDWIVES AND NURSES. 3088 02:19:23,800 --> 02:19:27,800 THE RESEARCH STUDIES ON 3089 02:19:27,800 --> 02:19:29,760 HOSPITALS AND THERE'S A MARKER 3090 02:19:29,760 --> 02:19:32,160 TO INDICATE THERE'S A RAINBOW 3091 02:19:32,160 --> 02:19:36,040 FAMILY. 3092 02:19:36,040 --> 02:19:39,800 SOMEONE MIGHT WALK IN THE ROOM 3093 02:19:39,800 --> 02:19:41,960 AND SAY THINGS LIKE ARE BREAST 3094 02:19:41,960 --> 02:19:42,800 FEEDING, DO YOU WANT SOMETHING 3095 02:19:42,800 --> 02:19:46,520 FOR YOUR BABY, CONGRATULATIONS. 3096 02:19:46,520 --> 02:19:50,080 WE NEED TO MAKE TRAINING MORE 3097 02:19:50,080 --> 02:19:50,720 UNIVERSAL AND WITH THE VOICES OF 3098 02:19:50,720 --> 02:20:00,200 PARENTS. 3099 02:20:00,200 --> 02:20:03,880 >>GIVEN THE IMPLEMENTATION OF 3100 02:20:03,880 --> 02:20:07,040 SOARS IN UTAH DO YOU HAVE 3101 02:20:07,040 --> 02:20:09,160 THOUGHTS HOW IMPACTFUL SOARS HAS 3102 02:20:09,160 --> 02:20:14,400 BEEN IN ADDRESSING THE 3103 02:20:14,400 --> 02:20:24,880 PSYCHOLOGICAL IMPACTS IN -- 3104 02:21:06,680 --> 02:21:08,160 >>WE'VE OFFERED THE PEOPLE WHO 3105 02:21:08,160 --> 02:21:11,240 PARTICIPATE IN SOARS A NO-COST 3106 02:21:11,240 --> 02:21:14,760 CONSULTATION ABOUT THEIR 3107 02:21:14,760 --> 02:21:16,160 STILLBIRTH AND A SUBSET OF 3108 02:21:16,160 --> 02:21:18,360 PATIENTS HAVE DONE THAT AND WE 3109 02:21:18,360 --> 02:21:20,160 CAN ADDRESS THEIR PSYCHOSOCIAL 3110 02:21:20,160 --> 02:21:22,480 NEEDS AND MAKE REFERRALS AND 3111 02:21:22,480 --> 02:21:23,040 ADDRESS THOSE ISSUES. 3112 02:21:23,040 --> 02:21:24,760 FOR THOSE PATIENTS WHO DON'T DO 3113 02:21:24,760 --> 02:21:26,880 THAT IT'S A MATTER OF THEM 3114 02:21:26,880 --> 02:21:28,560 FILLING OUT THE FORMS. 3115 02:21:28,560 --> 02:21:31,880 THE BEAUTY OF SOARS IS WE CAN 3116 02:21:31,880 --> 02:21:32,560 ASK QUESTIONS AND GET 3117 02:21:32,560 --> 02:21:35,960 INFORMATION WE CAN'T OTHERWISE 3118 02:21:35,960 --> 02:21:41,800 GET AND BUT THERE'S AN 3119 02:21:41,800 --> 02:21:47,840 OPPORTUNITY AND SEE PEOPLE OR 3120 02:21:47,840 --> 02:21:51,120 MEETING THEM AT THE POINT OF 3121 02:21:51,120 --> 02:21:53,080 CONTACT WHEN THEY HAVE THEIR 3122 02:21:53,080 --> 02:21:54,960 BABY TO PLUG THEM IN THE 3123 02:21:54,960 --> 02:22:03,840 PSYCHOSOCIAL SUPPORT SERVICES. 3124 02:22:03,840 --> 02:22:05,840 >>WE CAN'T HEAR YOU DR. JAIN. 3125 02:22:05,840 --> 02:22:11,240 >>SINCE WE HAVE YOU ON THE 3126 02:22:11,240 --> 02:22:13,440 SCREEN, OB PROGRAMS ACROSS THE 3127 02:22:13,440 --> 02:22:16,240 COUNTRY DO PRE-DELIVERY 3128 02:22:16,240 --> 02:22:20,160 DEPRESSION SCREENING IN MOTHERS 3129 02:22:20,160 --> 02:22:25,240 TO BE ABLE TO PREDICT HOW BAD 3130 02:22:25,240 --> 02:22:27,680 POSTPARTUM ISSUES ARE GOING TO 3131 02:22:27,680 --> 02:22:29,840 BE WHICH GET EXAGGERATED IN THE 3132 02:22:29,840 --> 02:22:34,240 EVENT OF A DEATH? 3133 02:22:34,240 --> 02:22:37,960 >>I'M NOT 100% SURE BUT I WOULD 3134 02:22:37,960 --> 02:22:40,520 BE FLABBERGASTED IF EVERYONE 3135 02:22:40,520 --> 02:22:42,440 CENTER DOESN'T DO DEPRESSION 3136 02:22:42,440 --> 02:22:42,720 SCREENING. 3137 02:22:42,720 --> 02:22:44,880 WE DO IT AT EVERY SINGLE VISIT 3138 02:22:44,880 --> 02:22:49,840 AND IT'S HARD TO IMAGINE OTHERS 3139 02:22:49,840 --> 02:22:51,680 DON'T AS WELL. 3140 02:22:51,680 --> 02:22:57,840 CERTAINLY KATIE AND JOANNE AND 3141 02:22:57,840 --> 02:22:59,560 OTHERS AND UMA CAN SPEAK TO THAT 3142 02:22:59,560 --> 02:23:00,160 AS WELL. 3143 02:23:00,160 --> 02:23:04,160 >>DR. STONE, HOW ABOUT YOUR 3144 02:23:04,160 --> 02:23:08,640 PROGRAM? 3145 02:23:08,640 --> 02:23:16,720 >>FOR GENERAL OBSTETRICS THEY 3146 02:23:16,720 --> 02:23:19,480 DO IT INITIALLY AND IT'S 3147 02:23:19,480 --> 02:23:22,400 INTERESTING THAT HAS VALUE AND 3148 02:23:22,400 --> 02:23:24,080 POSTPARTUM WE DO TWO WEEKS AND 3149 02:23:24,080 --> 02:23:25,840 SIX WEEKS POSTPARTUM. 3150 02:23:25,840 --> 02:23:30,480 I THINK THE DEPRESSION SCREENING 3151 02:23:30,480 --> 02:23:33,040 IS SO VALUABLE AND IT'S VERY 3152 02:23:33,040 --> 02:23:33,640 DIFFERENT. 3153 02:23:33,640 --> 02:23:34,840 MEDICAID REQUIRES IT AS 3154 02:23:34,840 --> 02:23:36,000 DIFFERENT TIME INTERVALS. 3155 02:23:36,000 --> 02:23:39,200 IF YOU LOOK AT PATIENTS WHO HAVE 3156 02:23:39,200 --> 02:23:44,160 HAD COMMERCIAL INSURANCE THEY 3157 02:23:44,160 --> 02:23:52,760 OFTEN DON'T HAVE IT. 3158 02:23:52,760 --> 02:23:59,160 >>A QUICK COMMENT AS A 3159 02:23:59,160 --> 02:24:09,680 LOGISTICAL THING, IF YOU DID DO 3160 02:24:16,240 --> 02:24:18,600 THE SCREENING AT 28 WEEKS AND 3161 02:24:18,600 --> 02:24:21,160 LATER ON IN THE THIRD TRIMESTER. 3162 02:24:21,160 --> 02:24:26,960 NOT EVERY VISIT BUT WE TRY TO 3163 02:24:26,960 --> 02:24:34,840 GET IT IN IN TERMS OF DR. GOLD, 3164 02:24:34,840 --> 02:24:37,400 YOU DID A PAPER IN 2007, 15 3165 02:24:37,400 --> 02:24:38,800 YEARS AGO WHERE YOU DID 3166 02:24:38,800 --> 02:24:43,600 META-ANALYSIS OF WHAT FAMILIES 3167 02:24:43,600 --> 02:24:48,720 VALUE IN BEREAVEMENT CARE AND 3168 02:24:48,720 --> 02:24:52,400 THAT PAPER IS STILL TRYING TO 3169 02:24:52,400 --> 02:24:53,320 IMPLEMENT WHAT YOU WROTE ABOUT 3170 02:24:53,320 --> 02:24:57,400 HOW TO TAKE CARE OF A FAMILY 3171 02:24:57,400 --> 02:24:59,800 THAT'S SUFFERED A STILLBIRTH. 3172 02:24:59,800 --> 02:25:04,000 TAKING FOOT PRINTS AND TAKING 3173 02:25:04,000 --> 02:25:04,280 PHOTOGRAPHS. 3174 02:25:04,280 --> 02:25:06,120 THE ARTICLE WAS RESEARCH YET THE 3175 02:25:06,120 --> 02:25:11,840 LEVEL OF DETAIL WHEN THERE'S 3176 02:25:11,840 --> 02:25:14,080 BEEN TWIN PREGNANCY AND ONE IS 3177 02:25:14,080 --> 02:25:16,160 STILLBIRTH AND LIVE BIRTH AN 3178 02:25:16,160 --> 02:25:19,720 TAKING PICTURES TOGETHER OF THE 3179 02:25:19,720 --> 02:25:21,200 SIBLINGS TOGETHER. 3180 02:25:21,200 --> 02:25:26,600 IN FORMS OF BEREAVEMENT TRAINING 3181 02:25:26,600 --> 02:25:33,120 THERE'S PLENTY OF PROGRAMS AND 3182 02:25:33,120 --> 02:25:34,640 BEING ABLE TO PROVIDE THE CARE 3183 02:25:34,640 --> 02:25:36,640 NOT JUST IN A BIG ACADEMIC 3184 02:25:36,640 --> 02:25:39,720 HOSPITALS BUT THROUGHOUT THE 3185 02:25:39,720 --> 02:25:39,960 COUNTRY. 3186 02:25:39,960 --> 02:25:43,240 I WANTED TO ACKNOWLEDGE THAT 3187 02:25:43,240 --> 02:25:43,920 PAPER WAS LIKE THE FIRST I HAD 3188 02:25:43,920 --> 02:25:54,240 SEEN AT THE TIME. 3189 02:25:55,680 --> 02:25:56,080 IN THE 3190 02:25:56,080 --> 02:25:57,800 >>IN THE RECENT SURVEY I ASKED 3191 02:25:57,800 --> 02:25:58,760 ABOUT THINGS PATIENTS WANT TO 3192 02:25:58,760 --> 02:26:00,960 TRY TO GET A SENSE OF HOW OFTEN 3193 02:26:00,960 --> 02:26:02,360 THEY'RE GETTING PICTURES OR 3194 02:26:02,360 --> 02:26:04,040 INVITED TO SEE OR HOLD THEIR 3195 02:26:04,040 --> 02:26:04,280 BABY. 3196 02:26:04,280 --> 02:26:06,400 WHAT I FOUND WAS PRONOUNCED 3197 02:26:06,400 --> 02:26:08,600 DIFFERENCES DEPENDING ON THE 3198 02:26:08,600 --> 02:26:14,040 VOLUME OF DELIVERIES OF THE 3199 02:26:14,040 --> 02:26:15,240 HOSPITAL WHICH WAS SURPRISING 3200 02:26:15,240 --> 02:26:16,960 BUT THE FIRST TIME I SAW DATA. 3201 02:26:16,960 --> 02:26:19,120 A BIG ACADEMIC INSTITUTION 3202 02:26:19,120 --> 02:26:21,240 PROBABLY HAS A ROBUST 3203 02:26:21,240 --> 02:26:23,000 BEREAVEMENT PROGRAM AND THEY'RE 3204 02:26:23,000 --> 02:26:24,080 STILL SEEING MORE STILLBIRTHS 3205 02:26:24,080 --> 02:26:27,240 AND CARING FOR MORE COMPLICATED 3206 02:26:27,240 --> 02:26:28,280 PREGNANCIES BUT THERE ARE THINGS 3207 02:26:28,280 --> 02:26:31,120 THAT CAN HAPPEN AT SMALLER LOWER 3208 02:26:31,120 --> 02:26:32,760 VOLUME HOSPITALS THAT ARE NOT 3209 02:26:32,760 --> 02:26:33,760 HIGH COST AND SOMETHING I THINK 3210 02:26:33,760 --> 02:26:36,160 I'D LIKE TO SEE DISSEMINATED AND 3211 02:26:36,160 --> 02:26:37,480 WOULD LIKE TO SEE RESEARCH HOW 3212 02:26:37,480 --> 02:26:46,440 THOSE THINGS IMPACT FAMILIES. 3213 02:26:46,440 --> 02:26:52,280 >>THAT SEEMS LIKE A GOOD WAY TO 3214 02:26:52,280 --> 02:26:56,080 IMPLEMENT THE STUDIES. 3215 02:26:56,080 --> 02:26:59,280 >>I HAVE A QUESTION FOR KATIE 3216 02:26:59,280 --> 02:27:02,080 OR JOANNE AND ANYBODY WHO HAS AN 3217 02:27:02,080 --> 02:27:03,360 ANSWER AND PEOPLE MAY HAVE 3218 02:27:03,360 --> 02:27:09,200 TOUCHED ON THIS BUT IN SOME 3219 02:27:09,200 --> 02:27:11,040 CASES IT SEEMS AS THOUGH WE TALK 3220 02:27:11,040 --> 02:27:12,160 ABOUT BEREAVEMENT AND DEPRESSION 3221 02:27:12,160 --> 02:27:15,200 AND ANXIETY, IT SEEMS AS THOUGH 3222 02:27:15,200 --> 02:27:23,840 A SUBSET OF PATIENTS EXPERIENCE 3223 02:27:23,840 --> 02:27:30,000 PTSD IT SEEMS TO BE WHAT THE 3224 02:27:30,000 --> 02:27:39,800 CRITERIA ARE. 3225 02:27:39,800 --> 02:27:41,840 IT SEEMS THE INTERVENTIONS MAY 3226 02:27:41,840 --> 02:27:43,640 BE APPLICABLE TO THIS 3227 02:27:43,640 --> 02:27:44,160 POPULATION. 3228 02:27:44,160 --> 02:27:46,600 I'D LOVE TO HEAR KATIE AND 3229 02:27:46,600 --> 02:27:48,160 JOANNE AND ANYBODY ELSE WHO HAS 3230 02:27:48,160 --> 02:27:49,240 A THOUGHT ABOUT THAT. 3231 02:27:49,240 --> 02:27:52,160 WOULD LOVE TO HEAR THE OPINION. 3232 02:27:52,160 --> 02:28:02,280 THANKS. 3233 02:28:07,440 --> 02:28:10,280 >>YOU'RE CORRECT A SOCIAL 3234 02:28:10,280 --> 02:28:14,120 WORKER DOES AN ASSESSMENT AND 3235 02:28:14,120 --> 02:28:15,280 WE'LL REFER OUT IF THERE'S 3236 02:28:15,280 --> 02:28:20,160 FURTHER ALARM. 3237 02:28:20,160 --> 02:28:23,800 I THINK THEY'RE SO TRAUMATIZED 3238 02:28:23,800 --> 02:28:30,040 FOR THE NEXT PREGNANCY THE LEVEL 3239 02:28:30,040 --> 02:28:31,760 OF ANXIETY IS SO HIGH AND 3240 02:28:31,760 --> 02:28:34,880 NOTHING WILL TAKE THAT AWAY 3241 02:28:34,880 --> 02:28:37,680 UNTIL THEY DELIVER. 3242 02:28:37,680 --> 02:28:38,760 DELIVERY ISN'T EVERYTHING 3243 02:28:38,760 --> 02:28:40,600 BECAUSE AFTER THE BIRTH IS STILL 3244 02:28:40,600 --> 02:28:43,480 RELIVING A TRAUMA FOR THEM 3245 02:28:43,480 --> 02:28:44,520 THOUGH THEY'RE HAPPY. 3246 02:28:44,520 --> 02:28:48,480 THE PSYCHOSOCIAL SUPPORT IS 3247 02:28:48,480 --> 02:28:49,280 INCREDIBLY IMPORTANT AND AS ALL 3248 02:28:49,280 --> 02:28:51,000 OF YOU HAVE SAID THERE'S SO MANY 3249 02:28:51,000 --> 02:28:53,800 THINGS WE CAN LEARN FROM 3250 02:28:53,800 --> 02:28:56,280 PATIENTS. 3251 02:28:56,280 --> 02:28:58,000 PATIENTS WANT TO KNOW THAT THEIR 3252 02:28:58,000 --> 02:29:03,000 CHILD IS RECOGNIZED. 3253 02:29:03,000 --> 02:29:06,520 THEY WANT YOU TO MENTION AND WE 3254 02:29:06,520 --> 02:29:11,840 ASK WHAT'S THE NAME OF THE CHILD 3255 02:29:11,840 --> 02:29:14,480 AND KEEP IT IN THE CHART TO SAY 3256 02:29:14,480 --> 02:29:16,160 CJ DELIVERED ON THIS DAY. 3257 02:29:16,160 --> 02:29:18,200 WE HAVE IT DOWN TO RECOGNIZE I'M 3258 02:29:18,200 --> 02:29:20,160 SORRY IT MUST BE A DIFFICULT 3259 02:29:20,160 --> 02:29:25,640 TIME BECAUSE WE KNOW THE 3260 02:29:25,640 --> 02:29:36,040 BIRTHDAY'S COMING UP. 3261 02:29:37,040 --> 02:29:43,240 AND THIS IS A LIST OF DOS AND 3262 02:29:43,240 --> 02:29:43,480 DON'TS. 3263 02:29:43,480 --> 02:29:47,160 WE NEED TO DO MORE IN TERMS OF 3264 02:29:47,160 --> 02:29:50,600 IN FIGURING OUT WAYS TO EDUCATE 3265 02:29:50,600 --> 02:29:52,560 PEOPLE AND LETTING THEM KNOW THE 3266 02:29:52,560 --> 02:29:55,760 THINGS IMPORTANT FOR OUR 3267 02:29:55,760 --> 02:29:56,440 PATIENTS WHO HAVE HAD 3268 02:29:56,440 --> 02:29:58,040 STILLBIRTHS AND HOW WE CARE FOR 3269 02:29:58,040 --> 02:29:59,680 THEM IN THE NEXT PREGNANCY. 3270 02:29:59,680 --> 02:30:10,160 THEY HAD A TERRIBLE TRAUMA. 3271 02:30:17,080 --> 02:30:20,160 >>WE LEARNED HAVING HIGH 3272 02:30:20,160 --> 02:30:27,320 ANXIETY IS AN ENORMATIVE 3273 02:30:27,320 --> 02:30:29,160 RESPONSE AND I TALK TO PATIENTS 3274 02:30:29,160 --> 02:30:30,480 ABOUT THAT BEING NORMATIVE AND 3275 02:30:30,480 --> 02:30:30,920 THAT'S OKAY. 3276 02:30:30,920 --> 02:30:33,040 WHAT WE KNOW FROM THE DATA IS 3277 02:30:33,040 --> 02:30:36,800 THAT CAN TENDS TO GET BETTER 3278 02:30:36,800 --> 02:30:38,920 AFTER PEOPLE DELIVER. 3279 02:30:38,920 --> 02:30:41,840 I WORRY ABOUT THE PTSD THAT MAY 3280 02:30:41,840 --> 02:30:42,720 PERSIST AFTER THE SUBSEQUENT 3281 02:30:42,720 --> 02:30:44,520 BIRTH OF A HEALTHY CHILD. 3282 02:30:44,520 --> 02:30:46,040 THERE'S A DIFFERENCE BETWEEN 3283 02:30:46,040 --> 02:30:51,200 NORMAL ANXIETY AFTER A BAD 3284 02:30:51,200 --> 02:30:56,920 OUTCOME AND HAVING PERSISTENT 3285 02:30:56,920 --> 02:30:59,600 PTSD OUTCOMES AND I MENTIONED 3286 02:30:59,600 --> 02:31:07,600 THEIO -- THE YOGA TRIAL AND 3287 02:31:07,600 --> 02:31:09,480 THERE WAS NO CHANGE BUT THERE'S 3288 02:31:09,480 --> 02:31:11,800 LITTLE RESEARCH OUT THERE. 3289 02:31:11,800 --> 02:31:15,960 IT'S A GOOD QUESTION. 3290 02:31:15,960 --> 02:31:22,520 >>MONICA, I KNOW IT'S BEEN A 3291 02:31:22,520 --> 02:31:24,640 LONG SESSION AND WE CAN HAVE AN 3292 02:31:24,640 --> 02:31:25,640 EARLIER BREAK BUT THERE'S 3293 02:31:25,640 --> 02:31:27,400 QUESTIONS IN THE CHAT BOX. 3294 02:31:27,400 --> 02:31:33,560 I WONDER IF SHE'S ABLE TO UNMUTE 3295 02:31:33,560 --> 02:31:35,840 AND GIVE HER THOUGHTS ON THE 3296 02:31:35,840 --> 02:31:36,120 REGISTRY. 3297 02:31:36,120 --> 02:31:41,000 TO DR. BARFIELD, I THINK 3298 02:31:41,000 --> 02:31:46,400 QUESTIONS KEEP COMING BACK TO 3299 02:31:46,400 --> 02:31:50,360 THE IMPORTANCE OF HAVING 3300 02:31:50,360 --> 02:31:55,800 REGIONAL OR NATIONAL REPOSITORY 3301 02:31:55,800 --> 02:32:00,840 OF INFORMATION THAT CAPTURES ALL 3302 02:32:00,840 --> 02:32:01,880 THIS DATA SO MEANINGFUL 3303 02:32:01,880 --> 02:32:05,000 ASSOCIATIONS CAN BE TESTED AND 3304 02:32:05,000 --> 02:32:11,080 IF THERE WERE A DATA BANK A BIO 3305 02:32:11,080 --> 02:32:16,360 REPOSITORY COULD BE MADE FOR 3306 02:32:16,360 --> 02:32:17,240 ADVANCES. 3307 02:32:17,240 --> 02:32:18,600 THANK YOU FOR THE MEANINGFUL 3308 02:32:18,600 --> 02:32:20,160 PRESENTATIONS SO FAR THIS 3309 02:32:20,160 --> 02:32:20,400 MORNING. 3310 02:32:20,400 --> 02:32:23,840 IT'S BEEN VERY NICE TO LISTEN 3311 02:32:23,840 --> 02:32:24,560 TO. 3312 02:32:24,560 --> 02:32:26,280 I THINK MY MAIN POINT I'M TRYING 3313 02:32:26,280 --> 02:32:29,600 TO GET ACROSS IS THE IMPORTANCE 3314 02:32:29,600 --> 02:32:32,520 OF HAVING POPULATION-BASED 3315 02:32:32,520 --> 02:32:34,400 RESEARCH BECAUSE I DO THINK AS 3316 02:32:34,400 --> 02:32:35,040 MENTIONED SEVERAL TIMES THIS 3317 02:32:35,040 --> 02:32:37,440 MORNING IT'S IMPORTANT TO NOT 3318 02:32:37,440 --> 02:32:39,960 ONLY TALK TO WOMEN THAT LOOK 3319 02:32:39,960 --> 02:32:44,240 LIKE ME, WHITE, HIGH EDUCATED. 3320 02:32:44,240 --> 02:32:46,080 I THINK WE CAN ONLY DO THAT IF 3321 02:32:46,080 --> 02:32:47,840 WE START FROM THE FOUNDATION OF 3322 02:32:47,840 --> 02:32:52,000 A POPULATION-BASED REGISTRY. 3323 02:32:52,000 --> 02:32:54,920 WITH THAT THOUGH WE CAN ONLY DO 3324 02:32:54,920 --> 02:32:56,120 THAT IF WE HAVE THE FOUNDATION 3325 02:32:56,120 --> 02:32:58,320 OF IDENTIFYING CAUSES AND 3326 02:32:58,320 --> 02:32:59,840 GETTING THE AUTOPSIES AT BIRTH 3327 02:32:59,840 --> 02:33:01,720 AND THE INFORMATION IN THE 3328 02:33:01,720 --> 02:33:07,080 MEDICAL RECORD IN A WAY THAT 3329 02:33:07,080 --> 02:33:10,120 THEN WE CAN BUILD A STILLBIRTH 3330 02:33:10,120 --> 02:33:11,840 REGISTRY ON TOP OF THAT BUT IT 3331 02:33:11,840 --> 02:33:13,760 WOULD OFFER OPPORTUNITIES TO 3332 02:33:13,760 --> 02:33:16,160 LOOK BACK THE WORK THAT I'VE 3333 02:33:16,160 --> 02:33:20,600 DONE AT CDC LOOKING AT POTENTIAL 3334 02:33:20,600 --> 02:33:22,200 CAUSES OF STILLBIRTH AND ALSO DO 3335 02:33:22,200 --> 02:33:23,400 THE IMPORTANT WORK IN FOLLOWING 3336 02:33:23,400 --> 02:33:27,400 UP AND SEEING HOW THE EXPERIENCE 3337 02:33:27,400 --> 02:33:29,960 OF THESE WOMEN HAVE BEEN AND 3338 02:33:29,960 --> 02:33:31,680 WHAT ARE EXPERIENCES DIFFERENT 3339 02:33:31,680 --> 02:33:34,320 WOMEN FACE AS THEY HAVE A 3340 02:33:34,320 --> 02:33:39,720 STILLBIRTH AND SO BUT I DO THINK 3341 02:33:39,720 --> 02:33:45,360 IT HAS TO START WITH A REGISTRY. 3342 02:33:45,360 --> 02:33:46,320 >>YOU BRING UP IMPORTANT 3343 02:33:46,320 --> 02:33:46,760 POINTS. 3344 02:33:46,760 --> 02:33:48,360 IT WOULD ALSO BE GOOD TO HEAR 3345 02:33:48,360 --> 02:33:53,720 FROM SOME OF THE OTHER PANELISTS 3346 02:33:53,720 --> 02:33:55,000 ABOUT WHAT THAT PROCESS 3347 02:33:55,000 --> 02:33:55,240 INVOLVES. 3348 02:33:55,240 --> 02:34:00,640 WE TALKED ABOUT TRAINING AND 3349 02:34:00,640 --> 02:34:02,640 HONESTLY WE'D LOVE IT TO BE A 3350 02:34:02,640 --> 02:34:04,200 SCIENCE BUT IT'S A LOT OF ART. 3351 02:34:04,200 --> 02:34:09,480 THERE'S MODELLING AND TEACHING 3352 02:34:09,480 --> 02:34:14,080 AN TRAINING THE CIRCUMSTANCES 3353 02:34:14,080 --> 02:34:16,680 AND THERE COULD NECESSITATE A 3354 02:34:16,680 --> 02:34:19,000 HANDOFF BETWEEN THE OBSTETRICAL 3355 02:34:19,000 --> 02:34:20,720 SIDE AND FOLLOWING UP FOR OTHERS 3356 02:34:20,720 --> 02:34:22,080 IN PRIMARY CARE SETTINGS. 3357 02:34:22,080 --> 02:34:27,880 WHERE ARE THE PEOPLE WHO ARE 3358 02:34:27,880 --> 02:34:29,840 ALSO LEARNING THE EXTENT AND 3359 02:34:29,840 --> 02:34:32,160 LENGTH OF TIME THAT NEEDS TO 3360 02:34:32,160 --> 02:34:38,280 OCCUR SO PEOPLE CAN IDENTIFY 3361 02:34:38,280 --> 02:34:41,480 THESE EVENTS AND NOT ONLY THE 3362 02:34:41,480 --> 02:34:42,440 DIVERSITY IN THE WOMEN WE'RE 3363 02:34:42,440 --> 02:34:43,800 SEEING OR THE FAMILIES WE'RE 3364 02:34:43,800 --> 02:34:48,000 SEEING BUT THE DIVERSITY IN 3365 02:34:48,000 --> 02:34:54,040 THOSE WHO MAKE INPUT IN DATA 3366 02:34:54,040 --> 02:34:54,360 COLLECTION. 3367 02:34:54,360 --> 02:34:56,080 THOSE WHO EXPERIENCED STILLBIRTH 3368 02:34:56,080 --> 02:34:57,480 OR INVOLVED IN COMMITTEES OR 3369 02:34:57,480 --> 02:34:58,840 GROUPS FOR DATA COLLECTION 3370 02:34:58,840 --> 02:35:01,880 TRYING TO MAKE SURE THAT THERE'S 3371 02:35:01,880 --> 02:35:02,160 DIVERSITY. 3372 02:35:02,160 --> 02:35:04,160 WE'VE LEARNED A LOT FROM 3373 02:35:04,160 --> 02:35:07,240 MATERNAL MORTALITY REVIEW 3374 02:35:07,240 --> 02:35:07,520 COMMITTEE. 3375 02:35:07,520 --> 02:35:12,320 THEY'RE VERY DIVERSE AND INCLUDE 3376 02:35:12,320 --> 02:35:17,240 COMMUNITY ENGAGEMENT AND EQUAL 3377 02:35:17,240 --> 02:35:18,760 SPACE TO HEAR FROM THE VOICES OF 3378 02:35:18,760 --> 02:35:20,200 COMMUNITY AND THOSE WHO MAY HAVE 3379 02:35:20,200 --> 02:35:26,240 HAD THE SIMILAR EXPERIENCES. 3380 02:35:26,240 --> 02:35:28,680 SO YOUR DATA IS MORE ROBUST 3381 02:35:28,680 --> 02:35:32,000 BECAUSE WE'VE BEEN TALKING ABOUT 3382 02:35:32,000 --> 02:35:32,920 THIS FOR A MINUTE. 3383 02:35:32,920 --> 02:35:35,040 DATA IS LACKING AND MISSING. 3384 02:35:35,040 --> 02:35:38,480 PART IS BECAUSE OF 3385 02:35:38,480 --> 02:35:38,800 PARTICIPATION. 3386 02:35:38,800 --> 02:35:41,240 WHAT ARE THE ISSUES WE NEED TO 3387 02:35:41,240 --> 02:35:43,240 IDENTIFY SO THAT WHEN WE DO 3388 02:35:43,240 --> 02:35:44,880 THINK ABOUT REGISTRIES, WE DO 3389 02:35:44,880 --> 02:35:47,960 THINK ABOUT DATA LINKAGE WE HAVE 3390 02:35:47,960 --> 02:35:52,120 DATA TO LINK. 3391 02:35:52,120 --> 02:35:56,160 >>COULD STILL BIRTH BE A 3392 02:35:56,160 --> 02:35:59,840 REPORTABLE EVENT WHICH MANDATES 3393 02:35:59,840 --> 02:36:04,600 DATA GATHERING? 3394 02:36:04,600 --> 02:36:05,920 >>THERE ARE CHALLENGES WITH 3395 02:36:05,920 --> 02:36:09,120 MANDATED REPORTING AND IN SOME 3396 02:36:09,120 --> 02:36:14,240 STATES THERE ARE EVEN CHALLENGES 3397 02:36:14,240 --> 02:36:19,520 IN REPORTING MAYBE NOT 3398 02:36:19,520 --> 02:36:20,200 NECESSARILY REPORTING BUT 3399 02:36:20,200 --> 02:36:21,440 OBTAINING THE DATA FOR USE. 3400 02:36:21,440 --> 02:36:22,000 LEGAL RESTRICTIONS. 3401 02:36:22,000 --> 02:36:26,800 >>GOT IT. 3402 02:36:26,800 --> 02:36:28,160 UNFORTUNATELY THAT MAY NOT BE 3403 02:36:28,160 --> 02:36:33,760 THE CASE AND GIVEN THE BREADTH 3404 02:36:33,760 --> 02:36:36,000 OF DIVERSITY OF JURISDICTIONS IS 3405 02:36:36,000 --> 02:36:40,040 NOT ALWAYS MET EAGERLY. 3406 02:36:40,040 --> 02:36:44,480 THE OPPORTUNITY IN TERMS OF HOW 3407 02:36:44,480 --> 02:36:48,160 DO WE MAKE THIS NOT A FORCED 3408 02:36:48,160 --> 02:36:51,040 EXERCISE BUT AN EXERCISE WHERE 3409 02:36:51,040 --> 02:36:53,840 INFORMATION'S READILY AVAILABLE 3410 02:36:53,840 --> 02:36:58,480 AND ABLE TO BE COLLECTED AGAIN 3411 02:36:58,480 --> 02:36:59,840 AT APPROPRIATE TIMES AND MORE 3412 02:36:59,840 --> 02:37:02,360 BROADLY. 3413 02:37:02,360 --> 02:37:04,680 AND THAT DOES REQUIRE RESOURCES. 3414 02:37:04,680 --> 02:37:11,640 DATA COLLECTION ISN'T SEXY. 3415 02:37:11,640 --> 02:37:15,400 AND IT REQUIRES TIME, ENERGY, 3416 02:37:15,400 --> 02:37:23,720 SUPPORT, DEDICATION, TRAINING. 3417 02:37:23,720 --> 02:37:26,440 FOR FAR TOO LONG WE HAVEN'T 3418 02:37:26,440 --> 02:37:31,680 GIVEN IT THE ATTENTION IT 3419 02:37:31,680 --> 02:37:31,920 DESERVES. 3420 02:37:31,920 --> 02:37:40,760 >>WE DO NEED TO DO IT SEVERAL 3421 02:37:40,760 --> 02:37:41,360 YEARS. 3422 02:37:41,360 --> 02:37:43,920 >>I WISH DR. JOANNE CACCIATORE 3423 02:37:43,920 --> 02:37:45,240 WAS HERE AS WELL. 3424 02:37:45,240 --> 02:37:50,360 I HAD SEVERAL QUESTIONS FOR HER. 3425 02:37:50,360 --> 02:37:54,360 PERHAPS WE CAN BRING THOSE UP IN 3426 02:37:54,360 --> 02:37:57,000 OUR PRIVATE CONVERSATIONS WITH 3427 02:37:57,000 --> 02:38:02,440 HER SO THEY BECOME A PART OF THE 3428 02:38:02,440 --> 02:38:04,160 REPORT BECAUSE HER PRESENTATION 3429 02:38:04,160 --> 02:38:12,480 WAS WAS POWERFUL AND KEEPING THE 3430 02:38:12,480 --> 02:38:14,480 THEME THIS IS SUCH A TRAUMATIC 3431 02:38:14,480 --> 02:38:16,160 EVENT AND THE THEME OF 3432 02:38:16,160 --> 02:38:20,160 PSYCHOLOGICAL IMPACT AND 3433 02:38:20,160 --> 02:38:22,000 IMPLICATIONS FOR TREATMENT OF 3434 02:38:22,000 --> 02:38:23,280 MOTHERS WHO GO THROUGH 3435 02:38:23,280 --> 02:38:23,840 STILLBIRTH. 3436 02:38:23,840 --> 02:38:27,720 JOANNE REFLECTED HER PERSONAL 3437 02:38:27,720 --> 02:38:28,400 EXPERIENCE AS WELL AS THAT OF AN 3438 02:38:28,400 --> 02:38:37,080 EXPERT IN THE AREA. 3439 02:38:37,080 --> 02:38:40,160 WE'RE BEFORE TO BREAK BUT I SEE 3440 02:38:40,160 --> 02:38:43,440 GOOD GOLD'S HANDS RAISED AND SEE 3441 02:38:43,440 --> 02:38:44,280 IF THERE'S SOMETHING MORE BEFORE 3442 02:38:44,280 --> 02:38:54,440 WE BREAK. 3443 02:38:54,440 --> 02:38:56,200 >>AS A RESEARCHER I'M LOOKING 3444 02:38:56,200 --> 02:38:59,000 FOR REPRODUCTIVE OUTCOMES AND 3445 02:38:59,000 --> 02:38:59,680 MENTAL HEALTH DATA AND IT'S HARD 3446 02:38:59,680 --> 02:39:04,920 TO FIND. 3447 02:39:04,920 --> 02:39:07,720 I CAN FIND IF A PERSON'S 3448 02:39:07,720 --> 02:39:11,440 PREGNANT BUT NOT THE OUTCOME OR 3449 02:39:11,440 --> 02:39:13,720 HOW MANY KIDS SHE'S HAD BUT NOT 3450 02:39:13,720 --> 02:39:15,960 IF SHE'S HAD A STILLBIRTH OR 3451 02:39:15,960 --> 02:39:18,840 INFANT DEATH AND GOING FORWARD 3452 02:39:18,840 --> 02:39:25,360 AND FOR EVACUATED -- CDC 3453 02:39:25,360 --> 02:39:27,720 THINKING OF PREGNANCY OUTCOMES 3454 02:39:27,720 --> 02:39:29,200 AND VARIABLES IN THE DATA SETS 3455 02:39:29,200 --> 02:39:30,680 EVEN IF IT'S ONLY A COUPLE 3456 02:39:30,680 --> 02:39:31,840 QUESTIONS WOULD BE HELPFUL IN 3457 02:39:31,840 --> 02:39:35,440 MOVING OUR ABILITY TO LOOK AT 3458 02:39:35,440 --> 02:39:45,960 BIG POPULATION-BASED DATA SETS. 3459 02:39:46,760 --> 02:39:47,880 >>WE HAVE TALKED BIG 3460 02:39:47,880 --> 02:39:50,760 DR. BARFIELD'S DIVISION IN 3461 02:39:50,760 --> 02:40:01,280 TRYING TO ESTABLISH THE LINK. 3462 02:40:06,840 --> 02:40:08,840 AND WE WERE LOOKING AT THIS 3463 02:40:08,840 --> 02:40:10,120 BEFORE COVID HAPPENED AND 3464 02:40:10,120 --> 02:40:12,600 SOMETHING I'M EAGER TO GET BACK 3465 02:40:12,600 --> 02:40:14,960 TO IS ESTABLISH THE CONNECTION 3466 02:40:14,960 --> 02:40:18,960 BETWEEN THOSE TWO ENTITIES THAT 3467 02:40:18,960 --> 02:40:20,120 SO CLOSELY BELONG TOGETHER. 3468 02:40:20,120 --> 02:40:22,600 THANK YOU. 3469 02:40:22,600 --> 02:40:25,200 >>GO AHEAD. 3470 02:40:25,200 --> 02:40:28,160 >>AND TO PIGGYBACK, I THINK YOU 3471 02:40:28,160 --> 02:40:29,840 GUYS ARE ON TRACK WITH THE 3472 02:40:29,840 --> 02:40:31,760 IMPORTANCE OF DATA. 3473 02:40:31,760 --> 02:40:35,040 I KNOW FROM THE PRAMS SIDE ONE 3474 02:40:35,040 --> 02:40:37,720 OF THE OPPORTUNITIES FOR MAKING 3475 02:40:37,720 --> 02:40:38,600 DATA A LITTLE BIT MORE AVAILABLE 3476 02:40:38,600 --> 02:40:42,640 IS OUR EFFORTS TO HAVE AN 3477 02:40:42,640 --> 02:40:43,880 AUTOMATED RESEARCH FILE WHERE 3478 02:40:43,880 --> 02:40:45,760 RESEARCHERS CAN BASICALLY 3479 02:40:45,760 --> 02:40:47,840 DOWNLOAD THE DATA SETS. 3480 02:40:47,840 --> 02:40:51,400 WE'LL HAVE SOME OF THE PRAMS 3481 02:40:51,400 --> 02:40:53,120 MENTAL CONDITIONS FOR THOSE THAT 3482 02:40:53,120 --> 02:40:54,160 HAVE DELIVERED A LIVE BIRTH. 3483 02:40:54,160 --> 02:40:57,520 AT THIS POINT THERE'S NOT A PLAN 3484 02:40:57,520 --> 02:40:59,520 FOR ADDING FETAL DEATHS TO THAT 3485 02:40:59,520 --> 02:41:00,760 BUT THAT'S BECAUSE I THINK THAT 3486 02:41:00,760 --> 02:41:04,520 WAS A STATE-BASED DECISION. 3487 02:41:04,520 --> 02:41:08,160 ADDITIONALLY, WE ALSO HAVE 3488 02:41:08,160 --> 02:41:16,800 QUESTIONS ON PRAMS AND SOARS 3489 02:41:16,800 --> 02:41:18,160 THAT CAN BE COMBINED AND LOOKED 3490 02:41:18,160 --> 02:41:18,720 AT FOR ASSESSING ANY OF THE 3491 02:41:18,720 --> 02:41:27,920 OUTCOMES. 3492 02:41:27,920 --> 02:41:29,840 >>IT'S A GREAT DISCUSSION FOR 3493 02:41:29,840 --> 02:41:30,320 ANSWERING THE CHARGE WE 3494 02:41:30,320 --> 02:41:36,640 REQUESTED. 3495 02:41:36,640 --> 02:41:40,360 IF THAT'S OKAY WE'LL ADD AROUND 3496 02:41:40,360 --> 02:41:41,760 15, 17 MINUTES BREAK AND COME 3497 02:41:41,760 --> 02:41:43,600 BACK AT 2:00. 3498 02:41:43,600 --> 02:41:45,000 YOU CAN LEAVE YOUR WEB ON AND 3499 02:41:45,000 --> 02:41:51,520 COME BACK AND WE'LL START WITH 3500 02:41:51,520 --> 02:41:58,280 OUR SECOND PART WITH THE KNOWN 3501 02:41:58,280 --> 02:41:59,360 RISK FACTOR FOR STILLBIRTH. 3502 02:41:59,360 --> 02:42:01,320 I WANT TO THANK THE SPEAKERS FOR 3503 02:42:01,320 --> 02:42:06,520 THE GREAT FIRST PANEL. 3504 02:42:06,520 --> 02:42:07,400 >>HI, EVERYONE. 3505 02:42:07,400 --> 02:42:09,560 I HOPE YOU HAD A CHANCE FOR A 3506 02:42:09,560 --> 02:42:09,960 BREAK. 3507 02:42:09,960 --> 02:42:15,280 I KNOW IT WAS AN INSIGHTFUL WE 3508 02:42:15,280 --> 02:42:17,440 HAD AND WORKING ON PANEL 2 THE 3509 02:42:17,440 --> 02:42:21,920 KNOWN RISK FACTOR FOR 3510 02:42:21,920 --> 02:42:24,800 STILLBIRTH. 3511 02:42:24,800 --> 02:42:26,880 WE'RE OPEN FOR DISCUSSION AND 3512 02:42:26,880 --> 02:42:30,760 WE'LL WORK WITH THAT DISCUSSION. 3513 02:42:30,760 --> 02:42:36,200 OUR FIRST SPEAKER IS DR. SILVER 3514 02:42:36,200 --> 02:42:40,080 THE CHAIR OF THE DEPARTMENT OF 3515 02:42:40,080 --> 02:42:42,680 OBSTETRICS DEPARTMENT OF THE 3516 02:42:42,680 --> 02:42:43,800 UNIVERSITY OF UTAH. 3517 02:42:43,800 --> 02:42:48,600 THANK YOU, DR. SILVER. 3518 02:42:48,600 --> 02:42:51,800 >>THANK YOU FOR INVITING ME AND 3519 02:42:51,800 --> 02:42:56,840 THE TOPIC IS BROAD AND THE TIME 3520 02:42:56,840 --> 02:42:58,000 IS A LITTLE BIT CUT DOWN BECAUSE 3521 02:42:58,000 --> 02:43:01,480 I'LL TALK ABOUT INFECTION LATER 3522 02:43:01,480 --> 02:43:01,640 ON. 3523 02:43:01,640 --> 02:43:03,880 I CAN JUST GIVE AN OVERVIEW AND 3524 02:43:03,880 --> 02:43:11,160 WILL TRY TO FOCUS ON THEMES THAT 3525 02:43:11,160 --> 02:43:15,320 RECU CUCUR AND GO INTO RISK FAC 3526 02:43:15,320 --> 02:43:16,040 THAT ARE OF INTEREST AND 3527 02:43:16,040 --> 02:43:18,120 CONTROVERSY SO IF I MISS YOUR 3528 02:43:18,120 --> 02:43:19,880 FAVORITE RISK FACTOR, APOLOGIZE 3529 02:43:19,880 --> 02:43:20,840 AND ASK ABOUT IT DURING THE 3530 02:43:20,840 --> 02:43:27,920 QUESTIONS. 3531 02:43:27,920 --> 02:43:35,880 ONE WAY TO THINK ABOUT RISK 3532 02:43:35,880 --> 02:43:38,400 FACTORS IS WE HAVE CAUSES AND 3533 02:43:38,400 --> 02:43:39,720 STILLBIRTHS BUT YOU CAN'T 3534 02:43:39,720 --> 02:43:41,200 DISTINGUISH BETWEEN THEM WITH 3535 02:43:41,200 --> 02:43:43,120 100% CERTAINTY. 3536 02:43:43,120 --> 02:43:47,120 AND THERE'S A LOT OF OVERLAP. 3537 02:43:47,120 --> 02:43:54,040 AND RISK FACTORS CAN BE DEFINED 3538 02:43:54,040 --> 02:43:59,520 AS MATERNAL I'M MISSING THE 3539 02:43:59,520 --> 02:44:01,160 BOTTOM OF THE SCREEN IN MY VIEW. 3540 02:44:01,160 --> 02:44:05,720 THEY CAN BE DEFINED AS MATERNAL 3541 02:44:05,720 --> 02:44:06,600 CHARACTERISTICS WITHOUT AN 3542 02:44:06,600 --> 02:44:07,480 UNKNOWN CAUSAL PATHWAY LEADING 3543 02:44:07,480 --> 02:44:08,920 TO DEATH AND THAT'S TRUE IN SOME 3544 02:44:08,920 --> 02:44:18,560 CASES BUT NOT ALL CASES THEY 3545 02:44:18,560 --> 02:44:20,440 ALSO IN OBESITY AND MATERNAL AGE 3546 02:44:20,440 --> 02:44:24,560 AND THAT'S FOR OTHER CAUSES AS 3547 02:44:24,560 --> 02:44:27,920 WELL AND DOWN SYNDROME IS A 3548 02:44:27,920 --> 02:44:28,840 CAUSE OF LIVE BIRTH. 3549 02:44:28,840 --> 02:44:36,000 THERE'S A LOT OF OVERLAP. 3550 02:44:36,000 --> 02:44:40,520 IN THE SERN STUDY YOU CAN GROUP 3551 02:44:40,520 --> 02:44:46,520 THE CAUSES OF DEATH INTO BROADER 3552 02:44:46,520 --> 02:44:50,040 GROUPS AND TO GIVE A FRAMEWORK, 3553 02:44:50,040 --> 02:44:55,560 A THIRD ARE PLACENTAL CAUSES AND 3554 02:44:55,560 --> 02:44:59,400 10% OR 15% ARE FETAL PROBLEMS 3555 02:44:59,400 --> 02:45:03,960 INTRINSICALLY OR MALFORMATIONS, 3556 02:45:03,960 --> 02:45:05,960 INFECTION AND MEDICAL 3557 02:45:05,960 --> 02:45:08,800 COMPLICATIONS LIKE DIABETES OR 3558 02:45:08,800 --> 02:45:10,560 THE UMBILICAL OR HYPERTENSIVE 3559 02:45:10,560 --> 02:45:19,240 DISORDERS. 3560 02:45:19,240 --> 02:45:21,040 YOU CAN ALSO LOOK AT THOSE 3561 02:45:21,040 --> 02:45:22,520 MATERNAL AND FETAL OR 3562 02:45:22,520 --> 02:45:24,960 ENVIRONMENTAL. 3563 02:45:24,960 --> 02:45:26,840 ANOTHER WAY TO THINK ABOUT IT IS 3564 02:45:26,840 --> 02:45:32,520 THOSE READILY OBTAINED AND THEY 3565 02:45:32,520 --> 02:45:34,840 CAN BE USED FOR PREDICTION AND 3566 02:45:34,840 --> 02:45:36,160 ROUTINELY ASSESSED AND OTHER 3567 02:45:36,160 --> 02:45:37,560 RISK FACTORS YOU'D HAVE TO DO 3568 02:45:37,560 --> 02:45:40,520 ADDITIONAL TESTING AND OBTAIN 3569 02:45:40,520 --> 02:45:41,840 ADDITIONAL INFORMATION NOT 3570 02:45:41,840 --> 02:45:44,240 ROUTINELY ASSESSED. 3571 02:45:44,240 --> 02:45:46,440 A DIFFERENT WAY TO THINK ABOUT 3572 02:45:46,440 --> 02:45:50,160 IT I FIND USEFUL IS WHAT'S THE 3573 02:45:50,160 --> 02:45:51,520 PURPOSE OF ASSESSING RISK 3574 02:45:51,520 --> 02:45:53,040 FACTORS, WHY SHOULD WE TALK 3575 02:45:53,040 --> 02:45:58,240 ABOUT THIS IN THE FIRST PLACE? 3576 02:45:58,240 --> 02:46:04,840 THE REASON THE EPIDEMIOLOGIC 3577 02:46:04,840 --> 02:46:07,600 REASONS ARE IMPORTANT AND YOU 3578 02:46:07,600 --> 02:46:09,040 HAVE TOBACCO AND SMOKE CESSATION 3579 02:46:09,040 --> 02:46:12,840 AND TO USE IT FOR PREDICTION OF 3580 02:46:12,840 --> 02:46:14,480 STILLBIRTH. 3581 02:46:14,480 --> 02:46:15,720 THAT CAN LEAD TO RISK 3582 02:46:15,720 --> 02:46:16,840 STRATIFICATION AND MANAGEMENT 3583 02:46:16,840 --> 02:46:19,200 INTERVENTIONS WITH HOPES OF 3584 02:46:19,200 --> 02:46:19,920 DECREASING THE RISK OF 3585 02:46:19,920 --> 02:46:21,360 STILLBIRTH FROM MEDICATIONS, 3586 02:46:21,360 --> 02:46:25,280 TESTING AND DELIVERY AND I THINK 3587 02:46:25,280 --> 02:46:28,440 RISK FACTORS CAN PROVIDE CLEARS 3588 02:46:28,440 --> 02:46:30,080 TO THE PATHOPHYSIOLOGY OF 3589 02:46:30,080 --> 02:46:30,360 STILLBIRTH. 3590 02:46:30,360 --> 02:46:32,840 IF WE ASK WHY IS THIS A RISK 3591 02:46:32,840 --> 02:46:35,520 FACTOR MAYBE WE'LL FIND A 3592 02:46:35,520 --> 02:46:37,120 PATHWAY TO STILLBIRTH AND CAN 3593 02:46:37,120 --> 02:46:39,760 IDENTIFY NOVEL THERAPEUTIC THAT 3594 02:46:39,760 --> 02:46:40,040 ARE GETS. 3595 02:46:40,040 --> 02:46:42,680 -- TARGETS. 3596 02:46:42,680 --> 02:46:45,400 THE NEXT FEW SLIDES ARE A 3597 02:46:45,400 --> 02:46:47,440 COALITION OF STILLBIRTH RISK 3598 02:46:47,440 --> 02:46:47,720 FACTORS. 3599 02:46:47,720 --> 02:46:50,440 I'LL SPARE GOING OVER IT IN 3600 02:46:50,440 --> 02:46:54,960 DETAIL BECAUSE IT WOULD BE LIKE 3601 02:46:54,960 --> 02:46:56,240 READING THE DICTIONARY BUT 3602 02:46:56,240 --> 02:46:57,720 ANOTHER FRAMEWORK FOR THINKING 3603 02:46:57,720 --> 02:46:58,520 ABOUT THESE. 3604 02:46:58,520 --> 02:47:00,360 IF WE LOOK AT RISK FACTORS IT'S 3605 02:47:00,360 --> 02:47:05,880 IMPORTANT TO THINK HOW COMMON IS 3606 02:47:05,880 --> 02:47:11,040 THE CONDITION AND HOW PROFOUND 3607 02:47:11,040 --> 02:47:12,720 IS THE RISK FACTOR. 3608 02:47:12,720 --> 02:47:14,440 IF YOU HAVE IT HOW MORE LIKELY 3609 02:47:14,440 --> 02:47:16,520 ARE YOU TO HAVE STILLBIRTH THAN 3610 02:47:16,520 --> 02:47:19,240 WITHOUT A RISK FACTOR AND WE 3611 02:47:19,240 --> 02:47:20,680 HAVE SMOKING AND OBESITY WHICH 3612 02:47:20,680 --> 02:47:22,440 ARE QUITE COMMON THOUGH THEY 3613 02:47:22,440 --> 02:47:24,240 ONLY INFECTIOUS THE RISK OF 3614 02:47:24,240 --> 02:47:26,200 STILLBIRTH A LITTLE BIT. 3615 02:47:26,200 --> 02:47:27,040 I WON'T TALK ABOUT OBESITY 3616 02:47:27,040 --> 02:47:28,800 BECAUSE THAT WILL BE THE SUBJECT 3617 02:47:28,800 --> 02:47:30,520 OF THE NEXT TALK IN DETAIL. 3618 02:47:30,520 --> 02:47:32,840 LOW EDUCATION. 3619 02:47:32,840 --> 02:47:34,640 I WANT TO PAY ATTENTION TO THE 3620 02:47:34,640 --> 02:47:36,040 PRIOR FETAL GROWTH RESTRICTION. 3621 02:47:36,040 --> 02:47:41,720 THE REASON IS NOT THAT THAT'S A 3622 02:47:41,720 --> 02:47:43,040 PROFOUND FACTOR BUT WHEN WE 3623 02:47:43,040 --> 02:47:45,080 STUDY STILLBIRTH WE STUDY ALL 3624 02:47:45,080 --> 02:47:48,360 ADVERSE PREGNANCY OUTCOMES AND 3625 02:47:48,360 --> 02:47:49,560 THE HISTORY OF ANY ADVERSE 3626 02:47:49,560 --> 02:47:52,240 OUTCOME LEADS TO A RISK OF 3627 02:47:52,240 --> 02:47:53,800 STILLBIRTH AND OTHER ADVERSE 3628 02:47:53,800 --> 02:47:56,800 PREGNANCY OUTCOMES AND YOU'RE AN 3629 02:47:56,800 --> 02:47:58,200 INCREASED RISK OF SUBSEQUENT 3630 02:47:58,200 --> 02:48:02,800 PREGNANCY OUTCOMES. 3631 02:48:02,800 --> 02:48:08,400 WE'RE STUDYING ALL OBSTETRIC 3632 02:48:08,400 --> 02:48:08,840 COMPLICATIONS. 3633 02:48:08,840 --> 02:48:13,840 WE HAVE GESTATION AND RACE AND 3634 02:48:13,840 --> 02:48:16,600 THINGS LIKE MEDICAL CONDITIONS 3635 02:48:16,600 --> 02:48:21,800 AND CHRONIC HYPERTENSION AND 3636 02:48:21,800 --> 02:48:25,720 DIABETES AND HYPERTENSIVE 3637 02:48:25,720 --> 02:48:28,520 CONDITIONS AND GESTATIONAL 3638 02:48:28,520 --> 02:48:38,680 DIABETES. 3639 02:48:39,920 --> 02:48:45,680 YOU'VE HEARD TALKS ABOUT 3640 02:48:45,680 --> 02:48:49,040 DISPARITIES AND RATES IN 3641 02:48:49,040 --> 02:48:49,680 NON-HISPANIC BLACK WOMEN ARE 3642 02:48:49,680 --> 02:48:53,880 TWICE AS HIGH AS OTHERS. 3643 02:48:53,880 --> 02:48:55,520 I THINK ILLINOIS STRAIGHTS HOW 3644 02:48:55,520 --> 02:49:01,640 TO USE THIS TO GET AT 3645 02:49:01,640 --> 02:49:02,000 PATHOPHYSIOLOGY. 3646 02:49:02,000 --> 02:49:05,000 AND IF YOU'RE BLACK HIGHER 3647 02:49:05,000 --> 02:49:08,680 PROPORTION OF STILLBIRTHS WERE 3648 02:49:08,680 --> 02:49:10,920 DUE TO COMPLICATIONS OR 3649 02:49:10,920 --> 02:49:12,360 INFECTION DUE TO OTHER RACE OR 3650 02:49:12,360 --> 02:49:12,640 ETHNICITY. 3651 02:49:12,640 --> 02:49:15,440 THAT'S HOW WE CAN USE THE RISK 3652 02:49:15,440 --> 02:49:19,280 FACTORS TO DRILL DOWN AND IN 3653 02:49:19,280 --> 02:49:20,840 TERMS OF HOW TO BE BETTER ABOUT 3654 02:49:20,840 --> 02:49:28,560 STILLBIRTHS. 3655 02:49:28,560 --> 02:49:31,480 THIS SHOWS AGES ASSOCIATED AND 3656 02:49:31,480 --> 02:49:35,080 35 TO 39 IS 1.3 AND OVER 4 IS 3657 02:49:35,080 --> 02:49:35,480 1.7. 3658 02:49:35,480 --> 02:49:38,080 THERE ARE THINGS IF YOU'RE OLDER 3659 02:49:38,080 --> 02:49:40,360 OR MORE LIKELY TO HAVE 3660 02:49:40,360 --> 02:49:43,920 COMORBIDITIES BUT IF YOU ADJUST 3661 02:49:43,920 --> 02:49:44,840 FOR THOSE THINGS THE 3662 02:49:44,840 --> 02:49:48,440 RELATIONSHIP HOLDS. 3663 02:49:48,440 --> 02:49:51,240 THERE WAS A RANDOMIZED TRIAL 3664 02:49:51,240 --> 02:49:54,080 DONE RELATIVELY RECENTLY. 3665 02:49:54,080 --> 02:49:55,720 THEY TOOK PATIENTS OVER 35 YEARS 3666 02:49:55,720 --> 02:49:59,160 OF AGE AND INDUCED THEM AT 39 3667 02:49:59,160 --> 02:49:59,800 WEEKS OR EXPECT ANALLY MANAGED 3668 02:49:59,800 --> 02:50:04,840 THEM. 3669 02:50:04,840 --> 02:50:05,920 THERE WAS BASICALLY NO 3670 02:50:05,920 --> 02:50:06,760 DIFFERENCE IN THE GROUPS. 3671 02:50:06,760 --> 02:50:08,080 IT WAS A RELATIVELY SMALL NUMBER 3672 02:50:08,080 --> 02:50:15,760 OF PATIENTS. 3673 02:50:15,760 --> 02:50:19,960 THE REASON I WANTED TO SHOW THAT 3674 02:50:19,960 --> 02:50:23,280 SLIDE IS WE HAVE RISK FACTORS 3675 02:50:23,280 --> 02:50:28,840 AND THEN MEDICAL INTERVENTIONS 3676 02:50:28,840 --> 02:50:31,920 THAT ALTER RISK IT CAN CHANGE 3677 02:50:31,920 --> 02:50:33,760 OVER TIME AND WAS INTERESTING IN 3678 02:50:33,760 --> 02:50:35,520 THE TALK MOST RECENT STUDIES 3679 02:50:35,520 --> 02:50:37,480 DIDN'T SHOW IT TO BE A RISK 3680 02:50:37,480 --> 02:50:37,720 FACTOR. 3681 02:50:37,720 --> 02:50:40,280 I THINK IT'S BECAUSE WE WIDELY 3682 02:50:40,280 --> 02:50:42,120 ADOPTED THE PRACTICE OF DOING 3683 02:50:42,120 --> 02:50:44,160 NON-STRESS TEST AND INDUCING 3684 02:50:44,160 --> 02:50:46,800 FOLKS AT 39 WEEKS EVEN WITHOUT 3685 02:50:46,800 --> 02:50:47,080 EVIDENCE. 3686 02:50:47,080 --> 02:50:54,520 THERE ARE MORE RECENT STUDIES IN 3687 02:50:54,520 --> 02:50:55,680 STUDIES THAT SHOWED NO 3688 02:50:55,680 --> 02:50:57,440 INTERVENTION AND THIS CAN ALTER 3689 02:50:57,440 --> 02:50:59,840 RISK AND THIS IS A GOOD 3690 02:50:59,840 --> 02:51:00,160 ILLUSTRATION. 3691 02:51:00,160 --> 02:51:03,400 AND IMPORTANT TO NOTE THEY CAN 3692 02:51:03,400 --> 02:51:09,760 INTERACT AND WITH EXPOSURES AND 3693 02:51:09,760 --> 02:51:11,200 GENETIC VARIATION WE ALSO HAVE 3694 02:51:11,200 --> 02:51:12,840 TO STUDY THEM IN RELATIONSHIP TO 3695 02:51:12,840 --> 02:51:19,200 EACH OTHER. 3696 02:51:19,200 --> 02:51:25,680 TOBACCO IS THE LARGEST 3697 02:51:25,680 --> 02:51:31,520 PREVENTIBLE CAUSE OF STILLBIRTH 3698 02:51:31,520 --> 02:51:35,480 THE ODDS RATIO IS 1.5 PER 3699 02:51:35,480 --> 02:51:36,800 STILLBIRTH AND NOTEWORTHY THE 3700 02:51:36,800 --> 02:51:39,320 RISK IS MITIGATED IF YOU STOP 3701 02:51:39,320 --> 02:51:44,840 SMOKING IN THE FIRST TRIMESTER. 3702 02:51:44,840 --> 02:51:49,120 THERE'S GOOD PLAUSIBILITY AND 3703 02:51:49,120 --> 02:51:55,640 THERE'S INCREASED HEMOGLOBIN AND 3704 02:51:55,640 --> 02:52:00,160 SLIGHT INCREASE IN ABRUPTION AND 3705 02:52:00,160 --> 02:52:08,840 THE SCRN ASSESSED THIS AND WE 3706 02:52:08,840 --> 02:52:14,520 ALSO ASSESSED ILLICIT DRUG USE 3707 02:52:14,520 --> 02:52:16,280 IN UMBILICAL CORD SECTIONS. 3708 02:52:16,280 --> 02:52:17,720 IF YOU WERE NEGATIVE SO THERE 3709 02:52:17,720 --> 02:52:21,880 WAS NO SMOKING THAT WAS THE 3710 02:52:21,880 --> 02:52:22,160 REFERENCE. 3711 02:52:22,160 --> 02:52:24,400 LOOKING AT THE ODDS RATIO THE 3712 02:52:24,400 --> 02:52:28,520 HIGHER THE LEVEL THE HIGHER THE 3713 02:52:28,520 --> 02:52:30,960 RISK OF STILLBIRTH. 3714 02:52:30,960 --> 02:52:33,920 NOT PERFECT BUT A STRONG TREND 3715 02:52:33,920 --> 02:52:36,160 WHERE THE LOWEST LEVEL IS 3716 02:52:36,160 --> 02:52:44,800 TWOFOLD INCREASE. 3717 02:52:44,800 --> 02:52:53,160 THIS SHOWS TOXICOLOGY AND IF YOU 3718 02:52:53,160 --> 02:52:57,600 HAD POSITIVE THC THERE WAS A 2.8 3719 02:52:57,600 --> 02:52:59,600 FOLD INCREASED RISK OF 3720 02:52:59,600 --> 02:53:01,800 STILLBIRTH GIVEN HOW 3721 02:53:01,800 --> 02:53:04,400 INCREASINGLY COMMON THC USE IS. 3722 02:53:04,400 --> 02:53:10,440 THERE WAS A PROFOUND ASSOCIATION 3723 02:53:10,440 --> 02:53:17,120 WITH OXYCODONE AND WE TRIED TO 3724 02:53:17,120 --> 02:53:19,160 NOT INCLUDE PRESCRIPTION DRUGS 3725 02:53:19,160 --> 02:53:20,840 AND THERE WAS A STRONG 3726 02:53:20,840 --> 02:53:21,760 RELATIONSHIP BETWEEN SMOKING AND 3727 02:53:21,760 --> 02:53:28,000 DRUG USE WHICH IS HARD TO 3728 02:53:28,000 --> 02:53:28,280 UNTANGLE. 3729 02:53:28,280 --> 02:53:30,840 IT'S ALSO HARD TO FIGURE OUT 3730 02:53:30,840 --> 02:53:32,680 ALCOHOL BECAUSE THERE'S NO GOOD 3731 02:53:32,680 --> 02:53:34,520 BIOMARKER AND PEOPLE ARE 3732 02:53:34,520 --> 02:53:36,520 RELUCTANT TO BE HONEST ABOUT 3733 02:53:36,520 --> 02:53:38,160 ALCOHOL USE BECAUSE OF STIGMA. 3734 02:53:38,160 --> 02:53:41,160 THERE'S BEEN A RELATIVE RISK OF 3735 02:53:41,160 --> 02:53:42,080 ABOUT 3. 3736 02:53:42,080 --> 02:53:44,360 THERE WAS A PAST STUDY FUNDED BY 3737 02:53:44,360 --> 02:53:48,840 NICHD AND A WANT TO HIGHLIGHT 3738 02:53:48,840 --> 02:53:51,080 THE WORK DONE BY NICHD THAT 3739 02:53:51,080 --> 02:53:52,840 ISN'T DIRECTLY RELATED TO 3740 02:53:52,840 --> 02:53:56,840 STILLBIRTH BUT STILL RELATED TO 3741 02:53:56,840 --> 02:53:58,000 STILLBIRTH RESEARCH. 3742 02:53:58,000 --> 02:54:00,640 THIS WAS CONDUCTED WHERE THERE'S 3743 02:54:00,640 --> 02:54:02,920 LESS STIGMA ABOUT DRINK AND HIGH 3744 02:54:02,920 --> 02:54:04,160 ALCOHOLISM RATES AND 22% OF THE 3745 02:54:04,160 --> 02:54:06,960 COHORT ADMITTED TO ALCOHOL USE 3746 02:54:06,960 --> 02:54:08,800 AND STROKING AND 90% ALCOHOL 3747 02:54:08,800 --> 02:54:10,440 ONLY. 3748 02:54:10,440 --> 02:54:12,840 THERE WAS AN INCREASED RISK OF 3749 02:54:12,840 --> 02:54:14,440 STILLBIRTH THAT PEOPLE DID BOTH 3750 02:54:14,440 --> 02:54:16,840 AND A SIGNIFICANT THREE-FOLD 3751 02:54:16,840 --> 02:54:20,840 INCREASE IN THE RISK OF LATE 3752 02:54:20,840 --> 02:54:23,720 STILLBIRTH. 3753 02:54:23,720 --> 02:54:24,840 MATERNAL DISEASES WE CAN'T GO 3754 02:54:24,840 --> 02:54:27,480 THROUGH ALL BUT 10% OF 3755 02:54:27,480 --> 02:54:31,720 STILLBIRTHS ARE ASSOCIATED WITH 3756 02:54:31,720 --> 02:54:34,720 DIABETES AND HYPERTENSION AND 3757 02:54:34,720 --> 02:54:36,400 LATE FETAL TOGETHER ARE 3758 02:54:36,400 --> 02:54:37,040 ASSOCIATED WITH THESE CONDITIONS 3759 02:54:37,040 --> 02:54:39,000 THAT ARE POTENTIALLY 3760 02:54:39,000 --> 02:54:39,560 PREVENTIBLE. 3761 02:54:39,560 --> 02:54:43,920 AND A COUPLE EXAMPLES THIS IS A 3762 02:54:43,920 --> 02:54:46,160 SLIDE OF MATERNAL HYPERTENSION 3763 02:54:46,160 --> 02:54:48,400 IN YELLOW AND WHAT GESTATIONAL 3764 02:54:48,400 --> 02:54:49,880 AGES THEY OCCUR IN. 3765 02:54:49,880 --> 02:54:52,840 THAT ALLOWS US TO TARGET 3766 02:54:52,840 --> 02:54:53,320 INTERVENTIONS AT THOSE 3767 02:54:53,320 --> 02:55:03,360 GESTATIONAL AGES. 3768 02:55:03,360 --> 02:55:06,640 HERE'S A SIMILAR SLIDE AND WHEN 3769 02:55:06,640 --> 02:55:09,320 YOU HIT 38 WEEKS AND DRAMATIC 3770 02:55:09,320 --> 02:55:11,880 AFTER 40 WEEKS AND DATA LIKE 3771 02:55:11,880 --> 02:55:14,040 THIS LED TO RECOMMENDATION TO 3772 02:55:14,040 --> 02:55:15,240 INDUCE PEOPLE WITH DIABETES AT 3773 02:55:15,240 --> 02:55:17,640 39 WEEKS AND HAS INFLUENCED THE 3774 02:55:17,640 --> 02:55:19,640 RATE OF STILLBIRTHS WITH 3775 02:55:19,640 --> 02:55:20,840 PATIENTS WITH DIABETES AND IN 3776 02:55:20,840 --> 02:55:22,680 SOME STUDIES THERE WAS NO 3777 02:55:22,680 --> 02:55:32,920 INCREASE RATE. 3778 02:55:37,600 --> 02:55:40,040 YOU HAVE GESTATIONAL SERUM BIO 3779 02:55:40,040 --> 02:55:42,320 ASSAYS AND AFFECTS 2% OF 3780 02:55:42,320 --> 02:55:42,720 PREGNANCIES. 3781 02:55:42,720 --> 02:55:48,800 THERE'S DIFFERENCES IN DIFFERENT 3782 02:55:48,800 --> 02:55:49,520 POPULATIONS. 3783 02:55:49,520 --> 02:55:50,880 AND THERE'S AN INCREASE RISK. 3784 02:55:50,880 --> 02:55:54,040 WE USED TO THINK IT WAS USED TO 3785 02:55:54,040 --> 02:55:56,720 BILE ACIDS IN THE PLACENTA BUT 3786 02:55:56,720 --> 02:56:03,200 IT HASN'T REALLY PANNED OUT AND 3787 02:56:03,200 --> 02:56:04,520 IT'S LED TO OBSTETRIC 3788 02:56:04,520 --> 02:56:14,760 INTERVENTIONS. 3789 02:56:18,560 --> 02:56:21,560 AND TO GIVE PERSPECTIVE A 3790 02:56:21,560 --> 02:56:23,920 THRESHOLD OF OVER GOES TO A 3791 02:56:23,920 --> 02:56:25,520 CONDITION AND WE'VE DONE A LOT 3792 02:56:25,520 --> 02:56:28,040 OF OBSTETRIC INTERVENTIONS WHICH 3793 02:56:28,040 --> 02:56:29,320 INCLUDE AGGRESSIVE PRETERM BIRTH 3794 02:56:29,320 --> 02:56:32,640 AND THAT HAS REDUCED THE RISK OF 3795 02:56:32,640 --> 02:56:36,040 STILL BIRTH BECAUSE MOST COHORT 3796 02:56:36,040 --> 02:56:38,280 STUDIES SEE IT EXCEEDINGLY RARE 3797 02:56:38,280 --> 02:56:39,560 BUT IT'S IN THE CLEAR WHETHER 3798 02:56:39,560 --> 02:56:41,480 WE'RE CAUSING MORE HARM THAN 3799 02:56:41,480 --> 02:56:44,840 GOOD AND THE CASE CONTROL STUDY 3800 02:56:44,840 --> 02:56:48,080 WE MEASURED BILE ACIDS AND FOUND 3801 02:56:48,080 --> 02:56:48,960 NO ASSOCIATION WITH BILE ACIDS 3802 02:56:48,960 --> 02:56:58,000 AND STILLBIRTH. 3803 02:56:58,000 --> 02:57:01,320 AND I WANT TO SPEAK TO 3804 02:57:01,320 --> 02:57:06,480 SUBSEQUENT COMPLICATIONS ON 3805 02:57:06,480 --> 02:57:06,800 STILLBIRTH. 3806 02:57:06,800 --> 02:57:14,360 THE AND THE OVER ALL STILLBIRTH 3807 02:57:14,360 --> 02:57:18,680 RATE IS 0-8% AND INCREASED 3808 02:57:18,680 --> 02:57:22,920 TENFOLD BUT HIGHER RISK WITH AN 3809 02:57:22,920 --> 02:57:26,600 EARLIER LOSS OR NON-HISPANIC 3810 02:57:26,600 --> 02:57:31,120 BLACK AND THE INCREASED LOSS FOR 3811 02:57:31,120 --> 02:57:31,920 UNEXPLAINED STILLBIRTH. 3812 02:57:31,920 --> 02:57:33,440 PREVIOUS HISTORY CAN INFORM US 3813 02:57:33,440 --> 02:57:34,520 IN TERMS OF COUNSELLING 3814 02:57:34,520 --> 02:57:43,120 PATIENTS. 3815 02:57:43,120 --> 02:57:47,760 AND THERE WAS A LOT OF PUBLICITY 3816 02:57:47,760 --> 02:57:49,080 A DECADE AGO AND TESTING DONE 3817 02:57:49,080 --> 02:57:51,120 AND IN CASE CONTROL STUDIES 3818 02:57:51,120 --> 02:57:53,400 THERE WAS A FOURFOLD INCREASE 3819 02:57:53,400 --> 02:57:55,200 RISK OF STILLBIRTH AND AN 3820 02:57:55,200 --> 02:57:56,920 ASSOCIATION WITH PREECLAMPSIA 3821 02:57:56,920 --> 02:58:06,080 AND IT WAS HYPOTHESIZED AND 3822 02:58:06,080 --> 02:58:09,640 THROMBOPHILIA PRE DISPOSES YOU 3823 02:58:09,640 --> 02:58:14,000 TO BLOOD CLOTS AND WOULD LEAD TO 3824 02:58:14,000 --> 02:58:16,520 ABRUPTION AND DAMAGE TO THE 3825 02:58:16,520 --> 02:58:26,720 PLACENTA. 3826 02:58:28,000 --> 02:58:34,200 THERE WAS A COHORT STUDY WITH 3827 02:58:34,200 --> 02:58:38,560 THE MOST COMMON THROMBOPHILIA 3828 02:58:38,560 --> 02:58:40,840 WAS NOT ASSOCIATED WITH THIS AND 3829 02:58:40,840 --> 02:58:44,840 IT WAS NOTABLE IN THE COHORT 3830 02:58:44,840 --> 02:58:47,320 STUDY THERE WAS NO ASSOCIATION 3831 02:58:47,320 --> 02:58:49,320 BETWEEN THIS AND PREGNANCY LOSS 3832 02:58:49,320 --> 02:58:51,120 AND JUST AS COMMON IN CONTROLS 3833 02:58:51,120 --> 02:59:01,640 AS CARRIERS AND SIMILAR DATA. 3834 02:59:03,360 --> 02:59:04,640 THERE'S CONFLICTING RESULTS 3835 02:59:04,640 --> 02:59:06,720 BETWEEN THE RETROSPECTIVE AND 3836 02:59:06,720 --> 02:59:09,920 PROSPECTIVE STUDY AND MOST HAVE 3837 02:59:09,920 --> 02:59:13,360 A NORMAL PREGNANCY OUTCOME. 3838 02:59:13,360 --> 02:59:19,080 HOW DO YOU MAKE SENSE OF THIS? 3839 02:59:19,080 --> 02:59:25,600 MAYBE THROMBOPHILIA ALONE IS NOT 3840 02:59:25,600 --> 02:59:30,920 A RISK FACTOR FOR STILLBIRTH. 3841 02:59:30,920 --> 02:59:33,600 THE ONE THROMBOPHILIA WHICH IS 3842 02:59:33,600 --> 02:59:35,400 AN ACQUIRED CONDITION BUT NOT 3843 02:59:35,400 --> 02:59:40,520 GENETIC CONDITION THAT IS 3844 02:59:40,520 --> 02:59:45,320 ASSOCIATED WITH STILLBIRTHS IS 3845 02:59:45,320 --> 02:59:48,040 THE SYNDROME THAT YOU HAVE TO 3846 02:59:48,040 --> 02:59:52,200 MEET CERTAIN CRITERIA FOR BUT 3847 02:59:52,200 --> 02:59:55,480 EVEN IN THE ABSENCE IF YOU 3848 02:59:55,480 --> 03:00:03,560 MEASURE ANOPHOSPHOLIPID 3849 03:00:03,560 --> 03:00:06,120 ANTIBODIES WE WERE ABLE TO SHOW 3850 03:00:06,120 --> 03:00:10,200 THIS IN THE STUDY AND SOME 3851 03:00:10,200 --> 03:00:15,480 ANTIBODIES BECAUSE THERE'S MANY 3852 03:00:15,480 --> 03:00:17,920 THAT ARE MORE ASSOCIATED WITH 3853 03:00:17,920 --> 03:00:23,840 STILLBIRTHS WITH THE ODDS RATIO 3854 03:00:23,840 --> 03:00:33,960 OF 4. 3855 03:00:35,720 --> 03:00:38,640 AND TO SUMMARIZE THEY'RE PRESENT 3856 03:00:38,640 --> 03:00:45,720 IN 11% OF STILLBIRTHSES AND THE 3857 03:00:45,720 --> 03:00:48,120 ISO TYPES ARE HIGHER RISK 3858 03:00:48,120 --> 03:00:48,880 FACTORS THAN OTHERS. 3859 03:00:48,880 --> 03:00:56,080 IT'S A MEANINGFUL RISK FACTOR. 3860 03:00:56,080 --> 03:00:58,520 FETAL GROWTH RESTRICTION A RISK 3861 03:00:58,520 --> 03:01:00,480 FACTOR AND SOMETHING WE HAVE AN 3862 03:01:00,480 --> 03:01:01,880 OPPORTUNITY TO DO BETTER WITH 3863 03:01:01,880 --> 03:01:06,960 SUBSEQUENT RESEARCH. 3864 03:01:06,960 --> 03:01:10,560 REPORTEDLY A SIXFOLD RISK 3865 03:01:10,560 --> 03:01:11,680 FACTOR. 3866 03:01:11,680 --> 03:01:16,800 MANY OF THE STUDIES ASSUME THE 3867 03:01:16,800 --> 03:01:19,080 WEIGHT AT BIRTH IS BASED ON A 3868 03:01:19,080 --> 03:01:20,800 GESTATIONAL AGE ASSUMING THE 3869 03:01:20,800 --> 03:01:25,040 BABY DIED THE DAY BEFORE. 3870 03:01:25,040 --> 03:01:27,360 MANY TIMES THERE'S A THEY ARE 3871 03:01:27,360 --> 03:01:28,360 BETWEEN THE TIME OF DEATH AND 3872 03:01:28,360 --> 03:01:31,000 THE TIME OF DELIVERY. 3873 03:01:31,000 --> 03:01:34,520 EVEN WITH THAT, IT'S STILL A 3874 03:01:34,520 --> 03:01:35,720 CONSIDERABLE RISK FACTOR AND NON 3875 03:01:35,720 --> 03:01:37,320 SPECIFIC BECAUSE WE OFTEN DEFINE 3876 03:01:37,320 --> 03:01:43,680 THIS AS THE BOTTOM 10% OF A 3877 03:01:43,680 --> 03:01:45,960 NORMAL POPULATION AND IDENTIFY 3878 03:01:45,960 --> 03:01:51,640 CONSTITUTIONALLY SMALL FETUSES 3879 03:01:51,640 --> 03:01:54,920 AND WE CAN ADDRESS BABE YES THAT 3880 03:01:54,920 --> 03:01:56,640 ARE AT RISK FOR STILLBIRTHS. 3881 03:01:56,640 --> 03:02:02,840 PEOPLE HAVE SUGGESTED USING 3882 03:02:02,840 --> 03:02:07,360 CUSTOMIZED GROWTH CURVE AND NOT 3883 03:02:07,360 --> 03:02:12,520 HAVE PANNED OUT AS GOOD AS HOPE 3884 03:02:12,520 --> 03:02:16,800 AND SOME PUBLISHED WHERE THEY 3885 03:02:16,800 --> 03:02:20,240 DID ROUTINE THIRD TRI MEST 3886 03:02:20,240 --> 03:02:21,960 ULTRASOUND AND THEY WERE ABLE TO 3887 03:02:21,960 --> 03:02:25,280 HAVE A THREEFOLD INCREASE IN THE 3888 03:02:25,280 --> 03:02:28,320 IDENTIFICATION OF GESTATIONALLY 3889 03:02:28,320 --> 03:02:29,360 AGED FETUS OR GROWTH RESTRICTION 3890 03:02:29,360 --> 03:02:32,840 HOWEVER, THE BABIES DIDN'T DO 3891 03:02:32,840 --> 03:02:35,920 ANY BETTER. 3892 03:02:35,920 --> 03:02:40,320 IT'S NOT CLEAR IT'S VALUABLE. 3893 03:02:40,320 --> 03:02:43,880 I WANT IT TALK ABOUT FETAL 3894 03:02:43,880 --> 03:02:45,800 MOVEMENT COUNTING AND THOSE OF 3895 03:02:45,800 --> 03:02:48,840 US DOING THIS A WHILE THERE'S 3896 03:02:48,840 --> 03:02:51,400 MANY STORIES OF PATIENTS HAVING 3897 03:02:51,400 --> 03:02:55,560 DECREASED FETAL MOVEMENT AND 3898 03:02:55,560 --> 03:03:00,760 COMING IN WITH A STILLBIRTH OR 3899 03:03:00,760 --> 03:03:08,280 DID A CAESAREAN AND THOUGHT WE 3900 03:03:08,280 --> 03:03:11,800 SAVED THE BABY'S LIFE. 3901 03:03:11,800 --> 03:03:14,720 AFTER META-ANALYSIS OF RCTs AND 3902 03:03:14,720 --> 03:03:18,000 THEY HAD A STANDARDIZED PROTOCOL 3903 03:03:18,000 --> 03:03:21,120 WHERE THEY HAD PEOPLE PAY 3904 03:03:21,120 --> 03:03:24,240 ATTENTION AND IT LED TO FETAL 3905 03:03:24,240 --> 03:03:25,640 MONITORING AND THERE WAS A 3906 03:03:25,640 --> 03:03:27,480 SLIGHT DIFFERENCE IN PERINATAL 3907 03:03:27,480 --> 03:03:29,160 DEATH BETWEEN THE STUDY GROUP 3908 03:03:29,160 --> 03:03:30,400 THAT COUNTED FETAL MOVEMENTS AND 3909 03:03:30,400 --> 03:03:34,480 THE CONTROL GROUP. 3910 03:03:34,480 --> 03:03:37,600 THE DIFFERENCE IS .54 VERSUS 3911 03:03:37,600 --> 03:03:40,040 .59% AND THERE WAS NO 3912 03:03:40,040 --> 03:03:41,560 IMPROVEMENT IN SECONDARY 3913 03:03:41,560 --> 03:03:43,480 OUTCOMES AND THERE WAS AN 3914 03:03:43,480 --> 03:03:46,160 INCREASE IN CAESAREAN AND 3915 03:03:46,160 --> 03:03:46,960 PRETERM DEATH IN THE KICK COUNT 3916 03:03:46,960 --> 03:03:52,520 GROUP. 3917 03:03:52,520 --> 03:03:54,640 THE STUDY TRIED TO SHOW A 3918 03:03:54,640 --> 03:03:56,320 BENEFIT TO ASSESSING FETAL 3919 03:03:56,320 --> 03:03:58,520 MOVEMENT WAS A TRIAL DONE IN THE 3920 03:03:58,520 --> 03:03:58,720 U.S. 3921 03:03:58,720 --> 03:04:03,320 A STEP WEDGE CLUSTER RANDOMIZED 3922 03:04:03,320 --> 03:04:04,800 TRIAL THEY HAD A CURE PACKAGE 3923 03:04:04,800 --> 03:04:09,600 FOR REDUCED FETAL MOVEMENT AND 3924 03:04:09,600 --> 03:04:13,760 HAD A CONTROL PERIOD AND WASHOUT 3925 03:04:13,760 --> 03:04:19,800 PERIOD AND A STANDARDIZED 3926 03:04:19,800 --> 03:04:25,520 MANAGEMENT AND THE RISK WAS 0.9. 3927 03:04:25,520 --> 03:04:26,600 A TREND TOWARDS STILLBIRTH 3928 03:04:26,600 --> 03:04:28,560 REDUCTION BUT IT WAS A NEGATIVE 3929 03:04:28,560 --> 03:04:30,160 STUDY BUT MAY HAVE BEEN UNDER 3930 03:04:30,160 --> 03:04:37,960 POWERED FOR A RARE OUTCOME. 3931 03:04:37,960 --> 03:04:39,600 YOU HEARD PREVIOUS DISCUSSION 3932 03:04:39,600 --> 03:04:41,400 AND IT COULD BE WE'RE SIMPLY 3933 03:04:41,400 --> 03:04:43,960 UNDER POWERED AND IT'S A RARE 3934 03:04:43,960 --> 03:04:46,040 OUTCOME AND WE NEED LARGER 3935 03:04:46,040 --> 03:04:48,200 SAMPLE SIZES TO SHOW IMPACT. 3936 03:04:48,200 --> 03:04:54,240 WE ALSO MAY NEED BETTER RISK 3937 03:04:54,240 --> 03:04:56,880 STRATIFICATION. 3938 03:04:56,880 --> 03:04:58,640 AND DECREASED MOVEMENT WITHOUT 3939 03:04:58,640 --> 03:05:01,720 THE OTHER FACTORS AND THEM THOSE 3940 03:05:01,720 --> 03:05:02,680 PATIENTS ARE OKAY. 3941 03:05:02,680 --> 03:05:04,800 SOME ARE STUDYING THE RATIO AS A 3942 03:05:04,800 --> 03:05:06,920 WAY TO STRATIFY THESE FOLKS. 3943 03:05:06,920 --> 03:05:09,160 MAYBE WE THESE BETTER 3944 03:05:09,160 --> 03:05:11,400 INTERVENTIONS OR IT MAY TURN OUT 3945 03:05:11,400 --> 03:05:12,880 THE FETAL MOVEMENT IS JUST TOO 3946 03:05:12,880 --> 03:05:16,520 NON SPECIFIC BECAUSE IT'S SO 3947 03:05:16,520 --> 03:05:17,960 COMMON. 3948 03:05:17,960 --> 03:05:19,720 IT MAY NOT BE AS USEFUL AS HOPED 3949 03:05:19,720 --> 03:05:25,880 BUT NEEDS MORE WORK. 3950 03:05:25,880 --> 03:05:29,120 ANOTHER AREA IS SLEEP POSITION 3951 03:05:29,120 --> 03:05:30,320 ASSOCIATED WITH STILLBIRTH. 3952 03:05:30,320 --> 03:05:32,840 IN CASE CONTROL STUDIES THE ODDS 3953 03:05:32,840 --> 03:05:37,360 RATIO IS 2.5 TO 8. 3954 03:05:37,360 --> 03:05:40,560 META-ANALYSIS SHOWED 2.6. 3955 03:05:40,560 --> 03:05:44,840 IF YOU LIE SUPINE WHEN PREGNANT 3956 03:05:44,840 --> 03:05:47,920 SOME PATIENTS WILL COMPRESS THE 3957 03:05:47,920 --> 03:05:50,000 IBC AND HAVE REDUCED BLOOD FLOW. 3958 03:05:50,000 --> 03:05:54,960 IF YOU HAVE LEFT LATERAL TILT 3959 03:05:54,960 --> 03:05:58,680 THAT WILL OBVIATE THAT AND 3960 03:05:58,680 --> 03:06:09,200 PATIENTS CAN BE KNAUSS -- NA 3961 03:06:10,880 --> 03:06:12,120 EXPERIENCE NAUSEA OR DIZZY AND 3962 03:06:12,120 --> 03:06:16,480 WE TRY TO MITIGATE THE RECALL 3963 03:06:16,480 --> 03:06:18,200 BIAS BY ASKING CONTROLS ABOUT 3964 03:06:18,200 --> 03:06:20,040 GOING TO SLEEP WHILE PREGNANT 3965 03:06:20,040 --> 03:06:21,400 BUT THERE'S STILL RECALL BIAS 3966 03:06:21,400 --> 03:06:23,640 WHEN YOU ASK FOLKS ABOUT 3967 03:06:23,640 --> 03:06:26,160 STILLBIRTH BUT IT'S LED TO 3968 03:06:26,160 --> 03:06:26,920 PUBLIC HEALTH CAMPAIGNS SO IT'S 3969 03:06:26,920 --> 03:06:28,520 ANOTHER AREA WE NEED TO WRAP OUR 3970 03:06:28,520 --> 03:06:33,560 HANDS AROUND. 3971 03:06:33,560 --> 03:06:37,680 SLEEP BREATHING STUDY WAS PART 3972 03:06:37,680 --> 03:06:39,160 OF THE NEW MOM-TO-BE STUDY. 3973 03:06:39,160 --> 03:06:41,320 WE WANT TO GIVE FOLKS CREDIT. 3974 03:06:41,320 --> 03:06:47,720 ITS WAS AN OBSERVATIONAL COHORT 3975 03:06:47,720 --> 03:06:50,360 STUDY AND PEOPLE HAD VISITS 6 3976 03:06:50,360 --> 03:06:52,800 WEEKS TO 14 WEEKS AND THE THIRD 3977 03:06:52,800 --> 03:06:55,480 22 TO 30 AND MOST WERE 28 TO 30 3978 03:06:55,480 --> 03:06:55,760 WEEKS. 3979 03:06:55,760 --> 03:07:01,000 THEY HAD A LOT OF STUFF DONE AND 3980 03:07:01,000 --> 03:07:02,360 ALSO 10,000 PATIENTS ANSWERED 3981 03:07:02,360 --> 03:07:06,280 QUESTIONS ABOUT SLEEP AND A 3982 03:07:06,280 --> 03:07:07,680 THIRD HAD AN OBJECTIVE 3983 03:07:07,680 --> 03:07:10,560 ASSESSMENT OF SLEEP AT HOME. 3984 03:07:10,560 --> 03:07:11,960 AND THE FOCUS WAS SLEEP DISORDER 3985 03:07:11,960 --> 03:07:15,320 BREATHING BUT WE WERE ABLE TO 3986 03:07:15,320 --> 03:07:15,880 ASCERTAIN INFORMATION ABOUT 3987 03:07:15,880 --> 03:07:18,040 SLEEP POSITION. 3988 03:07:18,040 --> 03:07:20,600 USING A COMPOSITE ADVERSE 3989 03:07:20,600 --> 03:07:22,840 PREGNANCY OUTCOME THERE WAS NO 3990 03:07:22,840 --> 03:07:25,320 ASSOCIATION FOR SELF-REPORTED 3991 03:07:25,320 --> 03:07:28,560 SUPINE SLEEP IN A COMPOSITE 3992 03:07:28,560 --> 03:07:29,720 PREGNANCY OUTCOMES AT THE 3993 03:07:29,720 --> 03:07:30,520 FURTHER STUDY VISIT. 3994 03:07:30,520 --> 03:07:34,560 AT THE THIRD STUDY VISIT THE 3995 03:07:34,560 --> 03:07:38,360 ODDS RATIO WAS 0.27 AND 3996 03:07:38,360 --> 03:07:39,440 PROTECTIVE EFFECT OF SUPINE 3997 03:07:39,440 --> 03:07:39,880 SLEEP. 3998 03:07:39,880 --> 03:07:41,480 NO ONE THINKS IT'S PROTECTIVE 3999 03:07:41,480 --> 03:07:44,320 BUT CALLS INTO QUESTION WHETHER 4000 03:07:44,320 --> 03:07:45,880 SLEEP POSITION IS A CRITICAL 4001 03:07:45,880 --> 03:07:47,240 ISSUE. 4002 03:07:47,240 --> 03:07:52,560 THERE WAS ALSO NO ASSOCIATION 4003 03:07:52,560 --> 03:07:53,640 BETWEEN OBJECTIVE SUPINE SLEEP 4004 03:07:53,640 --> 03:07:55,480 OR IPOs. 4005 03:07:55,480 --> 03:07:56,920 THE ADVANTAGE OF THE STUDY IS IS 4006 03:07:56,920 --> 03:08:01,440 THE PROSPECTIVE STUDY IS 4007 03:08:01,440 --> 03:08:03,240 SUBJECTIVE TO OBJECTIVE DATA AND 4008 03:08:03,240 --> 03:08:07,400 UP TO 30 WEEKS GESTATION. 4009 03:08:07,400 --> 03:08:14,560 AND AT THE THEN OF PREGNANCY THE 4010 03:08:14,560 --> 03:08:19,160 UTERUS IS LARGER SO MAYBE WE 4011 03:08:19,160 --> 03:08:22,080 HAVEN'T ADDRESSED SUPINE SLEEP. 4012 03:08:22,080 --> 03:08:24,040 I WANT TO GO INTO RISK FACTORS 4013 03:08:24,040 --> 03:08:26,040 AND THE BEST TIME FOR DELIVERY. 4014 03:08:26,040 --> 03:08:27,360 IT'S A TERRIFIC AREA FOR 4015 03:08:27,360 --> 03:08:29,160 RESEARCH AND WAY TO UTILIZE RISK 4016 03:08:29,160 --> 03:08:32,360 FACTORS. 4017 03:08:32,360 --> 03:08:35,520 DELIVERY IS ONE OF THE KEY WAYS 4018 03:08:35,520 --> 03:08:37,240 TO PREVENT STILLBIRTH BUT ALSO 4019 03:08:37,240 --> 03:08:39,240 HAS A SIGNIFICANT DOWN SIDE. 4020 03:08:39,240 --> 03:08:46,200 WE HAVE TO REALLY BE EVIDENCE 4021 03:08:46,200 --> 03:08:47,320 BASED AND CAREFUL. 4022 03:08:47,320 --> 03:08:52,880 WE WANT TO GO TO THE LARGEST 4023 03:08:52,880 --> 03:08:58,440 BENEFIT OF INDUCED LABOR AND IF 4024 03:08:58,440 --> 03:09:04,400 YOU HAVE A 1 IN 5,000 RISK 4025 03:09:04,400 --> 03:09:07,240 YOU'LL CAUSE MORE HARM THAN WITH 4026 03:09:07,240 --> 03:09:10,440 NOT DELIVERING WE NEED TO FIGURE 4027 03:09:10,440 --> 03:09:11,240 THIS OUT. 4028 03:09:11,240 --> 03:09:13,280 THIS HOW WE NEED TO VIEW RISK 4029 03:09:13,280 --> 03:09:13,560 FACTORS. 4030 03:09:13,560 --> 03:09:16,560 IT TURNS OUT MANY RISK FACTORS 4031 03:09:16,560 --> 03:09:27,120 ARE ASSOCIATED WITH STILLBIRTH. 4032 03:09:28,520 --> 03:09:31,360 RISK FACTORS EXPLAIN VERY LITTLE 4033 03:09:31,360 --> 03:09:33,360 OF THESE AND IF WE'RE GOING TO 4034 03:09:33,360 --> 03:09:34,800 PREDICT STILLBIRTH WE HAVE TO 4035 03:09:34,800 --> 03:09:36,560 TARGET THE ENTIRE POPULATION AND 4036 03:09:36,560 --> 03:09:38,320 NEED BETTER METHODS TO IDENTIFY 4037 03:09:38,320 --> 03:09:44,600 HIGH RISK PATIENTS AND DO RISK 4038 03:09:44,600 --> 03:09:44,960 STRATIFICATION. 4039 03:09:44,960 --> 03:09:46,560 THERE'S MANY MODELS USING A.I. 4040 03:09:46,560 --> 03:09:50,840 OR MACHINE LEARNING BUT STILL 4041 03:09:50,840 --> 03:09:52,280 HAVE OVER ALL POOR PREDICTIONS 4042 03:09:52,280 --> 03:09:53,920 BUT SO MANY CASES HAPPEN WITH NO 4043 03:09:53,920 --> 03:09:56,720 RISK FACTORS SO WE NEED BETTER 4044 03:09:56,720 --> 03:09:59,040 RISK STRATIFICATION AND MAY BE 4045 03:09:59,040 --> 03:10:03,440 ABLE TO DO SO WITH BIOMARKERS. 4046 03:10:03,440 --> 03:10:06,640 AND I'M SUGGESTING AREAS OF 4047 03:10:06,640 --> 03:10:08,520 RESEARCH THUS FAR BIOMARKERS, 4048 03:10:08,520 --> 03:10:09,800 NONE ARE REALLY CLINICALLY 4049 03:10:09,800 --> 03:10:12,600 USEFUL BUT THERE'S THE POTENTIAL 4050 03:10:12,600 --> 03:10:14,760 FOR MARKERS THAT ARE ASSOCIATED 4051 03:10:14,760 --> 03:10:20,840 WITH FETAL HYPOXIA AND OXIDATIVE 4052 03:10:20,840 --> 03:10:23,880 STRESS TO BE USED. 4053 03:10:23,880 --> 03:10:27,200 SAME IS TRUE FOR ULTRASOUND AND 4054 03:10:27,200 --> 03:10:30,760 WE MEASURED THE PLACENTA AND 4055 03:10:30,760 --> 03:10:33,760 FLOW THROUGH MATERNAL OR FETAL 4056 03:10:33,760 --> 03:10:35,200 VESSELS AND HASN'T DONE VERY 4057 03:10:35,200 --> 03:10:36,840 WELL BUT THERE'S POTENTIAL TO BE 4058 03:10:36,840 --> 03:10:41,080 BETTER. 4059 03:10:41,080 --> 03:10:44,080 THE ARRIVE TRIAL HAS SHOWN 4060 03:10:44,080 --> 03:10:49,440 DELIVERY AT 39 WEEKS IS A SAFE 4061 03:10:49,440 --> 03:10:50,880 AND REASONABLE OPTION. 4062 03:10:50,880 --> 03:10:52,560 AND WOULD REDUCE SOME 4063 03:10:52,560 --> 03:10:53,200 STILLBIRTHS. 4064 03:10:53,200 --> 03:10:55,280 THERE'S MANY ACCEPTED 4065 03:10:55,280 --> 03:10:56,600 INDICATIONS FOR LATE TERM BIRTH 4066 03:10:56,600 --> 03:10:57,480 AND THOSE ARE ALL THE RISK 4067 03:10:57,480 --> 03:11:03,640 FACTORS WE'RE TALKING ABOUT. 4068 03:11:03,640 --> 03:11:04,920 MANY ARE BASED ON WEAK EVIDENCE 4069 03:11:04,920 --> 03:11:07,520 AND WE TEND TO USE A ONE-SIZE 4070 03:11:07,520 --> 03:11:12,840 FITS ALL FOR A BINARY OUTCOME 4071 03:11:12,840 --> 03:11:22,120 LIKE PREECLAMPSIA FEATURES 4072 03:11:22,120 --> 03:11:22,800 THERE'S A TREMENDOUS OPPORTUNITY 4073 03:11:22,800 --> 03:11:25,760 BASED ON RISK FACTORS. 4074 03:11:25,760 --> 03:11:28,920 I WANT TO ACKNOWLEDGE THE SERN 4075 03:11:28,920 --> 03:11:30,640 AND NICHD FOR ALL THE GREAT WORK 4076 03:11:30,640 --> 03:11:35,840 AND IT'S GREAT IT SEE MANY 4077 03:11:35,840 --> 03:11:40,280 PEOPLE ON THIS PANEL AND IF WE 4078 03:11:40,280 --> 03:11:41,920 WERE ALL A LITTLE BIT YOUNGER 4079 03:11:41,920 --> 03:11:45,720 AND HAD A LITTLE BIT MORE HAIR 4080 03:11:45,720 --> 03:11:45,920 THEN. 4081 03:11:45,920 --> 03:11:48,320 FINALLY LET'S NOT FORGET THERE'S 4082 03:11:48,320 --> 03:11:49,720 A STORY BEHIND EVERY STILLBIRTH. 4083 03:11:49,720 --> 03:11:51,120 I KNOW WE'RE GETTING MORE IN THE 4084 03:11:51,120 --> 03:11:53,040 SCIENCE BUT WE DON'T WANT TO 4085 03:11:53,040 --> 03:11:54,240 LOSE SIGHT OF WHY WE'RE DOING 4086 03:11:54,240 --> 03:11:56,840 THIS. 4087 03:11:56,840 --> 03:12:05,080 THANK YOU VERY MUCH. 4088 03:12:05,080 --> 03:12:09,160 >>THANK YOU. 4089 03:12:09,160 --> 03:12:10,560 THANK YOU FOR THE NEXT STEPS. 4090 03:12:10,560 --> 03:12:11,080 I APPRECIATE IT. 4091 03:12:11,080 --> 03:12:13,880 WE HAVE TO MOVE TO THE NEXT 4092 03:12:13,880 --> 03:12:16,520 PRESENTATION BECAUSE OF THE 4093 03:12:16,520 --> 03:12:16,840 TIME. 4094 03:12:16,840 --> 03:12:19,280 AND WE'LL OPEN THE DISCUSSION. 4095 03:12:19,280 --> 03:12:21,960 WE HAVE DR. SIMON PROFESSOR OF 4096 03:12:21,960 --> 03:12:25,640 DEPARTMENT OF OBSTETRICS AND 4097 03:12:25,640 --> 03:12:27,400 GYNECOLOGY AND REPRODUCTIVE 4098 03:12:27,400 --> 03:12:30,000 SCIENCE AND EXECUTIVE VICE CHAIR 4099 03:12:30,000 --> 03:12:32,880 AT THE UNIVERSITY OF PITTSBURGH 4100 03:12:32,880 --> 03:12:33,960 AND GOING TO TALK ABOUT 4101 03:12:33,960 --> 03:12:34,560 STILLBIRTHS. 4102 03:12:34,560 --> 03:12:39,160 THANK YOU SO MUCH. 4103 03:12:39,160 --> 03:12:43,960 >>THANK YOU FOR THE OPPORTUNITY 4104 03:12:43,960 --> 03:12:45,520 TO PARTICIPATE IN THE TOPIC. 4105 03:12:45,520 --> 03:12:48,880 AND MORE SO PLEASED ABOUT THE 4106 03:12:48,880 --> 03:12:50,560 OPPORTUNITY TO HEAR ALL THE 4107 03:12:50,560 --> 03:12:51,240 DISCUSSION. 4108 03:12:51,240 --> 03:12:53,560 SO FAR IT'S WIDE RANGING IN 4109 03:12:53,560 --> 03:12:57,800 SCOPE AND INCREDIBLY IMPORTANT. 4110 03:12:57,800 --> 03:12:59,440 I'M GLAD TO HAVE THE OPPORTUNITY 4111 03:12:59,440 --> 03:13:04,880 TO TALK ABOUT ONE OF THE RISK 4112 03:13:04,880 --> 03:13:08,640 FACTORS THAT BOB DISCUSSED 4113 03:13:08,640 --> 03:13:10,040 OBESITY AND STILLBIRTH. 4114 03:13:10,040 --> 03:13:12,040 IT'S IMPORTANT FOR A RANGE OF 4115 03:13:12,040 --> 03:13:15,280 REASONS. 4116 03:13:15,280 --> 03:13:20,840 I THINK WE KNOW THIS WITH 4117 03:13:20,840 --> 03:13:25,280 RESPECT TO SO MANY CONDITIONS 4118 03:13:25,280 --> 03:13:26,360 THAT PROVIDE HEALTH CARE BURDEN 4119 03:13:26,360 --> 03:13:27,920 WORLDWIDE AND THE U.S. 4120 03:13:27,920 --> 03:13:32,760 OBESITY CONTRIBUTES TO SO MANY 4121 03:13:32,760 --> 03:13:36,160 AND INCREASING IN FREQUENCY THIG 4122 03:13:36,160 --> 03:13:39,840 FIGURE IS FROM THE NIDDK AND 4123 03:13:39,840 --> 03:13:41,400 DESCRIBES THE FREQUENCY OF 4124 03:13:41,400 --> 03:13:44,080 OBESITY IS OVER ALL SEVERE IN 4125 03:13:44,080 --> 03:13:48,880 THE ADULT POPULATIONS IN THE 4126 03:13:48,880 --> 03:13:53,560 UNITED STATES FROM 2000 THROUGH 4127 03:13:53,560 --> 03:13:56,120 2018 WITH WHAT SEEMS LIKE AN 4128 03:13:56,120 --> 03:13:57,960 INCREASE IN FREQUENCY IN OBESITY 4129 03:13:57,960 --> 03:14:03,600 OVER ALL AND SEVERE OBESITY. 4130 03:14:03,600 --> 03:14:05,520 THAT BURDEN IN TERMS OF 4131 03:14:05,520 --> 03:14:10,760 FREQUENCY IS NOT UNIFORM IN OUR 4132 03:14:10,760 --> 03:14:19,640 POPULATION THIS FIGURE IS SEVERE 4133 03:14:19,640 --> 03:14:19,880 OBESITY. 4134 03:14:19,880 --> 03:14:24,880 YOU'LL SEE WOMEN HAVE A HIGHER 4135 03:14:24,880 --> 03:14:30,320 FREQUENCY OF SEVERE OBESITY AND 4136 03:14:30,320 --> 03:14:31,840 MUCH LIKE DATA WITH SO MANY 4137 03:14:31,840 --> 03:14:34,360 COMMON COMPLEX CONDITIONS AND 4138 03:14:34,360 --> 03:14:36,840 THE UNDERLYING EXPOSURES 4139 03:14:36,840 --> 03:14:40,200 RELATIVE WE SEE A DISPARITY IN 4140 03:14:40,200 --> 03:14:41,160 RACE AS WELL. 4141 03:14:41,160 --> 03:14:43,280 OUR POPULATIONS THE LEVERS OF 4142 03:14:43,280 --> 03:14:48,840 OUR POPULATION AT GREATEST RISK 4143 03:14:48,840 --> 03:14:53,520 FOR STILLBIRTH ALSO CARRY 4144 03:14:53,520 --> 03:14:59,600 GREATEST BURDEN OF OBESITY 4145 03:14:59,600 --> 03:15:00,840 CONTRIBUTOR. 4146 03:15:00,840 --> 03:15:04,000 THE THIS IS A RELATIVE WHIRLWIND 4147 03:15:04,000 --> 03:15:12,920 AND I'LL TALK ABOUT THE DATA 4148 03:15:12,920 --> 03:15:14,920 SHOWING THE DIRECTION AND 4149 03:15:14,920 --> 03:15:20,840 MAGNITUDE OF OBESITY AND LOOKING 4150 03:15:20,840 --> 03:15:26,280 AT SYSTEMATIC REVIEW AND 4151 03:15:26,280 --> 03:15:31,040 META-ANALYSIS AND THE FIGURE 4152 03:15:31,040 --> 03:15:32,200 INDICATES THE STUDIES IN ROWS 4153 03:15:32,200 --> 03:15:37,720 AND THE NUMBER OF PARTICIPANTS 4154 03:15:37,720 --> 03:15:40,520 IN EACH STUDY IN THE TABLE AND 4155 03:15:40,520 --> 03:15:44,200 THE BIGGER THE POPULATION THE 4156 03:15:44,200 --> 03:15:48,360 MORE INFLUENTIAL IT IS FOR 4157 03:15:48,360 --> 03:15:49,840 META-ANALYSIS AND WHAT IS A 4158 03:15:49,840 --> 03:15:51,320 RELATIVELY CLEAR WAY TO 4159 03:15:51,320 --> 03:15:53,120 UNDERSTAND THE MAGNITUDE OF THE 4160 03:15:53,120 --> 03:16:03,520 RELATIONSHIP OF OBESITY TO RISK 4161 03:16:03,520 --> 03:16:06,560 PER FIVE BMI UNITS. 4162 03:16:06,560 --> 03:16:16,800 WITH EVERY REFERENCE ABOVE 5 BMI 4163 03:16:16,800 --> 03:16:20,840 INDICATES INCREASE AND FOR EVERY 4164 03:16:20,840 --> 03:16:24,840 5 POINTS OF INCREASED IN BMI, 4165 03:16:24,840 --> 03:16:27,880 THE RELATIVE RISK OF STILLBIRTH 4166 03:16:27,880 --> 03:16:32,240 INCREASES BY 25%. 4167 03:16:32,240 --> 03:16:34,080 SUBSTANTIAL STATISTICALLY 4168 03:16:34,080 --> 03:16:35,360 CONSISTENT AND ACROSS STUDIES 4169 03:16:35,360 --> 03:16:39,000 WHICH WERE DONE ACROSS TIME AND 4170 03:16:39,000 --> 03:16:41,680 ACROSS POPULATIONS AND ACROSS 4171 03:16:41,680 --> 03:16:41,920 COUNTRIES. 4172 03:16:41,920 --> 03:16:43,760 CONSISTENT RESULT SHOWING THIS 4173 03:16:43,760 --> 03:16:49,240 ASSOCIATION AND THE MAGNITUDE 4174 03:16:49,240 --> 03:16:49,560 ASSOCIATION. 4175 03:16:49,560 --> 03:16:53,960 ANOTHER WAY OF DEPICTING THIS 4176 03:16:53,960 --> 03:16:57,720 YOU CAN SEE IT ALONG A CONTINUUM 4177 03:16:57,720 --> 03:16:59,640 IS RELATIVE RISK OF STILLBIRTHS 4178 03:16:59,640 --> 03:17:04,520 ON THE Y AXIS AND YOU SEE THE 4179 03:17:04,520 --> 03:17:06,720 INCREASE OF STILLBIRTH WITH THE 4180 03:17:06,720 --> 03:17:08,880 BMI AND OBESITY BECOMES MORE 4181 03:17:08,880 --> 03:17:19,000 SEVERE. 4182 03:17:24,560 --> 03:17:26,600 I WANT TO TALK ABOUT THE 4183 03:17:26,600 --> 03:17:27,960 POPULATION OF POPULATION 4184 03:17:27,960 --> 03:17:28,560 ATTRIBUTABLE RISK. 4185 03:17:28,560 --> 03:17:31,000 WE TALKED ABOUT A RANGE OF RISK 4186 03:17:31,000 --> 03:17:31,440 FACTORS. 4187 03:17:31,440 --> 03:17:34,640 MANY OF WHICH MAY COEXIST IN AN 4188 03:17:34,640 --> 03:17:38,480 INDIVIDUAL THAT MAY CONTRIBUTE 4189 03:17:38,480 --> 03:17:40,440 TO EACH OTHER AND HOW IMPORTANT 4190 03:17:40,440 --> 03:17:44,880 A RISK FACTOR IS FOR A CONDITION 4191 03:17:44,880 --> 03:17:47,840 IS RELATED TO THE STRENGTH OF 4192 03:17:47,840 --> 03:17:49,840 THE ASSOCIATION OF RELATIVE RISK 4193 03:17:49,840 --> 03:17:55,240 AND HOW COMMON THE RISK FACTOR 4194 03:17:55,240 --> 03:17:56,840 IS IN THE POPULATION. 4195 03:17:56,840 --> 03:18:02,200 AND THIS REVIEW GIVES INSIGHT 4196 03:18:02,200 --> 03:18:03,320 INTO THAT. 4197 03:18:03,320 --> 03:18:08,160 THIS META-ANALYSIS USED 4198 03:18:08,160 --> 03:18:09,080 POPULATION DATA FROM FIVE HIGH 4199 03:18:09,080 --> 03:18:11,000 INCOME COUNTRIES AROUND THE 4200 03:18:11,000 --> 03:18:12,600 WORLD ONE OF WHICH WAS AROUND 4201 03:18:12,600 --> 03:18:15,120 THE WORLD AND THE UNITED STATES 4202 03:18:15,120 --> 03:18:16,880 AND EXAMINED NOT JUST THE 4203 03:18:16,880 --> 03:18:18,280 STRENGTH OF THE ASSOCIATION OF 4204 03:18:18,280 --> 03:18:20,400 OBESITY AND VARIETY OF RISK 4205 03:18:20,400 --> 03:18:22,920 FACTORS BUT ALSO POPULATION 4206 03:18:22,920 --> 03:18:23,760 ATTRIBUTABLE RISK. 4207 03:18:23,760 --> 03:18:28,240 POPULATION ATTRIBUTABLE RISK IS 4208 03:18:28,240 --> 03:18:30,600 FRAMED A FRACTION OR PERCENT. 4209 03:18:30,600 --> 03:18:36,840 IT SAYS IF WE ACCOUNT FOR THE 4210 03:18:36,840 --> 03:18:40,000 MAJOR RISK FACTORS AND REMOVE A 4211 03:18:40,000 --> 03:18:41,000 GIVEN RISK FACTOR HOW MUCH WOULD 4212 03:18:41,000 --> 03:18:44,960 THAT RISK GO DOWN OR HOW MUCH OF 4213 03:18:44,960 --> 03:18:47,720 THE AGGREGATE POPULATION RISK OF 4214 03:18:47,720 --> 03:18:52,320 IN THIS CASE STILLBIRTH IS 4215 03:18:52,320 --> 03:18:54,240 ATTRIBUTABLE TO OBESITY? 4216 03:18:54,240 --> 03:18:55,920 THE ANSWER DEPENDING ON THE 4217 03:18:55,920 --> 03:18:57,800 COUNTRY IS 8 TO 18%. 4218 03:18:57,800 --> 03:19:01,760 AND IN TERMS OF TRANSLATING THAT 4219 03:19:01,760 --> 03:19:03,880 TO POPULATION FREQUENCY THERE'S 4220 03:19:03,880 --> 03:19:06,240 ABOUT 8,000 STILLBIRTHS A YEAR 4221 03:19:06,240 --> 03:19:10,000 AND THIS IS MODELLING RESULT NOT 4222 03:19:10,000 --> 03:19:10,400 COUNTING. 4223 03:19:10,400 --> 03:19:13,360 THE MODEL WOULD SUGGEST 8,000 4224 03:19:13,360 --> 03:19:20,880 STILLBIRTHS A YEAR ARE 4225 03:19:20,880 --> 03:19:24,840 ATTRIBUTABLE TO OBESITY. 4226 03:19:24,840 --> 03:19:30,400 PRETTY EXPOSURE FOR THAT REASON. 4227 03:19:30,400 --> 03:19:32,440 THE DETAILS ARE LISTED HERE AND 4228 03:19:32,440 --> 03:19:38,000 THIS IS AVAILABLE FOR REFERENCE 4229 03:19:38,000 --> 03:19:41,400 AND I DON'T INTEND YOU TO READ 4230 03:19:41,400 --> 03:19:42,800 EVERY ELEMENT BUT THERE'S A 4231 03:19:42,800 --> 03:19:48,240 COLUMN UNDER EACH COUNTRY LISTED 4232 03:19:48,240 --> 03:19:51,560 THERE IN THE COLUMNS AND WITHIN 4233 03:19:51,560 --> 03:19:53,720 EACH IS THE POPULATION 4234 03:19:53,720 --> 03:19:56,880 ATTRIBUTABLE RISK AND GIVES THIS 4235 03:19:56,880 --> 03:20:00,240 NUMBER FOR EACH RISK FACTOR AND 4236 03:20:00,240 --> 03:20:02,960 OBESITY'S AT THE TOP AND BY WAY 4237 03:20:02,960 --> 03:20:06,760 OF MAGNITUDE YOU CAN SEE HOW THE 4238 03:20:06,760 --> 03:20:08,960 OTHER RISK FACTORS LIKE SMOKING 4239 03:20:08,960 --> 03:20:11,160 AND MATERNAL AGE AND MEDICAL 4240 03:20:11,160 --> 03:20:12,800 DISEASE CONTRIBUTE. 4241 03:20:12,800 --> 03:20:16,560 AS A REFERENCE ITS GIVES A SENSE 4242 03:20:16,560 --> 03:20:21,040 OF THE FACTORS TOO. 4243 03:20:21,040 --> 03:20:23,720 I WANT TO TALK ABOUT OBESITY IN 4244 03:20:23,720 --> 03:20:26,960 THE CONTEXT OF OTHER OBESITY 4245 03:20:26,960 --> 03:20:31,320 RELATED PHENOMENON AND 4246 03:20:31,320 --> 03:20:32,400 CONDITIONS WE KNOW IT'S AN 4247 03:20:32,400 --> 03:20:34,560 IMPORTANT RISK FACTOR FOR 4248 03:20:34,560 --> 03:20:38,920 METABOLIC SYNDROME REFERRING TO 4249 03:20:38,920 --> 03:20:40,560 DIABETES AND WE KNOW THAT 4250 03:20:40,560 --> 03:20:42,960 HYPERTENSION AND OTHER MEDICAL 4251 03:20:42,960 --> 03:20:46,560 COMORBIDITIES AND DIABETES ARE 4252 03:20:46,560 --> 03:20:49,720 RISK FACTORS FOR STILLBIRTH AND 4253 03:20:49,720 --> 03:20:52,560 SO MAYBE OBESITY IS RELATED TO 4254 03:20:52,560 --> 03:20:54,080 STILLBIRTH NOT IN AND OF ITSELF 4255 03:20:54,080 --> 03:20:56,840 BUT IT CONTRIBUTES TO MEDICAL 4256 03:20:56,840 --> 03:20:59,080 CONDITIONS LIKE DIABETES. 4257 03:20:59,080 --> 03:21:00,880 THIS STUDY IS ONE OF A FEW 4258 03:21:00,880 --> 03:21:05,120 STUDIES TO LOOK AT THE QUESTION. 4259 03:21:05,120 --> 03:21:06,360 IS OBESITY RELATED TO STILLBIRTH 4260 03:21:06,360 --> 03:21:11,360 BECAUSE IT'S A RISK FACTOR FOR 4261 03:21:11,360 --> 03:21:11,600 DIABETES? 4262 03:21:11,600 --> 03:21:15,520 YOU SEE A LARGE DATA SET OF 4263 03:21:15,520 --> 03:21:18,200 BIRTHS FROM TEXAS AND EXCLUDED 4264 03:21:18,200 --> 03:21:19,040 HYPERTENSIVE DISEASES TAKE IT 4265 03:21:19,040 --> 03:21:23,480 OUT OF THE EQUATION AND EXCLUDED 4266 03:21:23,480 --> 03:21:27,800 GESTATIONAL DIABETES THAT DURING 4267 03:21:27,800 --> 03:21:33,200 PREGNANCY AND BY BMI SEVERITY 4268 03:21:33,200 --> 03:21:38,360 AND LOOK AT THE STILLBIRTH 4269 03:21:38,360 --> 03:21:39,160 SLIDE. 4270 03:21:39,160 --> 03:21:41,880 THIS TABLE SHOWS THE RAISE AND 4271 03:21:41,880 --> 03:21:47,200 THE TOP HALF ARE IN FOLKS NON 4272 03:21:47,200 --> 03:21:47,480 DIABETIC. 4273 03:21:47,480 --> 03:21:52,400 AND FOCUS ON THE COLUMN THAT 4274 03:21:52,400 --> 03:21:59,200 SAYS OVER ALL. 4275 03:21:59,200 --> 03:22:03,640 THAT SHOIZ 4276 03:22:03,640 --> 03:22:04,840 SHOWS THE NUMBER OF STILLBIRTHS 4277 03:22:04,840 --> 03:22:10,480 AND YOU GO FROM 15.3 FOR UNDER 4278 03:22:10,480 --> 03:22:13,120 WEIGHT AND 15 FOR NORMAL WEIGHT 4279 03:22:13,120 --> 03:22:14,680 NON-DIABETES AND MARCHES UP AND 4280 03:22:14,680 --> 03:22:20,640 THE NUMBER GETS BIG AS YOU GET 4281 03:22:20,640 --> 03:22:22,920 MORE MORBIDLY OBESE AND YOU SEE 4282 03:22:22,920 --> 03:22:31,680 THE NUMBERS FOR PREGESTATIONAL 4283 03:22:31,680 --> 03:22:31,960 DIABETES. 4284 03:22:31,960 --> 03:22:36,320 THAT'S A BIG RISK FACTOR FOR 4285 03:22:36,320 --> 03:22:40,520 STILLBIRTH AND WE KNEW THAT 4286 03:22:40,520 --> 03:22:42,680 BEFORE THE PAPER. 4287 03:22:42,680 --> 03:22:45,040 AN IMPORTANT POINT IS FOR THE 4288 03:22:45,040 --> 03:22:50,840 TOP HALF OF THE FIGURE AS YOU 4289 03:22:50,840 --> 03:22:52,560 CHANGE IN WEIGHT THERE'S AN 4290 03:22:52,560 --> 03:22:54,840 INCREASE IN STILLBIRTH RISK EVEN 4291 03:22:54,840 --> 03:22:56,200 WITHOUT DIABETES. 4292 03:22:56,200 --> 03:22:59,040 THE RISK OF STILLBIRTH 4293 03:22:59,040 --> 03:23:03,200 ATTRIBUTABLE DIABETES TO 4294 03:23:03,200 --> 03:23:08,840 DIABETES IS NOT ATTRIBUTABLE TO 4295 03:23:08,840 --> 03:23:10,200 PRE GESTATIONAL DIABETES. 4296 03:23:10,200 --> 03:23:11,920 THIS TAKES THE SAME SETS OF 4297 03:23:11,920 --> 03:23:14,920 RATES IN A HAZARD RATIO. 4298 03:23:14,920 --> 03:23:24,640 A MAGNITUDE IN RISK. 4299 03:23:24,640 --> 03:23:26,200 THIS THOSE THE RISK MARCHES UP 4300 03:23:26,200 --> 03:23:31,920 MORE WITH OBESE AND DIABETES. 4301 03:23:31,920 --> 03:23:35,400 THEY'RE INTERACTIVE AND AMPLIFY 4302 03:23:35,400 --> 03:23:44,840 THE EFFECTS OF EACH OTHER. 4303 03:23:44,840 --> 03:23:48,800 OBESITY RELATES TO STILLBIRTHS. 4304 03:23:48,800 --> 03:23:52,920 AN AREA OF RESEARCH INTERESTS 4305 03:23:52,920 --> 03:23:56,880 AND AN AREA OF CLINICAL INTEREST 4306 03:23:56,880 --> 03:23:59,160 AND PUBLIC HEALTH INTEREST HAS 4307 03:23:59,160 --> 03:24:01,360 BEEN GESTATIONAL WEIGHT GAIN. 4308 03:24:01,360 --> 03:24:09,400 AS DR. SILVER SAID AND LOOK 4309 03:24:09,400 --> 03:24:11,640 FORWARD TO A CONVERSATION 4310 03:24:11,640 --> 03:24:12,600 WHETHER GESTATIONAL DIABETES IS 4311 03:24:12,600 --> 03:24:13,680 PREVENTIBLE AND WHEN I SEE A 4312 03:24:13,680 --> 03:24:16,240 PATIENT FOR THE FIRST TIME IN A 4313 03:24:16,240 --> 03:24:21,760 NEW VISIT I CAN MODIFY THAT 4314 03:24:21,760 --> 03:24:25,400 PATIENT'S OBESITY WITH 4315 03:24:25,400 --> 03:24:27,880 COUNSELLING AND SO OUR 4316 03:24:27,880 --> 03:24:30,480 COUNSELLING AND CARE MIGHT BE 4317 03:24:30,480 --> 03:24:34,080 IMPLEMENTS TO INFLUENCE WEIGHT 4318 03:24:34,080 --> 03:24:36,720 GAIN OVER PREGNANCY. 4319 03:24:36,720 --> 03:24:37,560 OVER ALL IN THE GENERAL 4320 03:24:37,560 --> 03:24:42,560 POPULATION OR AMONG THOSE WHO 4321 03:24:42,560 --> 03:24:44,480 HAVE OBESITY. 4322 03:24:44,480 --> 03:24:48,840 THIS PAPER INVESTIGATE THE TOPIC 4323 03:24:48,840 --> 03:24:51,040 DOES GESTATIONAL WEIGHT GAIN 4324 03:24:51,040 --> 03:24:52,200 INCREASE THE RISK OF 4325 03:24:52,200 --> 03:24:52,480 STILLBIRTHS. 4326 03:24:52,480 --> 03:24:58,240 I CAN SHOW THE RESULTS IN A 4327 03:24:58,240 --> 03:25:04,440 SECOND AND THERE ARE CONFLICTING 4328 03:25:04,440 --> 03:25:07,800 AND UNCERTAINTY ON THE TOPIC. 4329 03:25:07,800 --> 03:25:10,560 I'LL TALK A LITTLE BIT AND THIS 4330 03:25:10,560 --> 03:25:14,720 STUDY ILLUMINATES WHY THAT MIGHT 4331 03:25:14,720 --> 03:25:15,000 BE. 4332 03:25:15,000 --> 03:25:15,680 THESE FIVE FIGURES ALL LAID OUT 4333 03:25:15,680 --> 03:25:17,400 THE SAME. 4334 03:25:17,400 --> 03:25:24,840 EACH OF THE FIVE TABLES IS 4335 03:25:24,840 --> 03:25:27,040 REFERRING TO A SUBSET OF THE 4336 03:25:27,040 --> 03:25:28,680 POPULATION AND NORMAL AND OBESE 4337 03:25:28,680 --> 03:25:31,880 AND MORBIDLY. 4338 03:25:31,880 --> 03:25:35,640 GOING FROM A TO E THE STRATUM 4339 03:25:35,640 --> 03:25:41,120 INCREASES AND EACH OF THE FOUR 4340 03:25:41,120 --> 03:25:44,120 LINES ON EACH OF THE FIGURES 4341 03:25:44,120 --> 03:25:46,280 SHOWS THE RISK OF STILLBIRTH IN 4342 03:25:46,280 --> 03:25:48,840 EACH OF THE FOUR STRATUM OF 4343 03:25:48,840 --> 03:25:51,240 GESTATIONAL WEIGHT GAIN. 4344 03:25:51,240 --> 03:25:53,360 ADEQUATE WEIGHT GAIN AND 4345 03:25:53,360 --> 03:25:53,640 INADEQUATE. 4346 03:25:53,640 --> 03:25:58,440 THERE'S WEIGHT GAIN BUT NOT 4347 03:25:58,440 --> 03:26:03,920 ENOUGH WEIGHT GAIN BY ILM AND 4348 03:26:03,920 --> 03:26:05,200 GAINING BEYOND AND THE RED LINE 4349 03:26:05,200 --> 03:26:07,440 WEIGHT LOSS OVER PREGNANCY. 4350 03:26:07,440 --> 03:26:09,120 THOSE ARE THE FOUR STRATUM KWN 4351 03:26:09,120 --> 03:26:18,400 OBESITY CATEGORIES. 4352 03:26:18,400 --> 03:26:21,400 THE ORDER OF THE LIVES IS GOING 4353 03:26:21,400 --> 03:26:28,200 RED, GREEN, PURPLE AND BLUE IS 4354 03:26:28,200 --> 03:26:29,000 DIFFERENT IN THE FIGURES. 4355 03:26:29,000 --> 03:26:32,880 I'LL POINT OUT THAT IN THE 4356 03:26:32,880 --> 03:26:34,800 NORMAL WEIGHT GROUP OVERWEIGHT 4357 03:26:34,800 --> 03:26:36,280 AND OBESE GROUP THE HIGHEST RISK 4358 03:26:36,280 --> 03:26:37,800 IS IN THE RED LINE. 4359 03:26:37,800 --> 03:26:40,560 FOLKS WHO LOSE WEIGHT DURING 4360 03:26:40,560 --> 03:26:45,640 PREGNANCY. 4361 03:26:45,640 --> 03:26:49,160 THIS IS NOT TRUE IN COLUMN E AND 4362 03:26:49,160 --> 03:26:52,880 NOT STATISTICALLY DIFFERENT FOR 4363 03:26:52,880 --> 03:26:56,840 WEIGHT LOSS IN THE MORBIDLY 4364 03:26:56,840 --> 03:26:59,400 OBESE POPULATION. 4365 03:26:59,400 --> 03:27:02,360 THE MAGNITUDE OF EXCESSIVE 4366 03:27:02,360 --> 03:27:03,600 WEIGHT GAIN IS THE BIGGEST RISK 4367 03:27:03,600 --> 03:27:10,000 FACTOR BY A FAIR AMOUNT. 4368 03:27:10,000 --> 03:27:12,680 IT'S NOT THAT AWAY FOR ANY OF 4369 03:27:12,680 --> 03:27:15,440 THE OTHER BMI STRATUM. 4370 03:27:15,440 --> 03:27:17,320 IF GESTATIONAL WEIGHT GAIN HAS 4371 03:27:17,320 --> 03:27:20,320 AN AND THAT'S BASED ON THE 4372 03:27:20,320 --> 03:27:24,040 CONTEXT OF TOPIC, I THINK IT'S 4373 03:27:24,040 --> 03:27:27,960 FAIR TO SAY WE CAN'T REALLY 4374 03:27:27,960 --> 03:27:29,600 APPRECIATE THE GESTATIONAL 4375 03:27:29,600 --> 03:27:31,880 WEIGHT GAIN AS A RISK FACTOR 4376 03:27:31,880 --> 03:27:38,960 WITHOUT THINKING ABOUT BMI AND 4377 03:27:38,960 --> 03:27:40,000 OBESITY UP FRONT. 4378 03:27:40,000 --> 03:27:44,080 SO AS WE INVESTIGATE THE 4379 03:27:44,080 --> 03:27:45,000 MECHANISMS UNDERLYING THIS OR 4380 03:27:45,000 --> 03:27:46,440 PUBLIC HEALTH RECOMMENDATIONS AN 4381 03:27:46,440 --> 03:27:47,920 NUTRITIONAL RECOMMENDATIONS 4382 03:27:47,920 --> 03:27:52,560 MOVING FORWARD ALL OF WHICH ARE 4383 03:27:52,560 --> 03:27:54,600 KNOWLEDGE AREAS WE SHOULD FOCUS 4384 03:27:54,600 --> 03:27:56,840 ON WE HAVE TO TAKE DATA LIKE 4385 03:27:56,840 --> 03:28:03,680 THIS INTO ACCOUNT. 4386 03:28:03,680 --> 03:28:05,760 I WANT IT TALK ABOUT CLINICAL 4387 03:28:05,760 --> 03:28:08,840 RECOMMENDATIONS AN CLINICAL CARE 4388 03:28:08,840 --> 03:28:17,200 WE DID IN OTHER TALKS AND FETAL 4389 03:28:17,200 --> 03:28:19,480 MOVEMENTS AND IT'S AN 4390 03:28:19,480 --> 03:28:20,840 EDUCATIONAL EFFORT WITH PUBLIC 4391 03:28:20,840 --> 03:28:24,840 HEALTH AND CLINICAL 4392 03:28:24,840 --> 03:28:27,960 RECOMMENDATIONS EVERY DAY IN 4393 03:28:27,960 --> 03:28:33,120 OB-GYN OFFICES AND THIS TALKS 4394 03:28:33,120 --> 03:28:38,600 ABOUT THE AFFECT OF OBESITY AND 4395 03:28:38,600 --> 03:28:44,840 THE DECREASED MOVEMENT OF FETAL 4396 03:28:44,840 --> 03:28:47,040 MOVEMENT AMONG PATIENTS. 4397 03:28:47,040 --> 03:28:51,920 IT'S A SYSTEMATIC REVIEW IN 4398 03:28:51,920 --> 03:28:53,640 META-ANALYSIS AND THE DETAILS 4399 03:28:53,640 --> 03:28:57,680 AREN'T THAT IMPORTANT THE TAKE 4400 03:28:57,680 --> 03:28:58,960 HOME POINT AMONG WOMEN THAT 4401 03:28:58,960 --> 03:29:00,840 PRESENT WITH DECREASED FETAL 4402 03:29:00,840 --> 03:29:03,080 MOVEMENT THOSE THAT GO ON TO 4403 03:29:03,080 --> 03:29:06,600 SUBSEQUENT STILLBIRTH ARE LIKELY 4404 03:29:06,600 --> 03:29:07,480 TO HAVE OBESITY. 4405 03:29:07,480 --> 03:29:12,840 THE IMPLICATION OF OBESITY WITH 4406 03:29:12,840 --> 03:29:18,680 DECREASED FETAL MOVEMENT WITH 4407 03:29:18,680 --> 03:29:20,480 RESPECT TO STILLBIRTHS IS 4408 03:29:20,480 --> 03:29:26,640 GREATER AMONG OBESE PATIENTS 4409 03:29:26,640 --> 03:29:28,640 AND WHEN A PATIENT PRESENTS WITH 4410 03:29:28,640 --> 03:29:34,040 DECREASED FETAL MOVEMENT WE DO 4411 03:29:34,040 --> 03:29:34,880 SOME ASSESSMENT OF FETAL 4412 03:29:34,880 --> 03:29:36,840 WELL-BEING WITHIN A STRESS TEST 4413 03:29:36,840 --> 03:29:42,000 AND IT'S POSSIBLE OBESITY ITSELF 4414 03:29:42,000 --> 03:29:43,400 INFLUENCES THE TEST FOR LOGISTIC 4415 03:29:43,400 --> 03:29:48,560 PERSPECTIVE AND INTERPRETATION 4416 03:29:48,560 --> 03:29:58,360 PERSPECTIVE. 4417 03:29:58,360 --> 03:30:03,480 AND THE INVESTIGATORS EXAMINED 4418 03:30:03,480 --> 03:30:06,520 THOSE WITH MORBID OBESITY ALONE 4419 03:30:06,520 --> 03:30:08,840 AND THOSE WITH MORBID OBESITY 4420 03:30:08,840 --> 03:30:17,120 PLUS MEDICAL COMORBIDITY AND 4421 03:30:17,120 --> 03:30:18,600 THOSE WITH A MEDICAL COMORBIDITY 4422 03:30:18,600 --> 03:30:21,160 AND FOUND A FEW IMPORTANT 4423 03:30:21,160 --> 03:30:22,600 POINTS. 4424 03:30:22,600 --> 03:30:25,480 OVER THE OBESITY WAS NOT 4425 03:30:25,480 --> 03:30:28,520 ASSOCIATED WITH THE NEED FOR 4426 03:30:28,520 --> 03:30:30,360 DOWN STREAM INTERVENTION LIKE 4427 03:30:30,360 --> 03:30:34,520 INDUCING LABOR OR DELIVERY OR 4428 03:30:34,520 --> 03:30:35,840 SOME SUCH INTERVENTION BUT FIND 4429 03:30:35,840 --> 03:30:37,640 OBESITY WAS ASSOCIATED WITH A 4430 03:30:37,640 --> 03:30:40,600 GREATER DURATION TO ACHIEVE A 4431 03:30:40,600 --> 03:30:48,240 NORMAL NON-STRESS TEST. 4432 03:30:48,240 --> 03:30:53,200 IN DOING THESE STRESS TESTS IT 4433 03:30:53,200 --> 03:30:54,400 CHANGES THE LOGISTICS OF DOING 4434 03:30:54,400 --> 03:30:56,080 THE TEST IN TERMS OF TIME IT 4435 03:30:56,080 --> 03:30:57,160 TAKES TO GET TO REACTIVE NON 4436 03:30:57,160 --> 03:31:03,480 STRESS TEST. 4437 03:31:03,480 --> 03:31:05,320 HOW THEY RESPOND MAY BE 4438 03:31:05,320 --> 03:31:07,320 DIFFERENT IN THOSE WHO HAVE 4439 03:31:07,320 --> 03:31:08,440 OBESITY VERSUS THOSE THAT DONE 4440 03:31:08,440 --> 03:31:09,880 AN IMPORTANT AS WE MAKE 4441 03:31:09,880 --> 03:31:12,520 RECOMMENDATIONS AND TRY TO GET 4442 03:31:12,520 --> 03:31:16,600 DATA TO DRIVE GOOD CLINICAL 4443 03:31:16,600 --> 03:31:26,880 DECISION MAKING. 4444 03:31:27,400 --> 03:31:29,640 AND FOR EVALUATING THE PHEE TUS 4445 03:31:29,640 --> 03:31:34,600 BY ULTRASOUND IN THE SPACE OF 4446 03:31:34,600 --> 03:31:38,360 ALL ULTRASOUND AND STILLBIRTH WE 4447 03:31:38,360 --> 03:31:40,840 THINK ULTRASOUND IS IMPORTANT 4448 03:31:40,840 --> 03:31:44,840 FOR GETTING A SENSE OF GESTA 4449 03:31:44,840 --> 03:31:47,560 GESTATIONAL AGE AND FETAL 4450 03:31:47,560 --> 03:31:48,840 ANATOMY AND WHETHER THERE'S 4451 03:31:48,840 --> 03:31:51,600 EXPECTED TO BE ANOMALIES FOR 4452 03:31:51,600 --> 03:31:53,600 BIRTH DEFECTS IN THE FETUS AND 4453 03:31:53,600 --> 03:31:56,840 USED FOR ASSURANCE FOR WELL 4454 03:31:56,840 --> 03:32:00,400 BEING. 4455 03:32:00,400 --> 03:32:02,120 THERE ARE SUBSTANTIAL DATA IN 4456 03:32:02,120 --> 03:32:05,400 ALL REGARDS TO SHOW OBESITY 4457 03:32:05,400 --> 03:32:07,920 PRESENTS TECHNICAL LIMITATIONS 4458 03:32:07,920 --> 03:32:10,080 FOR THE PERFORMANCE OF THE TEST 4459 03:32:10,080 --> 03:32:15,640 THE NOTION A SOUND WAVE 4460 03:32:15,640 --> 03:32:18,960 GENERATED BY THE DEVICE 4461 03:32:18,960 --> 03:32:19,920 PENETRATES TISSUE AND THERE'S 4462 03:32:19,920 --> 03:32:23,400 MORE DIAGNOSTIC UNCERTAINTY AND 4463 03:32:23,400 --> 03:32:24,840 INCREASE IN FALSE POSITIVES AND 4464 03:32:24,840 --> 03:32:27,240 FALSE NEGATIVES ASSOCIATED WITH 4465 03:32:27,240 --> 03:32:29,160 ULTRASOUND IN ALL THE DIAGNOSTIC 4466 03:32:29,160 --> 03:32:32,960 CATEGORIES THAT TALKED ABOUT IN 4467 03:32:32,960 --> 03:32:35,720 PATIENTS WITH OBESITY VERSUS 4468 03:32:35,720 --> 03:32:35,960 WITHOUT. 4469 03:32:35,960 --> 03:32:38,480 I HAVE A COUPLE PICTURES OF 4470 03:32:38,480 --> 03:32:40,120 THESE IMAGES ONLY TO SAY I 4471 03:32:40,120 --> 03:32:41,280 BELIEVE THERE'S OPPORTUNITIES IN 4472 03:32:41,280 --> 03:32:46,600 RESEARCH AND DEVELOPMENT FOR 4473 03:32:46,600 --> 03:32:49,280 TECHNOLO 4474 03:32:49,280 --> 03:32:51,600 TECHNOLOGIES AND OPTIMIZING 4475 03:32:51,600 --> 03:32:56,760 TECHNOLOGIES THAT HELP MINIMIZE 4476 03:32:56,760 --> 03:33:01,880 THE AFFECTS OF POOR TISSUE 4477 03:33:01,880 --> 03:33:03,280 PENETRATION ON CAPACITY. 4478 03:33:03,280 --> 03:33:05,480 ULTRASOUND WAS NOT MUCH BETTER 4479 03:33:05,480 --> 03:33:07,120 THAN READING TEA LEAVES WHEN I 4480 03:33:07,120 --> 03:33:08,200 FIRST STARTED AND BETTER THAN 4481 03:33:08,200 --> 03:33:13,960 THAT WITH EXCELLENT ADVANCES IN 4482 03:33:13,960 --> 03:33:16,520 TECHNOLOGY TO HAVE IMAGE 4483 03:33:16,520 --> 03:33:17,640 PROCESSING TO GET BETTER 4484 03:33:17,640 --> 03:33:18,920 PICTURES BUT NOT WHERE WE NEED 4485 03:33:18,920 --> 03:33:22,600 TO BE IN TERMS OF OPTIMIZING FOR 4486 03:33:22,600 --> 03:33:24,640 THE OBESE POPULATION AND THAT IS 4487 03:33:24,640 --> 03:33:32,520 INCREASING IN FREQUENCY. 4488 03:33:32,520 --> 03:33:34,960 I WANT TO BRIEFLY TALK ABOUT 4489 03:33:34,960 --> 03:33:40,200 MECHANISMS BY WHICH OBESE MAY 4490 03:33:40,200 --> 03:33:41,720 LEAD TO STILLBIRTH. 4491 03:33:41,720 --> 03:33:43,200 AND THIS IS A POINT MADE WITH 4492 03:33:43,200 --> 03:33:52,120 AREN'T TO STILLBIRTH OVER ALL. 4493 03:33:52,120 --> 03:33:54,200 OF THE OUTCOMES AND ABRUPTION 4494 03:33:54,200 --> 03:33:57,280 AND PREECLAMPSIA OR 4495 03:33:57,280 --> 03:33:58,600 HYPERSENSITIVE DISORDERS HAVE A 4496 03:33:58,600 --> 03:34:02,360 COMMON SET OF RISK FACTORS MAY 4497 03:34:02,360 --> 03:34:05,600 SHARE MECHANISMS AND A SIMILAR 4498 03:34:05,600 --> 03:34:06,480 SET OF CIRCUMSTANCES MAY 4499 03:34:06,480 --> 03:34:09,000 TRANSDUCE IN SOME PREGNANCIES TO 4500 03:34:09,000 --> 03:34:12,840 LEAD IT A SPONTANEOUS PRE TERM 4501 03:34:12,840 --> 03:34:16,160 BIRTH AND IN OTHERS LEAD TO 4502 03:34:16,160 --> 03:34:16,440 STILLBIRTHS. 4503 03:34:16,440 --> 03:34:20,880 TAKING A HIGH POPULATION 4504 03:34:20,880 --> 03:34:22,160 ATTRIBUTABLE RISK LIKE OBESITY 4505 03:34:22,160 --> 03:34:24,760 THAT HAS RISK FOR ALL THESE 4506 03:34:24,760 --> 03:34:26,600 ADVERSE OUTCOMES AND AGGREGATING 4507 03:34:26,600 --> 03:34:31,240 OR DISAGGREGATING SHARED OR 4508 03:34:31,240 --> 03:34:33,200 DISTINCT MECHANISMS IS LIKELY TO 4509 03:34:33,200 --> 03:34:35,080 BE QUITE FRUITFUL NOT ONLY IN 4510 03:34:35,080 --> 03:34:36,800 PREVENTION OF MORE COMMON 4511 03:34:36,800 --> 03:34:39,480 ADVERSE OUTCOMES LIKE PRE TERM 4512 03:34:39,480 --> 03:34:50,040 BIRTH OR PREECLAMPSIA BUT RARER 4513 03:34:51,640 --> 03:34:55,880 ONES AND FOR THE SAKE OF HEALTH 4514 03:34:55,880 --> 03:34:58,600 AND BETTER DIAGNOSTICS AND 4515 03:34:58,600 --> 03:34:59,880 COMMONALITIES FROM RISK FACTORS 4516 03:34:59,880 --> 03:35:03,200 LIKE OBESITY IS LIKELY TO BEAR 4517 03:35:03,200 --> 03:35:03,400 FRUIT. 4518 03:35:03,400 --> 03:35:07,560 I THINK THAT'S IMPORTANT TO 4519 03:35:07,560 --> 03:35:08,840 CONSIDER AS WE FRAME OUR 4520 03:35:08,840 --> 03:35:19,400 RESEARCH AGENDA MOVING FORWARD. 4521 03:35:35,880 --> 03:35:38,200 IS THE WORLD IN WHICH AN 4522 03:35:38,200 --> 03:35:39,160 INDIVIDUAL LIVES THE SOCIETY 4523 03:35:39,160 --> 03:35:41,360 WRIT LARGE AND THE COMMUNITY 4524 03:35:41,360 --> 03:35:46,600 WOMAN THAT SOCIETY CARE BE THE 4525 03:35:46,600 --> 03:35:51,360 SOCIAL DRIVERS OF HEALTH AND 4526 03:35:51,360 --> 03:35:53,680 THOSE INFLUENCE AND TRANSDUCE 4527 03:35:53,680 --> 03:35:57,240 BIOLOGICALLY TO TRANSMIT TO 4528 03:35:57,240 --> 03:36:00,840 AFFECT THE FETUS AND THERE ARE 4529 03:36:00,840 --> 03:36:02,800 DISCREET SET OF PATHWAYS AND 4530 03:36:02,800 --> 03:36:07,000 THESE ARE THE TRANSDUCERS OF 4531 03:36:07,000 --> 03:36:08,960 EXTERNAL ENVIRONMENT IMMUNE, 4532 03:36:08,960 --> 03:36:11,520 METABOLIC, ENDOCRINE AND 4533 03:36:11,520 --> 03:36:13,400 OXIDATIVE AND I LOOK FOR 4534 03:36:13,400 --> 03:36:14,200 CONTRIBUTIONS FROM THOSE TO 4535 03:36:14,200 --> 03:36:19,800 CONTRIBUTE AND THOSE ARE THE 4536 03:36:19,800 --> 03:36:22,600 DOMAINS HOW THEY TRANSDUCE AND 4537 03:36:22,600 --> 03:36:25,840 THEY TRANSDUCE THROUGH 4538 03:36:25,840 --> 03:36:28,480 INTRACELLULAR PROCESSES TO 4539 03:36:28,480 --> 03:36:36,840 AFFECT FETUS/PLA SEP -- 4540 03:36:36,840 --> 03:36:39,480 PLACENTA AND WE LOOK AT OBESITY 4541 03:36:39,480 --> 03:36:43,520 AS A DETERMINATE OF HEALTH AND 4542 03:36:43,520 --> 03:36:47,760 MAY BE CONTRIBUTES TO BY 4543 03:36:47,760 --> 03:36:58,240 UPSTREAM EXPOSURES TALK ABOUT 4544 03:37:00,600 --> 03:37:10,960 THE TRANSMISSION PATHWAYS. 4545 03:37:13,920 --> 03:37:15,520 THIS CONCEPTUAL FRAMEWORK IS 4546 03:37:15,520 --> 03:37:26,000 IMPORTANT TO KEEP IN MIND. 4547 03:37:31,560 --> 03:37:32,840 IT'S A LONG TIME COMING TO ADD 4548 03:37:32,840 --> 03:37:35,600 TO THE FOCUS IN THIS AREA AND 4549 03:37:35,600 --> 03:37:37,120 LOTS OF FOLKS HAVE CLINICAL 4550 03:37:37,120 --> 03:37:38,600 RESEARCH AND PUBLIC HEALTH 4551 03:37:38,600 --> 03:37:44,040 INTERESTS IN THIS DOMAIN AND IF 4552 03:37:44,040 --> 03:37:54,360 WE CAN BRING THIS. 4553 03:38:09,160 --> 03:38:10,600 I'LL BE HAPPY TO WAIT OR THE 4554 03:38:10,600 --> 03:38:12,880 DISCUSSION. 4555 03:38:12,880 --> 03:38:19,840 >>WE'RE GOING TO MOVE ALONG WOE 4556 03:38:19,840 --> 03:38:24,840 HAVE PROFESSOR OF PATHOLOGY AT 4557 03:38:24,840 --> 03:38:28,600 MASSACHUSETTS GENERAL HOSPITAL 4558 03:38:28,600 --> 03:38:39,040 AND ALSO AT PROFESSOR OF 4559 03:38:44,520 --> 03:38:45,760 PATHOLOGY AT HARVARD MEDICAL 4560 03:38:45,760 --> 03:38:46,040 SCHOOL. 4561 03:38:46,040 --> 03:38:48,880 THANK YOU FOR ACCEPTING OUR 4562 03:38:48,880 --> 03:38:52,600 INVITA 4563 03:38:52,600 --> 03:38:53,240 INVITA 4564 03:38:53,240 --> 03:39:03,640 INVITATION, DR. ROBERTS. 4565 03:39:04,760 --> 03:39:15,080 WE STILL DON'T HEAR YOU. 4566 03:39:27,520 --> 03:39:28,600 TECHNICAL TEAM, IS DR. ROBERTS 4567 03:39:28,600 --> 03:39:38,880 CONNECTED WELL? 4568 03:40:06,320 --> 03:40:16,760 SO WE ARE GOING TO DR. MONICA 4569 03:40:18,360 --> 03:40:23,280 WOJCIK'S PRESENTATION IN NEWBORN 4570 03:40:23,280 --> 03:40:28,480 MEDICINE MEDICAL DIRECTOR OF 4571 03:40:28,480 --> 03:40:30,480 MATERNAL FETAL CARE AT BOSTON 4572 03:40:30,480 --> 03:40:31,240 CHILDREN'S HOSPITAL. 4573 03:40:31,240 --> 03:40:32,440 >>IT'S BEEN WONDERFUL TO LEARN 4574 03:40:32,440 --> 03:40:33,840 FROM THOSE WHO ALREADY SPOKEN. 4575 03:40:33,840 --> 03:40:36,520 I'LL BE SPEAKING ABOUT GENOMIC 4576 03:40:36,520 --> 03:40:37,720 CONTRIBUTIONS TO STILLBIRTH. 4577 03:40:37,720 --> 03:40:40,880 I PRACTICE AS A NEONATOLOGIST 4578 03:40:40,880 --> 03:40:48,160 AND GENETICISTS AT BOSTON 4579 03:40:48,160 --> 03:40:55,040 CHILDREN'S HOSPITAL. 4580 03:40:55,040 --> 03:40:57,200 I'LL REVIEW THE CURRENT 4581 03:40:57,200 --> 03:40:58,480 UNDERSTANDING AND THE QUESTION 4582 03:40:58,480 --> 03:41:02,280 IS WHICH PROPORTION OF PERINATAL 4583 03:41:02,280 --> 03:41:03,080 DEATHS PARTICULARLY STILLBIRTHS 4584 03:41:03,080 --> 03:41:08,400 INVOLVE AN UNDERLYING GENETIC 4585 03:41:08,400 --> 03:41:08,680 CONDITION. 4586 03:41:08,680 --> 03:41:09,960 A RELATED QUESTION BUT EVEN IF 4587 03:41:09,960 --> 03:41:13,560 WE KNOW THE GENETIC CONDITION 4588 03:41:13,560 --> 03:41:17,760 WHAT'S THE RATE OF PERINATAL 4589 03:41:17,760 --> 03:41:19,280 LOSS AND THE ANSWER IS MORE 4590 03:41:19,280 --> 03:41:21,880 COMPLEX THAN IT APPEARS IT'S 4591 03:41:21,880 --> 03:41:24,080 HELPFUL TO HAVE AN UNDERSTANDING 4592 03:41:24,080 --> 03:41:28,720 HOW WE IDENTIFY THE GENETIC 4593 03:41:28,720 --> 03:41:29,000 DIAGNOSES. 4594 03:41:29,000 --> 03:41:33,520 THEY CAN BE FOUND AT THE LEVEL 4595 03:41:33,520 --> 03:41:35,400 OF THE CHROMOSOME OR GENE AND 4596 03:41:35,400 --> 03:41:37,680 DIFFERENT TESTS WOULD BE USED TO 4597 03:41:37,680 --> 03:41:39,760 IDENTIFY THE DIFFERENT TYPES OF 4598 03:41:39,760 --> 03:41:43,920 DIAGNOSES WHERE GENETIC TESTING 4599 03:41:43,920 --> 03:41:47,200 ARE DESIGN TO FIND CHROMOSOME 4600 03:41:47,200 --> 03:41:52,000 LEVEL DIAGNOSES BUT NOT RELATE 4601 03:41:52,000 --> 03:41:53,880 TO SINGLE GENES AND THERE'S 4602 03:41:53,880 --> 03:41:54,840 OTHER TECHNIQUES WE'D HAVE TO 4603 03:41:54,840 --> 03:41:55,080 USE. 4604 03:41:55,080 --> 03:41:56,800 THIS IS IMPORTANT AS WE GET TO 4605 03:41:56,800 --> 03:41:58,440 THE CURRENT STATE OF THE 4606 03:41:58,440 --> 03:41:58,760 LITERATURE. 4607 03:41:58,760 --> 03:42:04,200 INFORMATION THE LIMITATIONS AND 4608 03:42:04,200 --> 03:42:10,040 ABILITIES OF TESTS USED IMPACTS 4609 03:42:10,040 --> 03:42:15,040 THE ABILITY TO INTERPRET THE 4610 03:42:15,040 --> 03:42:15,280 RESULTS. 4611 03:42:15,280 --> 03:42:19,520 THIS IS AN OVER ALL SUMMARY ON 4612 03:42:19,520 --> 03:42:20,920 THE GENOMICS OF STILLBIRTH. 4613 03:42:20,920 --> 03:42:24,640 IF THERE'S ONE THING TO TAKE 4614 03:42:24,640 --> 03:42:27,000 FROM THIS OVER ALL THERE'S SO 4615 03:42:27,000 --> 03:42:28,600 MUCH TO UNDERSTAND AND WE MADE 4616 03:42:28,600 --> 03:42:29,800 WONDERFUL PROGRESS IN THE LAST 4617 03:42:29,800 --> 03:42:31,640 DECADE BUT THERE'S A LOT TO DO. 4618 03:42:31,640 --> 03:42:37,640 OVER ALL, IF YOU LOOK AT STUDIES 4619 03:42:37,640 --> 03:42:39,840 THAT INVESTIGATE FETAL LOSS IN 4620 03:42:39,840 --> 03:42:42,560 PARTICULAR, THE LIKELIHOOD OF 4621 03:42:42,560 --> 03:42:45,720 FINDING A GENETIC DIAGNOSIS OR 4622 03:42:45,720 --> 03:42:47,720 THE PROPORTION OF DIAGNOSES 4623 03:42:47,720 --> 03:42:48,800 IDENTIFIED VARIES BY SEVERAL 4624 03:42:48,800 --> 03:42:49,160 FACTORS. 4625 03:42:49,160 --> 03:42:53,760 THE FIRST WOULD BE GESTATIONAL 4626 03:42:53,760 --> 03:42:56,160 AGE WHERE EARLIER LOSS IS OFTEN 4627 03:42:56,160 --> 03:42:58,600 ATTRIBUTED TO CHROMOSOMAL 4628 03:42:58,600 --> 03:42:59,600 CHANGES AND THE DIAGNOSTIC YIELD 4629 03:42:59,600 --> 03:43:02,200 TENDS TO BE HIGHER FOR LOSSES OF 4630 03:43:02,200 --> 03:43:03,680 EARLIER GESTATIONAL AGES. 4631 03:43:03,680 --> 03:43:06,240 THE PRESENCE OF FETAL ANOMALIES 4632 03:43:06,240 --> 03:43:09,280 IS A MAJOR INFLUENCER OF THE 4633 03:43:09,280 --> 03:43:10,080 LIKELIHOOD OF IDENTIFYING A 4634 03:43:10,080 --> 03:43:20,400 GENETIC CONDITION. 4635 03:43:20,680 --> 03:43:21,720 FINALLY UNDERSTANDING THE 4636 03:43:21,720 --> 03:43:26,760 POPULATION BEING EVALUATED IS 4637 03:43:26,760 --> 03:43:28,600 IMPORTANT TOO AND CERTAIN 4638 03:43:28,600 --> 03:43:31,200 STUDIES THAT HAVE LOOKED AT 4639 03:43:31,200 --> 03:43:32,120 HIGHLY CONSANGUINEOUS 4640 03:43:32,120 --> 03:43:34,280 POPULATIONS THE TESTING 4641 03:43:34,280 --> 03:43:38,000 PARTICULARLY FOR RECESSSIVE 4642 03:43:38,000 --> 03:43:39,880 CONDITIONS WHERE BOTH PARENTS 4643 03:43:39,880 --> 03:43:44,840 ARE CARRIERS OF THE SAME VARIANT 4644 03:43:44,840 --> 03:43:45,360 WILL BE HIGHER. 4645 03:43:45,360 --> 03:43:48,640 I PUT PERCENTAGES AND IT'S A 4646 03:43:48,640 --> 03:43:49,160 BROAD YIELD. 4647 03:43:49,160 --> 03:43:52,080 IT HAS TO DO WITH THE STUDIES 4648 03:43:52,080 --> 03:43:54,200 AVAILABLE AND THE DIVERSITY OF 4649 03:43:54,200 --> 03:44:00,480 COHORTS INCLUDED IN THE STUDIES. 4650 03:44:00,480 --> 03:44:07,360 ANYWHERE FROM 10% TO 30% INVOLVE 4651 03:44:07,360 --> 03:44:12,320 CHROMOSOMAL CONDITIONS AND FROM 4652 03:44:12,320 --> 03:44:16,320 10% IN OVER ALL STILLBIRTHS 4653 03:44:16,320 --> 03:44:19,240 WITHOUT NO KNOWN FETAL 4654 03:44:19,240 --> 03:44:20,760 ABNORMALITIES ATTRIBUTABLE TO 4655 03:44:20,760 --> 03:44:21,880 MONOGENIC CONDITIONS AND COULD 4656 03:44:21,880 --> 03:44:28,600 GO UP TO 50% WITH A COHORT OF 4657 03:44:28,600 --> 03:44:31,120 PERINATAL LOSS WITH A SUSPICION 4658 03:44:31,120 --> 03:44:34,360 OF A GENETIC CONDITIONS AND THE 4659 03:44:34,360 --> 03:44:35,200 TESTING FOR STILLBIRTH DEPENDS 4660 03:44:35,200 --> 03:44:40,120 ON WHO YOU'RE SELECTING TO TEST. 4661 03:44:40,120 --> 03:44:42,320 ONE OF THE NICEST STUDIES 4662 03:44:42,320 --> 03:44:44,360 CURRENTLY IS FROM THE 4663 03:44:44,360 --> 03:44:44,920 STILLBIRTHS COLLABORATIVE 4664 03:44:44,920 --> 03:44:48,920 RESEARCH NETWORK AND THERE'S TWO 4665 03:44:48,920 --> 03:44:53,280 SEPARATE PAPERS THAT LOOKED AT 4666 03:44:53,280 --> 03:44:57,440 DIAGNOSTIC YIELD FOR CHROMOSOMAL 4667 03:44:57,440 --> 03:45:08,200 CONDITIONS USING KARYO-TYTYPE A 4668 03:45:08,920 --> 03:45:14,480 USING EXOME SEQUENCING AND IT'S 4669 03:45:14,480 --> 03:45:16,560 A CLOSE TO A 20% DIAGNOSTIC 4670 03:45:16,560 --> 03:45:24,440 YIELD WHICH IS QUITE HIGH. 4671 03:45:24,440 --> 03:45:30,480 I WANTED TO FIRST BRIEFLY TOUCH 4672 03:45:30,480 --> 03:45:31,800 ON SOME OF THE DIAGNOSES 4673 03:45:31,800 --> 03:45:34,200 IDENTIFIED TO THINK OF BROAD 4674 03:45:34,200 --> 03:45:35,600 CATEGORIES OF DIAGNOSES. 4675 03:45:35,600 --> 03:45:39,120 SOME THINGS WE FIND RELATE TO 4676 03:45:39,120 --> 03:45:44,160 MULTIPLE MALFORMATION SYNDROMES 4677 03:45:44,160 --> 03:45:46,080 LIKE DOWN SYNDROME AND THERE ARE 4678 03:45:46,080 --> 03:45:51,040 SINGLE GENE CONDITIONS THAT SEEM 4679 03:45:51,040 --> 03:45:52,600 TO COME UP OVER AND OVER AGAIN 4680 03:45:52,600 --> 03:45:57,480 LOOKING AT THE GENOMICS OF FETAL 4681 03:45:57,480 --> 03:46:04,960 LOSS AND AUTOSOMAL POLYCYSTIC 4682 03:46:04,960 --> 03:46:07,080 DISEASE AND OTHER BROAD 4683 03:46:07,080 --> 03:46:10,600 CATEGORIES OF GENETIC CONDITIONS 4684 03:46:10,600 --> 03:46:20,560 THAT CAN LEAD TO FETAL LOSS IS 4685 03:46:20,560 --> 03:46:23,120 NEUROMUSCULAR DISORDER AND FOR 4686 03:46:23,120 --> 03:46:26,120 THOSE THAT DON'T HAVE APPARENT 4687 03:46:26,120 --> 03:46:32,720 STRUCTURAL ALNOMALIES CARDIAC 4688 03:46:32,720 --> 03:46:36,600 ARRHYTHMIA WHICH WOULD 4689 03:46:36,600 --> 03:46:37,760 POTENTIALLY EXPLAIN FETAL LOSS 4690 03:46:37,760 --> 03:46:39,920 WITHOUT STRUCTURAL ANOMALIES 4691 03:46:39,920 --> 03:46:45,080 IDENTIFIED. 4692 03:46:45,080 --> 03:46:48,160 SO THE WAY TO GO ABOUT 4693 03:46:48,160 --> 03:46:49,200 IDENTIFYING THESE DIAGNOSES IS 4694 03:46:49,200 --> 03:46:51,720 MORE AND MORE OFTEN REFERRED TO 4695 03:46:51,720 --> 03:46:53,200 AS THE GENOMIC AUTOPSY. 4696 03:46:53,200 --> 03:46:55,440 TO DEFINE THAT MORE, THIS 4697 03:46:55,440 --> 03:46:58,800 INVOLVES SEQUENCING ACROSS THE 4698 03:46:58,800 --> 03:46:59,920 GENOME WHICH COULD BE EXOME 4699 03:46:59,920 --> 03:47:01,960 SEQUENCING WHICH LOOKS AT THE 4700 03:47:01,960 --> 03:47:03,600 CODING REGION OR GENOME 4701 03:47:03,600 --> 03:47:04,840 SEQUENCING WHICH EXPANDS ACROSS 4702 03:47:04,840 --> 03:47:07,680 THE ENTIRE GENOME TO LOOK FOR 4703 03:47:07,680 --> 03:47:08,880 DISEASE-CAUSING VARIANTS. 4704 03:47:08,880 --> 03:47:15,120 AND IF IT'S PERFORMED POST 4705 03:47:15,120 --> 03:47:16,600 MORTEM PEOPLE REFERRED TO THIS 4706 03:47:16,600 --> 03:47:18,720 AS THE GENOMIC AUTOPSY. 4707 03:47:18,720 --> 03:47:21,120 I HIGHLIGHTED WORK FLOW ARE 4708 03:47:21,120 --> 03:47:23,560 SAMPLES ARE USED FOR DNA 4709 03:47:23,560 --> 03:47:24,120 TESTING. 4710 03:47:24,120 --> 03:47:26,920 WE LIKE AS MUCH AS PHENOTYPE 4711 03:47:26,920 --> 03:47:30,360 INFORMATION AS POSSIBLE SO THIS 4712 03:47:30,360 --> 03:47:32,640 COULD COME FROM TRADITIONAL 4713 03:47:32,640 --> 03:47:36,000 AUTOPSY OR IMAGING FINDINGS OR 4714 03:47:36,000 --> 03:47:36,840 PHOTOGRAPHS AND VARIANTS ARE 4715 03:47:36,840 --> 03:47:38,200 CORRELATE WITH WHAT WE KNOW 4716 03:47:38,200 --> 03:47:39,560 ABOUT THE PHENOTYPE IN ORDER TO 4717 03:47:39,560 --> 03:47:44,880 TRY TO IDENTIFY A GENETIC 4718 03:47:44,880 --> 03:47:52,920 DIAGNOSIS. 4719 03:47:52,920 --> 03:47:54,360 THIS IS WHAT WE DO ON THE 4720 03:47:54,360 --> 03:47:54,880 RESEARCH SIDE. 4721 03:47:54,880 --> 03:47:58,520 THIS IS SOMEWHAT SIMILAR IN A 4722 03:47:58,520 --> 03:48:00,440 CLINICAL WORK FLOW BUT I'M NOT 4723 03:48:00,440 --> 03:48:02,360 AWARE THERE'S A LOT OF CLINICAL 4724 03:48:02,360 --> 03:48:04,600 WORK FLOW FOR GENOMIC SEQUENCING 4725 03:48:04,600 --> 03:48:05,680 OF STILLBIRTH. 4726 03:48:05,680 --> 03:48:08,400 THE FIRST STEP IS TO COLLECT AND 4727 03:48:08,400 --> 03:48:13,480 STORE A SAMPLE THAT CAN COME 4728 03:48:13,480 --> 03:48:16,600 FROM A PREVIOUSLY SAVED SAMPLE 4729 03:48:16,600 --> 03:48:20,000 OR BLOOD SAMPLE OR TISSUE 4730 03:48:20,000 --> 03:48:20,240 SAMPLE. 4731 03:48:20,240 --> 03:48:21,680 MY GROUP AND OTHERS I WORK WITH 4732 03:48:21,680 --> 03:48:24,400 WILL THEN ENROLL INTO A RESEARCH 4733 03:48:24,400 --> 03:48:26,680 PROTOCOL THROUGH WHICH WE CAN DO 4734 03:48:26,680 --> 03:48:28,160 GENOMIC SEQUENCING AND ANALYSIS 4735 03:48:28,160 --> 03:48:35,000 AND RETURN RESULTS IDEALLY IF 4736 03:48:35,000 --> 03:48:38,440 ANYTHING IS FOUND. 4737 03:48:38,440 --> 03:48:41,680 SOME OF THE ADVANTAGES OF THE 4738 03:48:41,680 --> 03:48:44,760 APPROACH IS THAT IT'S MINIMALLY 4739 03:48:44,760 --> 03:48:48,480 INVASIVE AND YOU ONLY NEED 1 OR 4740 03:48:48,480 --> 03:48:53,000 2 MLs OF BLOOD SO LESS THAN A 4741 03:48:53,000 --> 03:48:58,600 QUARTER OF TEASPOON CAN BE 4742 03:48:58,600 --> 03:49:01,080 OBTAINED THAT ARE MINIMALLY 4743 03:49:01,080 --> 03:49:03,040 INVASIVE AND IT'S USEFUL IF WE 4744 03:49:03,040 --> 03:49:05,680 CAN CORRELATE THINGS FOUND WITH 4745 03:49:05,680 --> 03:49:10,200 A TRADITIONAL AUTOPSY OR POST 4746 03:49:10,200 --> 03:49:12,560 MORTEM EXAMINE BUT FOR FAMILIES 4747 03:49:12,560 --> 03:49:13,360 WHO AREN'T CONSERVATIVE IT 4748 03:49:13,360 --> 03:49:17,240 OFFERS ANOTHER WAY TO LOOK FOR 4749 03:49:17,240 --> 03:49:18,680 POTENTIAL UNDERLYING DIAGNOSES 4750 03:49:18,680 --> 03:49:24,760 THAT IS MINIMALLY INVASIVE. 4751 03:49:24,760 --> 03:49:28,600 WE IT'S BECOMING INCREASINGLY 4752 03:49:28,600 --> 03:49:31,200 COST EFFECTIVE TO DO THIS. 4753 03:49:31,200 --> 03:49:34,600 A TEST THAT ONCE COSTS TENS OF 4754 03:49:34,600 --> 03:49:36,240 THOUSANDS OF DOLLARS ARE STILL 4755 03:49:36,240 --> 03:49:37,360 CHEAPER AND COST IS STILL 4756 03:49:37,360 --> 03:49:39,160 SIGNIFICANT TO FAMILIES AND WHY 4757 03:49:39,160 --> 03:49:40,760 THE TESTING OFTEN OCCURS IN THE 4758 03:49:40,760 --> 03:49:46,720 RESEARCH ENVIRONMENTS. 4759 03:49:46,720 --> 03:49:50,000 I IMAGINE THE COSTS WILL COME 4760 03:49:50,000 --> 03:49:50,200 DOWN. 4761 03:49:50,200 --> 03:49:53,520 SOME POTENTIAL BENEFITS OF A 4762 03:49:53,520 --> 03:49:57,840 GENETIC DIAGNOSIS IS FOUND IS 4763 03:49:57,840 --> 03:49:58,600 UNDERSTAND. 4764 03:49:58,600 --> 03:50:02,120 IT'S HELPFUL FOR FAMILIES AND 4765 03:50:02,120 --> 03:50:04,320 FOR PROVIDERS IN THINKING ABOUT 4766 03:50:04,320 --> 03:50:06,600 THE NEXT PREGNANCY. 4767 03:50:06,600 --> 03:50:09,520 MANY CONDITIONS COULD HAVE A 4768 03:50:09,520 --> 03:50:11,440 HIGHER REOCCURRENCE RISK OR 4769 03:50:11,440 --> 03:50:18,520 OCCUR IN SUBSEQUENT PREGNANCIES. 4770 03:50:18,520 --> 03:50:20,840 WE CAN SCREEN OR TEST FUTURE 4771 03:50:20,840 --> 03:50:22,080 PREGNANCIES AND IT CAN BE 4772 03:50:22,080 --> 03:50:24,240 HELPFUL TO IDENTIFY OTHER FAMILY 4773 03:50:24,240 --> 03:50:26,040 MEMBERS AT RISK FOR OTHER 4774 03:50:26,040 --> 03:50:26,600 GENETIC CONDITIONS OR FOR 4775 03:50:26,600 --> 03:50:33,520 AFFECTED PREGNANCIES. 4776 03:50:33,520 --> 03:50:36,520 THE THIRD IS TO UNDERSTAND THE 4777 03:50:36,520 --> 03:50:39,360 GENOMICS OF STILLBIRTH TO HELP 4778 03:50:39,360 --> 03:50:40,360 DIRECT INITIATIVES AND THINKING 4779 03:50:40,360 --> 03:50:41,920 OF WAYS AND OTHER STRATEGIES TO 4780 03:50:41,920 --> 03:50:44,400 USE TO TRY TO REDUCE UNEXPLAINED 4781 03:50:44,400 --> 03:50:45,200 FETAL DEATH. 4782 03:50:45,200 --> 03:50:47,520 IT'S HARD TO DO THIS WITHOUT 4783 03:50:47,520 --> 03:50:48,200 UNDERSTANDING WHICH CONDITIONS 4784 03:50:48,200 --> 03:50:56,640 ARE CAUSING THESE DEATHS. 4785 03:50:56,640 --> 03:50:58,200 I'M GOING TO SPEND TIME TALKING 4786 03:50:58,200 --> 03:50:59,680 ABOUT THE LIMITATIONS OF OUR 4787 03:50:59,680 --> 03:51:01,000 CURRENT UNDERSTANDING BECAUSE IT 4788 03:51:01,000 --> 03:51:06,120 PUTS WHAT I SAID INTO CONTEXT. 4789 03:51:06,120 --> 03:51:08,840 THESE ARE THE FOUR BROAD 4790 03:51:08,840 --> 03:51:10,600 CATEGORIES OF LIMITATIONS AND GO 4791 03:51:10,600 --> 03:51:16,920 INTO EACH ONE BY ONE. 4792 03:51:16,920 --> 03:51:21,600 ANY STUDIES LOOKING AT GENOMIC 4793 03:51:21,600 --> 03:51:22,600 SEQUENCING FOR STILLBIRTH 4794 03:51:22,600 --> 03:51:23,280 INVESTIGATION WILL HAVE SOME 4795 03:51:23,280 --> 03:51:25,920 DEGREE OF ASCERTAINMENT BIAS 4796 03:51:25,920 --> 03:51:28,400 BECAUSE YOU HAVE TO IDENTIFY A 4797 03:51:28,400 --> 03:51:29,120 COHORT YOU'LL SEQUENCE AND 4798 03:51:29,120 --> 03:51:32,640 GENERALLY THIS IS HAPPENING IN 4799 03:51:32,640 --> 03:51:33,640 THE RESEARCH ENVIRONMENT. 4800 03:51:33,640 --> 03:51:34,760 OFTEN PEOPLE ARE NOT BEING 4801 03:51:34,760 --> 03:51:38,600 REFERRED FOR SEQUENCING UNLESS 4802 03:51:38,600 --> 03:51:41,120 THERE'S CLINICAL SUSPICION OF AN 4803 03:51:41,120 --> 03:51:42,040 UNDERLYING CONDITION. 4804 03:51:42,040 --> 03:51:47,080 ALREADY YOU'RE DEALING WITH A 4805 03:51:47,080 --> 03:51:51,400 SELECTED POPULATION THE AVA 4806 03:51:51,400 --> 03:51:56,800 AVAILABILITY LEADS TO BIAS FOR 4807 03:51:56,800 --> 03:51:58,120 THE AFFECTED FETUS AND THE 4808 03:51:58,120 --> 03:52:00,440 PARENTS FOR A TRIO ANALYSIS. 4809 03:52:00,440 --> 03:52:02,160 THESE ALL LEAD TO DIFFERENCES IN 4810 03:52:02,160 --> 03:52:03,840 THE COHORTS BEING STUD YESTERDAY 4811 03:52:03,840 --> 03:52:07,760 AND MAKES IT HARDER TO 4812 03:52:07,760 --> 03:52:12,680 EXTRAPOLATE FINDINGS TO THE 4813 03:52:12,680 --> 03:52:16,600 GENERAL POPULATION. 4814 03:52:16,600 --> 03:52:18,920 IT'S IMPERATIVE TO DEFINE THE 4815 03:52:18,920 --> 03:52:22,360 GENOMIC CONTRIBUTIONS. 4816 03:52:22,360 --> 03:52:23,760 THE SECOND MAJOR LIMITATION IS 4817 03:52:23,760 --> 03:52:26,480 THE GENETIC TESTING APPROACHES 4818 03:52:26,480 --> 03:52:27,440 HAVE EVOLVED OVER TIME. 4819 03:52:27,440 --> 03:52:31,720 ALL GENETIC TESTS HAVE SOME 4820 03:52:31,720 --> 03:52:32,840 DEGREE OF LIMITATION. 4821 03:52:32,840 --> 03:52:34,440 DEPENDING ON WHAT TEST IS USED 4822 03:52:34,440 --> 03:52:36,640 ON THE STUDY AT HAND THERE COULD 4823 03:52:36,640 --> 03:52:40,920 BE PATHOGENIC VARIATION OR 4824 03:52:40,920 --> 03:52:41,840 DIAGNOSES THAT WEREN'T FOUND 4825 03:52:41,840 --> 03:52:44,720 BECAUSE OF THE TESTING APPROACH. 4826 03:52:44,720 --> 03:52:50,640 10 OR MORE YEARS AGO THEY WERE 4827 03:52:50,640 --> 03:52:52,480 USING KARYOTYPE TO DEFINE 4828 03:52:52,480 --> 03:52:54,640 CHARACTERISTIC YIELD AND WE'RE 4829 03:52:54,640 --> 03:52:56,360 SEEING EXOME SEQUENCING AND NOW 4830 03:52:56,360 --> 03:52:58,360 MORE GENOME SEQUENCING TO 4831 03:52:58,360 --> 03:53:00,840 CAPTURE THE WHOLE SPECTRUM OF 4832 03:53:00,840 --> 03:53:02,600 VARIATION THAT CAN LEAD TO 4833 03:53:02,600 --> 03:53:03,120 STILLBIRTH. 4834 03:53:03,120 --> 03:53:04,400 IN EVALUATING CURRENT STUDIES 4835 03:53:04,400 --> 03:53:07,800 OUT THERE TO TRY TO DEFINE 4836 03:53:07,800 --> 03:53:08,560 DIAGNOSTIC YIELD CAREFUL 4837 03:53:08,560 --> 03:53:09,920 CONSIDERATION OF THE TYPE OF 4838 03:53:09,920 --> 03:53:12,000 TESTS THAT WAS USED IS IMPORTANT 4839 03:53:12,000 --> 03:53:13,000 IN ORDER TO EXTRAPOLATE FROM THE 4840 03:53:13,000 --> 03:53:20,440 RESULTS. 4841 03:53:20,440 --> 03:53:22,560 IF YOU CAN FIND A VARIANT 4842 03:53:22,560 --> 03:53:24,240 INTERPRETING THE VARIANT IS THE 4843 03:53:24,240 --> 03:53:26,280 NEXT IMPORTANT STEP AND THIS IS 4844 03:53:26,280 --> 03:53:28,240 CHALLENGING IN THE PERINATAL 4845 03:53:28,240 --> 03:53:32,240 PERIOD WHERE YOU'RE LIMITED TO 4846 03:53:32,240 --> 03:53:34,520 POTENTIALLY ULTRASOUND 4847 03:53:34,520 --> 03:53:34,800 INFORMATION. 4848 03:53:34,800 --> 03:53:36,840 SOMETIMES POSTMOREM EXAMINATION 4849 03:53:36,840 --> 03:53:39,720 AND THEREFORE IF YOU FIND 4850 03:53:39,720 --> 03:53:41,400 VARIANTS THAT LOOK LIKE THEY 4851 03:53:41,400 --> 03:53:44,160 COULD BE DISEASE CAUSING TRYING 4852 03:53:44,160 --> 03:53:44,840 TO ATTRIBUTE CAUSALITY CAN BE 4853 03:53:44,840 --> 03:53:51,040 DIFFICULT. 4854 03:53:51,040 --> 03:53:52,600 PARTICULARLY IN THE ABSENCE OF 4855 03:53:52,600 --> 03:53:56,360 STRUCTURAL ANOMALIES IT CAN BE 4856 03:53:56,360 --> 03:53:57,960 HARD TO CONCLUSIVELY IDENTIFY A 4857 03:53:57,960 --> 03:54:00,280 DIAGNOSIS AN MORE CHALLENGING IF 4858 03:54:00,280 --> 03:54:04,320 THE STUDY'S DONE ONLY WITH THE 4859 03:54:04,320 --> 03:54:05,320 FETAL SAMPLE BECAUSE HAVING 4860 03:54:05,320 --> 03:54:07,600 PARENTAL DATA IS HELPFUL TO 4861 03:54:07,600 --> 03:54:09,440 INTERPRET VARIANTS AND LOOKING 4862 03:54:09,440 --> 03:54:14,160 AT WHETHER THINGS WERE HEINHERID 4863 03:54:14,160 --> 03:54:17,840 OR NOT AND THERE'S A MORE 4864 03:54:17,840 --> 03:54:18,600 CONSERVATIVE ESTIMATE OF THE 4865 03:54:18,600 --> 03:54:23,680 YIELD WHERE THE YIELD DEFINED BY 4866 03:54:23,680 --> 03:54:25,720 CONCLUSIVE DIAGNOSES BUT MANY 4867 03:54:25,720 --> 03:54:27,120 WILL LIST THOSE SUSPICIOUS BUT 4868 03:54:27,120 --> 03:54:31,440 DIDN'T HAVE THE LEVEL OF 4869 03:54:31,440 --> 03:54:33,640 EVIDENCE REQUIRED TO MAKE IT 4870 03:54:33,640 --> 03:54:34,160 MORE CONCLUSIVE. 4871 03:54:34,160 --> 03:54:34,840 CONSIDERING THE RANGE IS HELPFUL 4872 03:54:34,840 --> 03:54:43,560 AS WELL. 4873 03:54:43,560 --> 03:54:46,240 FINALLY, EVEN IF DIAGNOSES ARE 4874 03:54:46,240 --> 03:54:47,600 IDENTIFIED AND HOW THE 4875 03:54:47,600 --> 03:54:48,600 INFORMATION TRANSLATES TO 4876 03:54:48,600 --> 03:54:49,320 MORTALITY STATISTICS AND DEATH 4877 03:54:49,320 --> 03:54:49,840 REPORTING IS A FURTHER 4878 03:54:49,840 --> 03:54:53,440 CHALLENGE. 4879 03:54:53,440 --> 03:54:56,840 WE DID WORK IN THE INFANT 4880 03:54:56,840 --> 03:54:58,640 MORTALITY SPACE HOW GENETIC 4881 03:54:58,640 --> 03:55:00,840 DIAGNOSES WERE REFLECTED IN 4882 03:55:00,840 --> 03:55:02,320 MORTALITY STATISTICS AND FOUND A 4883 03:55:02,320 --> 03:55:03,920 SUBSTANTIAL PROPORTION WERE NOT 4884 03:55:03,920 --> 03:55:04,600 INCLUDED IN THE DEATH 4885 03:55:04,600 --> 03:55:07,880 CERTIFICATE OR UNKNOWN AT THE 4886 03:55:07,880 --> 03:55:09,320 TIME OF DEATH OR WEREN'T 4887 03:55:09,320 --> 03:55:09,920 APPROPRIATELY CAPTURED IN THE 4888 03:55:09,920 --> 03:55:18,560 CODING SYSTEM. 4889 03:55:18,560 --> 03:55:22,160 WE TALKED ABOUT IF YOU FIND A 4890 03:55:22,160 --> 03:55:23,320 DIAGNOSIS AFTER DEATH AND THE 4891 03:55:23,320 --> 03:55:24,840 REPORT HAS BEEN CERTIFIED YOU 4892 03:55:24,840 --> 03:55:27,480 CAN GO BACK AND AMEND THE REPORT 4893 03:55:27,480 --> 03:55:29,720 TO INCLUDE THE GENETIC DIAGNOSIS 4894 03:55:29,720 --> 03:55:33,040 BUT IT HAPPENS I WOULD IMAGINE 4895 03:55:33,040 --> 03:55:33,360 INFREQUENTLY. 4896 03:55:33,360 --> 03:55:39,840 AS DIAGNOSES ARE IDENTIFIED, 4897 03:55:39,840 --> 03:55:40,680 ACCURATELY CAPTURING THE 4898 03:55:40,680 --> 03:55:47,640 INFORMATION IS A MAJOR 4899 03:55:47,640 --> 03:55:47,920 CHALLENGE. 4900 03:55:47,920 --> 03:55:52,840 THIS WAS MEANT TO BE AN OVERVIEW 4901 03:55:52,840 --> 03:55:54,360 OF THE STATE OF GENOMIC TESTING 4902 03:55:54,360 --> 03:55:57,560 AND I LOOK TOWARDS THE FUTURE 4903 03:55:57,560 --> 03:55:59,360 WHERE I HOPE MULTI-CENTERED 4904 03:55:59,360 --> 03:56:00,240 COLLABORATIONS CAN LEAD TOWARDS 4905 03:56:00,240 --> 03:56:04,600 A BROAD AND DIVERSE APPLICATION 4906 03:56:04,600 --> 03:56:07,120 OF GENOMIC AUTOPSY. 4907 03:56:07,120 --> 03:56:10,320 IF YOU THINK ABOUT THE 4908 03:56:10,320 --> 03:56:12,000 LIMITATIONS IT'S COMING FROM 4909 03:56:12,000 --> 03:56:16,600 STUDIES WITH SMALLER SAMPLE SIZE 4910 03:56:16,600 --> 03:56:18,080 NOT POPULATION-BASED. 4911 03:56:18,080 --> 03:56:20,000 INVOLVING MULTIPLE CENTERS TO 4912 03:56:20,000 --> 03:56:21,760 GET THE LARGEST POSSIBLE COHORT 4913 03:56:21,760 --> 03:56:23,840 IN ORDER TO LOOK FOR DIAGNOSES 4914 03:56:23,840 --> 03:56:29,360 AND BETTER DEFINE THEM IS 4915 03:56:29,360 --> 03:56:31,840 CRITICAL TO UNDERSTAND THE TRUE 4916 03:56:31,840 --> 03:56:33,760 DIAGNOSTIC YIELD FOR STILLBIRTH. 4917 03:56:33,760 --> 03:56:34,680 SECONDLY, THINKING OF DESIGN OF 4918 03:56:34,680 --> 03:56:37,880 FUTURE STUDIES AND TAKING THE 4919 03:56:37,880 --> 03:56:42,720 BROADEST TESTING APPROACH 4920 03:56:42,720 --> 03:56:44,280 POSSIBLE IS A STEP MANY ARE 4921 03:56:44,280 --> 03:56:44,840 TAKING. 4922 03:56:44,840 --> 03:56:47,800 WE USED TO RELY ON CHROMOSOMAL 4923 03:56:47,800 --> 03:56:52,560 TESTING AND NOW MOVING TOWARDS 4924 03:56:52,560 --> 03:56:54,600 GENOME SEQUENCING AND IT'S A 4925 03:56:54,600 --> 03:56:56,520 TECHNIQUE TO FIND MANY 4926 03:56:56,520 --> 03:56:56,840 VARIATION. 4927 03:56:56,840 --> 03:56:57,600 MANY STUDIES ARE USING THIS 4928 03:56:57,600 --> 03:57:05,920 GOING FORWARD TO TRY TO IDENTIFY 4929 03:57:05,920 --> 03:57:07,280 AS MANY DIAGNOSES AS POSSIBLE 4930 03:57:07,280 --> 03:57:08,880 AND IT'S POWERFUL WHEN YOU CAN 4931 03:57:08,880 --> 03:57:14,240 MATCH UP VARIANTS WITH 4932 03:57:14,240 --> 03:57:20,360 COMPREHENSIVE PHENOTYPING. 4933 03:57:20,360 --> 03:57:24,840 AN LOOK AT GENOMIC 4934 03:57:24,840 --> 03:57:26,960 INTERPRETATION AND COLLECTING 4935 03:57:26,960 --> 03:57:37,480 THE INFORMATION IS CRITICAL IF 4936 03:57:38,440 --> 03:57:42,960 YOU THINK OF A 20% POTENTIAL 4937 03:57:42,960 --> 03:57:44,320 DIAGNOSTIC YIELD IN STILLBIRTH 4938 03:57:44,320 --> 03:57:48,520 THAT'S 1 IN 5. 4939 03:57:48,520 --> 03:57:50,760 IF YOU CAN FIND AND THESE ARE 4940 03:57:50,760 --> 03:57:51,560 RARE CONDITIONS. 4941 03:57:51,560 --> 03:57:54,160 IF YOU CAN FIND THE RARE 4942 03:57:54,160 --> 03:57:56,040 DIAGNOSES THEY CAN INFORM THE 4943 03:57:56,040 --> 03:57:58,560 RISK FOR FUTURE PREGNANCIES. 4944 03:57:58,560 --> 03:58:04,600 THIS SAY WAY TO POTENTIALLY 4945 03:58:04,600 --> 03:58:05,920 PREVENT STILLBIRTH OCCURRENCE 4946 03:58:05,920 --> 03:58:12,840 AND WHERE WE'RE NOT ABLE TO 4947 03:58:12,840 --> 03:58:21,560 IDENTIFY MONOGENIC RISK FACTORS 4948 03:58:21,560 --> 03:58:22,600 THERE MAY BE A COMBINATION OF 4949 03:58:22,600 --> 03:58:28,080 THE RISK FACTORS AND 4950 03:58:28,080 --> 03:58:32,240 ENVIRONMENTAL RISK FACTOR FACT 4951 03:58:32,240 --> 03:58:32,920 TOGETHER CONTRIBUTE AND REQUIRES 4952 03:58:32,920 --> 03:58:34,680 LARGER STUDIES TO DEVELOP THE 4953 03:58:34,680 --> 03:58:36,240 POPULATION THAT'S REQUIRED TO 4954 03:58:36,240 --> 03:58:37,360 TEST THIS HYPOTHESIS. 4955 03:58:37,360 --> 03:58:38,680 I THINK IT WILL BE ANOTHER 4956 03:58:38,680 --> 03:58:44,840 BENEFIT GOING FORWARD OF TRYING 4957 03:58:44,840 --> 03:58:54,720 TO COLLECT AND TRACK AND HAVE A 4958 03:58:54,720 --> 03:58:56,840 DATABASE TO ANSWER THESE 4959 03:58:56,840 --> 03:59:02,320 QUESTIONS ON A POPULATION LEVEL. 4960 03:59:02,320 --> 03:59:04,280 I'VE TRIED TO GO OVER MANY 4961 03:59:04,280 --> 03:59:06,040 THINGS RELATED TO GENOMICS AND 4962 03:59:06,040 --> 03:59:08,040 STILLBIRTHS AND I LISTS 4963 03:59:08,040 --> 03:59:12,960 REFERENCES OF STUDIES I ALLUDED 4964 03:59:12,960 --> 03:59:15,280 TO AND I BENEFIT FROM FANTASTIC 4965 03:59:15,280 --> 03:59:16,640 RESEARCH SUPPORT AND ABOVE ALL 4966 03:59:16,640 --> 03:59:18,360 HAVE TO THANK THE FAMILIES THAT 4967 03:59:18,360 --> 03:59:19,920 HAVE AGREED TO PARTICIPATE IN 4968 03:59:19,920 --> 03:59:22,680 THE RESEARCH TESTING THAT'S LED 4969 03:59:22,680 --> 03:59:24,840 TO THE INFORMATION WE KNOW 4970 03:59:24,840 --> 03:59:25,440 TODAY. 4971 03:59:25,440 --> 03:59:27,120 MUCH OF THE TESTING IS NOT 4972 03:59:27,120 --> 03:59:30,200 AVAILABLE CLINICALLY AND WE'RE 4973 03:59:30,200 --> 03:59:31,800 JUST IMMENSELY THANKFUL TO THE 4974 03:59:31,800 --> 03:59:34,320 FAMILIES THAT AGREED TO 4975 03:59:34,320 --> 03:59:35,920 PARTICIPATE TO BENEFIT 4976 03:59:35,920 --> 03:59:42,520 THEMSELVES AND OTHERS. 4977 03:59:42,520 --> 03:59:45,400 I'M HAPPY TO TAKE QUESTIONS IN 4978 03:59:45,400 --> 03:59:55,800 THE PANEL THAT FOLLOWS. 4979 03:59:56,320 --> 03:59:58,480 >>THANK YOU FOR THE 4980 03:59:58,480 --> 03:59:59,480 PRESENTATION AND FOR ANOTHER 4981 03:59:59,480 --> 04:00:01,120 PIECE OF THE PUZZLE IN THE ISSUE 4982 04:00:01,120 --> 04:00:04,600 OF DATA COLLECTION AND LOOKING 4983 04:00:04,600 --> 04:00:09,680 FORWARD TO THE DISCUSSION. 4984 04:00:09,680 --> 04:00:11,800 IF YOU'D LIKE TO START YOUR 4985 04:00:11,800 --> 04:00:13,040 PRESENTATION THAT WOULD BE 4986 04:00:13,040 --> 04:00:13,240 GREAT. 4987 04:00:13,240 --> 04:00:23,720 >>ARE YOU GOING PULL IT UP? 4988 04:00:26,960 --> 04:00:28,720 >>THANK YOU. 4989 04:00:28,720 --> 04:00:31,680 >>I'M A PER I NATAL PATHOLOGIST 4990 04:00:31,680 --> 04:00:35,880 AND SPEND MY CAREER LOOKING AT 4991 04:00:35,880 --> 04:00:36,520 PLACENTAS FOR DIFFERENT REASONS 4992 04:00:36,520 --> 04:00:38,720 INCLUDING STILLBIRTH. 4993 04:00:38,720 --> 04:00:40,160 BEFORE I START THIS TALK WHICH 4994 04:00:40,160 --> 04:00:41,320 IS A LITTLE BIT DIFFERENT FROM 4995 04:00:41,320 --> 04:00:51,000 ALL THE OTHER TALKS, I WANTED TO 4996 04:00:51,000 --> 04:00:53,880 OFFER MY SYMPATHY WHO LOST A 4997 04:00:53,880 --> 04:00:55,000 CHILD TO STILLBIRTH BECAUSE THE 4998 04:00:55,000 --> 04:00:56,280 TALK IS GOING TO BE VERY MEDICAL 4999 04:00:56,280 --> 04:00:57,920 AND MAY COME OFF COLD AND I 5000 04:00:57,920 --> 04:01:00,200 WANTED TO APOLOGIZE IN ADVANCE 5001 04:01:00,200 --> 04:01:04,080 BECAUSE I KNOW IT'S A VERY 5002 04:01:04,080 --> 04:01:10,120 EMOTIONAL TOPIC IN THE PLACENTA 5003 04:01:10,120 --> 04:01:16,600 IT'S VERY CLOSE TO THE CAUSE OF 5004 04:01:16,600 --> 04:01:19,840 DEATH. 5005 04:01:19,840 --> 04:01:22,520 I WANTED TO START WITH A NICE 5006 04:01:22,520 --> 04:01:24,480 NORMAL PLACENTA BECAUSE WE'LL 5007 04:01:24,480 --> 04:01:27,320 SEE ABNORMAL PLACENTAS. 5008 04:01:27,320 --> 04:01:30,160 THIS IS A NICE NORMAL COLOR AND 5009 04:01:30,160 --> 04:01:32,840 THE NEXT SLIDE IS A REVIEW OF 5010 04:01:32,840 --> 04:01:35,240 PLACENTAS. 5011 04:01:35,240 --> 04:01:41,720 IT'S A VITAL ORGAN FOR THE FETUS 5012 04:01:41,720 --> 04:01:44,720 BUT THE LARGEST AND GROWS AND 5013 04:01:44,720 --> 04:01:50,080 DIFFERENTIATES ACROSS GESTATION 5014 04:01:50,080 --> 04:01:55,120 AND GROWS DIFFERENTLY AND 5015 04:01:55,120 --> 04:01:56,880 PROFUSE THE PREGNANT PERSON BUT 5016 04:01:56,880 --> 04:01:59,040 THE BLOOD SUPPLIES SHOULD REMAIN 5017 04:01:59,040 --> 04:02:02,040 SEPARATE AND THE PLACENTA IS A 5018 04:02:02,040 --> 04:02:06,240 RARE ORGAN ONCE REMOVED IS NOT 5019 04:02:06,240 --> 04:02:09,800 ALWAYS SENT TO PATHOLOGY FOR 5020 04:02:09,800 --> 04:02:10,200 EXAMINATION. 5021 04:02:10,200 --> 04:02:12,840 WE NEED CRITERIA FOR EXAMINING 5022 04:02:12,840 --> 04:02:16,720 THE PLACENTA. 5023 04:02:16,720 --> 04:02:21,720 THIS REVIEWS IT REQUIRES A 5024 04:02:21,720 --> 04:02:24,840 SPECIALIZED EDUCATION AND 5025 04:02:24,840 --> 04:02:29,280 THERE'S FEW EXPERTS IN PLACENTAL 5026 04:02:29,280 --> 04:02:33,760 PATHOLOGY AND CAN PREDICT FUTURE 5027 04:02:33,760 --> 04:02:36,840 OUTCOMES AND FOR THIS WORKSHOP 5028 04:02:36,840 --> 04:02:42,360 REVEALS THE MOST LIKELY CAUSE OF 5029 04:02:42,360 --> 04:02:44,840 DEATH IN A THIRD OF STILLBIRTHS 5030 04:02:44,840 --> 04:02:46,440 FROM THE COLLABORATIVE. 5031 04:02:46,440 --> 04:02:50,960 STILLBIRTH IS A CRITICAL TRIAGE 5032 04:02:50,960 --> 04:02:52,600 CRITERIA IN ALL STILLBIRTH 5033 04:02:52,600 --> 04:02:59,520 PLACENTAS SHOULD BE EXAMINED 5034 04:02:59,520 --> 04:02:59,920 PATHOLOGICALLY. 5035 04:02:59,920 --> 04:03:03,280 WE CAN'T REALLY DO RANDOMIZED 5036 04:03:03,280 --> 04:03:05,400 CONTROL STUDIES AND CAN'T EVEN 5037 04:03:05,400 --> 04:03:07,280 DO CASE CONTROL STUDIES BECAUSE 5038 04:03:07,280 --> 04:03:10,520 WE DON'T REALLY HAVE A CONTROL 5039 04:03:10,520 --> 04:03:13,880 SET OF PLACENTAS SINCE NOT ALL 5040 04:03:13,880 --> 04:03:14,280 ARE EXAMINED. 5041 04:03:14,280 --> 04:03:16,640 WE CAN TALK ABOUT FINDINGS 5042 04:03:16,640 --> 04:03:21,400 ASSOCIATED AND SOME WE THINK ARE 5043 04:03:21,400 --> 04:03:21,720 CAUSATIONAL. 5044 04:03:21,720 --> 04:03:24,240 THESE HAVE BEEN FOUND TO BE 5045 04:03:24,240 --> 04:03:25,920 INCREASED IN PREVALENCE AT 5046 04:03:25,920 --> 04:03:27,360 STILLBIRTH IN THE PLACENTA AND 5047 04:03:27,360 --> 04:03:30,560 THE ONES BOLDED ARE ESPECIALLY 5048 04:03:30,560 --> 04:03:32,840 INCREASED IN PREVALENCE AND THIS 5049 04:03:32,840 --> 04:03:35,400 IS ALSO FROM DR. PINAR IN THE 5050 04:03:35,400 --> 04:03:40,640 STILLBIRTH COLLABORATIVE AND THE 5051 04:03:40,640 --> 04:03:46,640 NEXT SLIDE SHOWS PATHOLOGY 5052 04:03:46,640 --> 04:03:48,840 PROBABLY CAUSATIONAL WITH OUR 5053 04:03:48,840 --> 04:03:54,320 BEST ESTIMATE OF WHAT CAUSES 5054 04:03:54,320 --> 04:03:56,760 STILLBIRTH. 5055 04:03:56,760 --> 04:04:05,640 AND FEATURES CONSISTENT WITH UM 5056 04:04:05,640 --> 04:04:10,560 -- UMBILICAL CORD AND WE USED 5057 04:04:10,560 --> 04:04:13,640 TO CALL ABOUT PLACENTAL 5058 04:04:13,640 --> 04:04:15,760 INEFFICIENCY AND NOT SO COMMON 5059 04:04:15,760 --> 04:04:17,000 OR RARE BUT CRITICALLY IMPORTANT 5060 04:04:17,000 --> 04:04:27,440 TO CAUSES OF STILLBIRTHS. 5061 04:04:28,560 --> 04:04:36,840 LET'S TALK ABOUT UMBILICAL CORD. 5062 04:04:36,840 --> 04:04:38,840 INJURY TO THE UMBILICAL CORD IS 5063 04:04:38,840 --> 04:04:43,280 OFTEN LETHAL. 5064 04:04:43,280 --> 04:04:46,600 WE CAN TELL THE UMBILICAL CORD 5065 04:04:46,600 --> 04:04:47,960 HAS BEEN DAMAGED BY JUST LOOKING 5066 04:04:47,960 --> 04:04:48,920 AT THE PLACENTA. 5067 04:04:48,920 --> 04:04:53,880 WE LOOK AT IT FOR FLAT REGIONS 5068 04:04:53,880 --> 04:04:55,480 AND SUGGESTING COMPRESSION. 5069 04:04:55,480 --> 04:04:58,120 FOR COILING ABNORMALITIES AND 5070 04:04:58,120 --> 04:05:00,640 FOR INSERTIONAL ABNORMALITIES 5071 04:05:00,640 --> 04:05:02,640 AND HISTOLOGICALLY WE CAN TELL 5072 04:05:02,640 --> 04:05:05,920 THERE'S BEEN UMBILICAL CORD 5073 04:05:05,920 --> 04:05:10,320 OBSTRUCTION WHEN WE SEE BRUISES 5074 04:05:10,320 --> 04:05:12,840 IN THE PLACENTA OR FETAL 5075 04:05:12,840 --> 04:05:15,200 VASCULAR MALPROFUSION 5076 04:05:15,200 --> 04:05:17,200 INTERRUPTION IN THE PLACENTAL 5077 04:05:17,200 --> 04:05:19,600 FLOW FROM THE FETUS. 5078 04:05:19,600 --> 04:05:22,520 THE NEXT SLIDE IS ABNORMAL 5079 04:05:22,520 --> 04:05:26,760 INSERTION OF THE UMBILICAL CORD 5080 04:05:26,760 --> 04:05:28,040 AND SEE THE LARGE VESSELS IN THE 5081 04:05:28,040 --> 04:05:29,720 MEMBRANES AND THEY'RE EXPOSED 5082 04:05:29,720 --> 04:05:31,080 AND EASILY DAMAGED. 5083 04:05:31,080 --> 04:05:32,680 THOSE ARE THE VESSELS THAT GO TO 5084 04:05:32,680 --> 04:05:35,720 THE PLACENTA FROM THE FETUS OR 5085 04:05:35,720 --> 04:05:37,960 BACK TO THE FETUS FROM THE 5086 04:05:37,960 --> 04:05:38,240 PLACENTA. 5087 04:05:38,240 --> 04:05:41,600 INJURY OR DAMAGE TO THOSE 5088 04:05:41,600 --> 04:05:43,200 VESSELS ARE CRITICAL TO THE WELL 5089 04:05:43,200 --> 04:05:47,880 BEING OF THE FETUS IN UTERO. 5090 04:05:47,880 --> 04:05:50,560 THE NEXT SLIDE SHOWS COILING. 5091 04:05:50,560 --> 04:05:54,920 THE UMBILICAL CORD HAS A COIL TO 5092 04:05:54,920 --> 04:06:05,480 THE LEFT AND YOU SEE THE HYPER 5093 04:06:06,040 --> 04:06:08,600 COILED UMBILICAL CORD AND THE 5094 04:06:08,600 --> 04:06:10,800 COILING IS PARTICULARLY LETHAL 5095 04:06:10,800 --> 04:06:13,600 BECAUSE IT CAN KINK. 5096 04:06:13,600 --> 04:06:16,120 WHEN IT KINKS THERE'S CESSATION 5097 04:06:16,120 --> 04:06:18,520 OF BLOOD FLOW TO THE FETUS OR 5098 04:06:18,520 --> 04:06:23,080 PLACENTA WHICH CAN BE FATAL. 5099 04:06:23,080 --> 04:06:25,000 WE SEE EVIDENCE OF THIS AND THIS 5100 04:06:25,000 --> 04:06:27,360 PLACENTA YOU SEE ON THE LEFT IS 5101 04:06:27,360 --> 04:06:28,640 FROM A STILLBIRTH. 5102 04:06:28,640 --> 04:06:36,600 YOU CAN TELL THAT IMMEDIATELY 5103 04:06:36,600 --> 04:06:38,080 LOOKING AT THE COLOR AND IT'S 5104 04:06:38,080 --> 04:06:39,200 BROWN OR TAN OR RUDDY. 5105 04:06:39,200 --> 04:06:42,880 YOU CAN SEE ON THE RIGHT-HAND 5106 04:06:42,880 --> 04:06:44,920 SIDE THIS IS AN UMBILICAL VESSEL 5107 04:06:44,920 --> 04:06:48,840 WITH INJURY TO IT AND HAS 5108 04:06:48,840 --> 04:06:50,680 PATHOLOGY OF FETAL VASCULAR 5109 04:06:50,680 --> 04:06:52,880 MALPROFUSION PROBABLY DUE TO 5110 04:06:52,880 --> 04:06:57,960 KINKING FROM THE HYPERCOILED 5111 04:06:57,960 --> 04:06:58,920 UMBILICAL CORD. 5112 04:06:58,920 --> 04:07:04,240 THE NEXT SLIDE SHOWS FOUR 5113 04:07:04,240 --> 04:07:11,440 PICTURES OF FEELAL -- THE SEE 5114 04:07:11,440 --> 04:07:16,360 THE WHITE VESSEL WITH A WHITE 5115 04:07:16,360 --> 04:07:18,160 THROMBUS IN THE VESSEL. 5116 04:07:18,160 --> 04:07:18,720 THAT'S THROMBOTIC DISEASE. 5117 04:07:18,720 --> 04:07:20,320 THERE'S DIFFERENT CAUSES BUT THE 5118 04:07:20,320 --> 04:07:23,840 MOST COMMON IS UMBILICAL CORD 5119 04:07:23,840 --> 04:07:25,920 OBSTRUCTION AND THE HISTOLOGY IS 5120 04:07:25,920 --> 04:07:28,120 A BLOOD CLOT ALMOST FILLING THE 5121 04:07:28,120 --> 04:07:29,680 VESSEL. 5122 04:07:29,680 --> 04:07:32,840 YOU SEE THAT ABOVE ON THE RIGHT 5123 04:07:32,840 --> 04:07:33,200 UPPER. 5124 04:07:33,200 --> 04:07:36,840 ON THE LEFT SIDE SHOWS TWO 5125 04:07:36,840 --> 04:07:41,080 DOWNSTREAM AFFECTS OF POOR 5126 04:07:41,080 --> 04:07:43,080 PROFUSION TO THE PLACENTA. 5127 04:07:43,080 --> 04:07:49,720 THE NEXT SLIDE I'LL TALK ABOUT 5128 04:07:49,720 --> 04:07:55,000 AN INAPPROPRIATELY IMMATURE 5129 04:07:55,000 --> 04:08:00,800 BILUS AND THE PLACENTA -- 5130 04:08:00,800 --> 04:08:02,600 DELAYED VILLOUS AND IF IT 5131 04:08:02,600 --> 04:08:04,560 DOESN'T MATURE APPROPRIATELY IT 5132 04:08:04,560 --> 04:08:08,840 CAN'T CONTINUE TO NOURISH THE 5133 04:08:08,840 --> 04:08:16,640 FETUS WITH GASES AND OTHER 5134 04:08:16,640 --> 04:08:20,840 NUTRIENTS. 5135 04:08:20,840 --> 04:08:31,360 CORE AND YOU CAN HE SEE THE 5136 04:08:37,280 --> 04:08:39,120 VILLI FILLED WITH BLOOD FROM THE 5137 04:08:39,120 --> 04:08:42,320 FETUS ON THE RIGHT SIDE YOU SEE 5138 04:08:42,320 --> 04:08:45,240 A DELAYED VILLOUS MATURATION AND 5139 04:08:45,240 --> 04:08:48,320 HOW MUCH LARGER THE VILLI ARE 5140 04:08:48,320 --> 04:08:50,680 AND HOW MUCH MORE CAPILLARIES 5141 04:08:50,680 --> 04:08:52,080 THERE ARE IN THE VILLI AND THE 5142 04:08:52,080 --> 04:08:53,560 VESSELS ARE NOT WHERE THEY 5143 04:08:53,560 --> 04:08:55,720 SHOULD BE AT THE PERIPHERY BUT 5144 04:08:55,720 --> 04:08:58,200 MORE CENTRALLY PLACED. 5145 04:08:58,200 --> 04:09:00,880 THIS IS AN INEFFICIENT PLACENTA 5146 04:09:00,880 --> 04:09:11,400 AND CAN CAUSE SUDDEN FETAL DEATH 5147 04:09:12,200 --> 04:09:12,400 IN UTERO. 5148 04:09:12,400 --> 04:09:14,760 AND THIS IS WHEN THE PLACENTA IS 5149 04:09:14,760 --> 04:09:17,800 NOT PROFUSED WELL BY THE MOTHER 5150 04:09:17,800 --> 04:09:19,240 OR PREGNANT PERSON. 5151 04:09:19,240 --> 04:09:21,080 THAT'S ASSOCIATED WITH HIGHER 5152 04:09:21,080 --> 04:09:23,880 TENSION OR DIABETES BUT OTHER 5153 04:09:23,880 --> 04:09:26,080 THINGS CAN CAUSE MATERNAL MASS 5154 04:09:26,080 --> 04:09:27,200 PROFUSION AS WELL. 5155 04:09:27,200 --> 04:09:32,000 IT'S A CONSTELLATION OF FEATURES 5156 04:09:32,000 --> 04:09:37,400 FOR THE DIAGNOSE AND THE 5157 04:09:37,400 --> 04:09:44,240 PLACENTA IS SMALL AND THE FETUS 5158 04:09:44,240 --> 04:09:46,640 THE FETAL DEMANDS WITH LIMITED 5159 04:09:46,640 --> 04:09:48,760 RESERVES PERHAPS CANNOT BE MET 5160 04:09:48,760 --> 04:09:51,920 ESPECIALLY WITH LABOR. 5161 04:09:51,920 --> 04:09:54,320 IT'S ANOTHER CAUSE OF DEATH IN 5162 04:09:54,320 --> 04:09:57,840 UTERO OFTEN INTRAPARTUM. 5163 04:09:57,840 --> 04:10:03,040 THE NEXT SLIDE SHOWS FEATURES OF 5164 04:10:03,040 --> 04:10:04,560 A SMALL PLACENTA CUT ON CROSS 5165 04:10:04,560 --> 04:10:04,800 SECTION. 5166 04:10:04,800 --> 04:10:10,360 YOU SEE ON THE RIGHT SIDE NORM 5167 04:10:10,360 --> 04:10:20,920 AL PARENCHIMA AND THE FETUS IS 5168 04:10:25,960 --> 04:10:28,640 ONLY LIVING OFF HALF THE 5169 04:10:28,640 --> 04:10:33,560 PLACENTA WHICH IS ALREADY SMALL. 5170 04:10:33,560 --> 04:10:41,120 THIS CAN BE ASSOCIATED WITH POOR 5171 04:10:41,120 --> 04:10:49,600 OUTCOME. 5172 04:10:49,600 --> 04:11:00,120 AND THIS IS A SUBACUTE ABRUPTION 5173 04:11:00,360 --> 04:11:04,640 AND THEY'RE LETHAL AND CAN BE 5174 04:11:04,640 --> 04:11:06,360 ACU 5175 04:11:06,360 --> 04:11:11,800 ACUTE HAVE NO PATHOLOGY OR 5176 04:11:11,800 --> 04:11:22,360 INFARCTION AROUND THE HEMATOMA. 5177 04:11:24,760 --> 04:11:26,040 AND WHAT WE SEE IS VESSEL THAT 5178 04:11:26,040 --> 04:11:32,680 LOOK JUST LIKE THE VESSELS OF 5179 04:11:32,680 --> 04:11:34,560 CORONARY ARTERY DISEASE IN THE 5180 04:11:34,560 --> 04:11:38,240 VESSELS PROFUSING THE PLACENTA. 5181 04:11:38,240 --> 04:11:41,400 YOU SEE A SMALL ARTERIOLE AND 5182 04:11:41,400 --> 04:11:44,840 YOU SEE THE SAME POWER OF 5183 04:11:44,840 --> 04:11:46,280 MAGNIFICATION A MUCH LARGER 5184 04:11:46,280 --> 04:11:48,560 VESSEL WITH NECROSIS AND SOME 5185 04:11:48,560 --> 04:11:49,600 INFLAMMATION. 5186 04:11:49,600 --> 04:11:56,680 THIS IS CALLED DECIDUAL 5187 04:11:56,680 --> 04:12:00,040 ARTERIOPATHY AND ASSOCIATED WITH 5188 04:12:00,040 --> 04:12:01,320 PERINATAL MORBIDITY AND WITH 5189 04:12:01,320 --> 04:12:06,720 OTHER FEATURES WITH PERINATAL 5190 04:12:06,720 --> 04:12:07,000 MORTALITY. 5191 04:12:07,000 --> 04:12:08,840 THE NEXT TWO SLIDES SHOW 5192 04:12:08,840 --> 04:12:10,720 DIFFERENT VERSIONS OF THE SAME 5193 04:12:10,720 --> 04:12:11,000 PATHOLOGY. 5194 04:12:11,000 --> 04:12:15,720 YOU SEE THE NECROSIS AND THE 5195 04:12:15,720 --> 04:12:17,760 NEXT SLIDE SHOWS THE CELLS IN 5196 04:12:17,760 --> 04:12:20,840 THE VESSEL WALL ALMOST OCCLUDE 5197 04:12:20,840 --> 04:12:23,920 THE ATHEROSIS. 5198 04:12:23,920 --> 04:12:27,760 AND I WANTED TO SHOW WHAT 5199 04:12:27,760 --> 04:12:30,400 HAPPENS TO THE PARENCHYMA AND 5200 04:12:30,400 --> 04:12:32,400 THIS IS HYPERMATURATION. 5201 04:12:32,400 --> 04:12:34,640 THE VILLI ARE SMALL AND THERE'S 5202 04:12:34,640 --> 04:12:37,960 A LOT OF SPACE BETWEEN THEM AND 5203 04:12:37,960 --> 04:12:42,760 THAT'S BECAUSE THEY'RE ISCHEMIC. 5204 04:12:42,760 --> 04:12:44,200 THEY'RE POORLY DEVELOPED BECAUSE 5205 04:12:44,200 --> 04:12:47,400 THEY'RE NOT GETTING ENOUGH 5206 04:12:47,400 --> 04:12:50,320 OXYGEN AND THERE ARE THEY CAN'T 5207 04:12:50,320 --> 04:12:56,760 PROVIDE THAT TO THE FETUS. 5208 04:12:56,760 --> 04:13:02,400 SOME RARE FINDINGS ARE LISTED 5209 04:13:02,400 --> 04:13:03,040 HERE. 5210 04:13:03,040 --> 04:13:07,320 AND THEY ARE CAUSATIONAL OF A 5211 04:13:07,320 --> 04:13:07,520 LOSS. 5212 04:13:07,520 --> 04:13:09,600 WE TALKED ABOUT A LARGE 5213 04:13:09,600 --> 04:13:11,320 ABRUPTION AND THE NEXT SLIDE 5214 04:13:11,320 --> 04:13:15,120 SHOWS A LETHAL ACUTE ABRUPTION 5215 04:13:15,120 --> 04:13:17,280 WITH A LARGE PLACENTAL 5216 04:13:17,280 --> 04:13:18,680 HEMORRHAGE INDENTING THE 5217 04:13:18,680 --> 04:13:20,080 PLACENTA AND WE'RE LOOKING AT 5218 04:13:20,080 --> 04:13:25,360 THE MATERNAL SURFACE OR THE 5219 04:13:25,360 --> 04:13:30,560 UNDER SIDE THE NEXT SHOWED THE 5220 04:13:30,560 --> 04:13:31,160 HISTOL 5221 04:13:31,160 --> 04:13:31,400 HISTOLOGY. 5222 04:13:31,400 --> 04:13:34,120 SOMETIMES WE SEE THIS. 5223 04:13:34,120 --> 04:13:36,560 THIS A BRUFD PLACENTA. 5224 04:13:36,560 --> 04:13:37,640 THE VILLI ARE RED BECAUSE 5225 04:13:37,640 --> 04:13:38,560 THEY'RE FILLED WITH BLOOD FROM 5226 04:13:38,560 --> 04:13:43,000 THE INCREASED PRESSURE FROM THE 5227 04:13:43,000 --> 04:13:43,240 ABRUPTION. 5228 04:13:43,240 --> 04:13:48,560 THIS IS CALLED INTRAVILLOUS 5229 04:13:48,560 --> 04:13:50,400 HEMORRHAGE ONE OF THE THINGS 5230 04:13:50,400 --> 04:13:52,840 THAT YOU CAN USE TO SUPPORT A 5231 04:13:52,840 --> 04:13:59,920 DIAGNOSIS OF ABRUPTION. 5232 04:13:59,920 --> 04:14:03,240 FETAL MATERNAL HEMORRHAGE OR 5233 04:14:03,240 --> 04:14:08,240 ANEMIA IS SOMETHING CAN DIAGNOSE 5234 04:14:08,240 --> 04:14:11,440 AND WE CAN ALSO DIAGNOSE THE 5235 04:14:11,440 --> 04:14:13,320 CHRONIC FETAL MATERNAL 5236 04:14:13,320 --> 04:14:13,840 HEMORRHAGE. 5237 04:14:13,840 --> 04:14:17,080 A HIGHER POWER PICTURE OF VILLI 5238 04:14:17,080 --> 04:14:19,080 AND THE BLUE PURPLE DOTS MIXED 5239 04:14:19,080 --> 04:14:22,280 WITH THE RED BLOOD CELLS ARE 5240 04:14:22,280 --> 04:14:24,920 IMMATURE RED BLOOD CELLS AND 5241 04:14:24,920 --> 04:14:28,640 THAT HAPPENS WITH FETAL ANEMIA 5242 04:14:28,640 --> 04:14:30,280 INCLUDING FETAL HEMORRHAGE. 5243 04:14:30,280 --> 04:14:33,520 THE NEXT SLIDE I WANT TO TALK 5244 04:14:33,520 --> 04:14:34,920 ABOUT THE DEPOSITION. 5245 04:14:34,920 --> 04:14:38,640 IT'S A RARE PATHOLOGY BUT HAS A 5246 04:14:38,640 --> 04:14:42,600 HIGH STILLBIRTH RATE AND A HIGH 5247 04:14:42,600 --> 04:14:46,600 REOCCURRENCE RATE. 5248 04:14:46,600 --> 04:14:50,440 IT'S ASSOCIATED WITH IMMUNE 5249 04:14:50,440 --> 04:14:52,640 DISORDER, THROMBOPHILIAS AND IN 5250 04:14:52,640 --> 04:14:58,880 SECTIONS LIKE SARS COV2. 5251 04:14:58,880 --> 04:15:00,840 THE NEXT SLIDE SHOWS WHAT THE 5252 04:15:00,840 --> 04:15:11,160 PLACENTA LOOKS LIKE. 5253 04:15:15,920 --> 04:15:21,240 THIS SHOWS A CUT SECTION OF THE 5254 04:15:21,240 --> 04:15:21,840 PLACENTA. 5255 04:15:21,840 --> 04:15:27,520 YOU CAN SEE THE MARBLING OF THE 5256 04:15:27,520 --> 04:15:30,440 PLACENTA WITH ALL THE WHITE PINK 5257 04:15:30,440 --> 04:15:32,560 TISSUE WHICH IS FIBRIN AND THE 5258 04:15:32,560 --> 04:15:33,320 NORMAL PLACENTA. 5259 04:15:33,320 --> 04:15:38,120 YOU CAN SEE HOW LITTLE NORMAL 5260 04:15:38,120 --> 04:15:39,440 PLACENTA IS PRESENT IN THIS 5261 04:15:39,440 --> 04:15:42,160 DEPOSITION AND THE NEXT SLIDE 5262 04:15:42,160 --> 04:15:44,800 SHOWS WHAT HAPPENS TO THE VILLI. 5263 04:15:44,800 --> 04:15:50,440 THEY'RE BEING SMOTHERED BY THE 5264 04:15:50,440 --> 04:15:52,560 FIBRIN AND UNDER GO NECROSIS AND 5265 04:15:52,560 --> 04:15:53,400 IT'S NOT PROVIDING OXYGEN TO THE 5266 04:15:53,400 --> 04:16:02,000 FETUS. 5267 04:16:02,000 --> 04:16:05,360 THE NEXT SLIDE -- 5268 04:16:05,360 --> 04:16:07,720 >>DR. ROBERTS, WE HAVE TO TRY 5269 04:16:07,720 --> 04:16:09,200 TO WRAP UP AS MUCH AS YOU CAN IN 5270 04:16:09,200 --> 04:16:13,240 THE NEXT FEW MINUTES TO ALLOW 5271 04:16:13,240 --> 04:16:14,920 FOR THE NEXT PRESENTER AND 5272 04:16:14,920 --> 04:16:16,040 DISCUSSION. 5273 04:16:16,040 --> 04:16:16,320 SORRY. 5274 04:16:16,320 --> 04:16:22,600 >>WE CAN SKIP THIS BECAUSE IT'S 5275 04:16:22,600 --> 04:16:24,160 RARE. 5276 04:16:24,160 --> 04:16:26,600 JUST GO THROUGH TO THE 5277 04:16:26,600 --> 04:16:27,200 CONGENITAL INFECTION WE HAVE 5278 04:16:27,200 --> 04:16:30,720 ANOTHER TALK ON. 5279 04:16:30,720 --> 04:16:31,640 THIS IS THE LAST SLIDE. 5280 04:16:31,640 --> 04:16:37,080 I WANTED TO SAY THAT PLACENTAL 5281 04:16:37,080 --> 04:16:40,640 PATHOLOGY I BELIEVE IT ANSWERS 5282 04:16:40,640 --> 04:16:42,720 THE WHAT AND THE HOW AND I THINK 5283 04:16:42,720 --> 04:16:46,800 THAT'S VERY HELPFUL FOR FAMILIES 5284 04:16:46,800 --> 04:16:52,600 AND PROVIDERS AND HELPS CLOSURE 5285 04:16:52,600 --> 04:16:57,200 AND HELPS WITH AIDING AND 5286 04:16:57,200 --> 04:16:58,280 APPROPRIATE GRIEVING AND 5287 04:16:58,280 --> 04:16:58,920 PROVIDING FOR CARE IN FUTURE 5288 04:16:58,920 --> 04:17:07,880 PREGNANCIES. 5289 04:17:07,880 --> 04:17:09,080 >>THANK YOU FOR THE WONDERFUL 5290 04:17:09,080 --> 04:17:09,400 PRESENTATION. 5291 04:17:09,400 --> 04:17:13,760 WE'RE RUNNING 20, 30 MINUTES 5292 04:17:13,760 --> 04:17:13,960 LATE. 5293 04:17:13,960 --> 04:17:19,880 WE HAVE DR. SILVER TO GIVE AN 5294 04:17:19,880 --> 04:17:22,600 OVERVIEW ABOUT OVERVIEW. 5295 04:17:22,600 --> 04:17:24,560 SORRY WE'RE RUNNING BEHIND. 5296 04:17:24,560 --> 04:17:28,120 WE STILL WOULD LIKE TO HAVE AT 5297 04:17:28,120 --> 04:17:29,840 LEAST 15 TO 20 MINUTE DISCUSSION 5298 04:17:29,840 --> 04:17:30,400 IF POSSIBLE. 5299 04:17:30,400 --> 04:17:33,240 >>YOU BET. 5300 04:17:33,240 --> 04:17:35,160 I'LL TRY TO BE -- APOLOGIZE. 5301 04:17:35,160 --> 04:17:36,840 >>IT'S NOT YOUR FAULT. 5302 04:17:36,840 --> 04:17:37,200 THANK YOU. 5303 04:17:37,200 --> 04:17:47,440 >>THANK YOU. 5304 04:18:09,560 --> 04:18:11,000 AT A HIGH LEVEL THERE'S SEVERAL 5305 04:18:11,000 --> 04:18:16,080 WAYS STILLBIRTH CAN CAUSE 5306 04:18:16,080 --> 04:18:16,360 INFECTION. 5307 04:18:16,360 --> 04:18:20,400 ONE IS DIRECT FETAL INFECTION 5308 04:18:20,400 --> 04:18:22,960 CAUSING PNEUMONIA WITH SEPSIS 5309 04:18:22,960 --> 04:18:28,640 AND WITH VIRAL INFECTIONS EARLY 5310 04:18:28,640 --> 04:18:31,640 IN PREGNANCY LIKE RUBELLA AND 5311 04:18:31,640 --> 04:18:33,200 CAN DAMAGE THE PLACENTA BY 5312 04:18:33,200 --> 04:18:36,160 DAMAGING THE PLACENTA AND 5313 04:18:36,160 --> 04:18:38,040 LEADING TO DECREASED BLOOD FLOW 5314 04:18:38,040 --> 04:18:43,160 AND OXYGEN AND NUTRIENTS AND/OR 5315 04:18:43,160 --> 04:18:46,200 OR THE MOM BECOMES CRITICALLY 5316 04:18:46,200 --> 04:18:48,840 ILL AND BABIES SUFFER HYPOXIA 5317 04:18:48,840 --> 04:18:50,640 AND DEATH AND IT'S ASSOCIATED 5318 04:18:50,640 --> 04:18:52,520 WITH PRETERM LABOR AND THE 5319 04:18:52,520 --> 04:18:55,360 ASSOCIATED CONDITIONS WHICH CAN 5320 04:18:55,360 --> 04:18:56,840 LEAD TO PRE TERM BIRTH AND 5321 04:18:56,840 --> 04:19:01,000 STILLBIRTH. 5322 04:19:01,000 --> 04:19:07,440 GOING OVER THESE IN MORE DETAIL 5323 04:19:07,440 --> 04:19:18,000 YOU HEARD EXAMPLES LIKE STEPTO 5324 04:19:20,360 --> 04:19:23,280 CAUCUS AND MALARIA AND SYPHILIS 5325 04:19:23,280 --> 04:19:25,680 CAN AFFECT THE BABY AND PLACENTA 5326 04:19:25,680 --> 04:19:28,640 AND OF RECENT INTEREST THE 5327 04:19:28,640 --> 04:19:30,000 CORONAVIRUS. 5328 04:19:30,000 --> 04:19:32,840 SEVERE MATERNAL ILLNESS IF MOMS 5329 04:19:32,840 --> 04:19:34,680 BECOME CRITICALLY ILL IT CAN 5330 04:19:34,680 --> 04:19:37,440 LEAD TO STILLBIRTH IN A 5331 04:19:37,440 --> 04:19:38,360 STRAIGHTFORWARD WAY AND 5332 04:19:38,360 --> 04:19:39,200 INFLUENZA, POLIO AND CORONAVIRUS 5333 04:19:39,200 --> 04:19:49,520 ARE GOOD EXAMPLES. 5334 04:19:54,280 --> 04:19:56,840 AND WE SEE ANY OF THESE SYMPTOMS 5335 04:19:56,840 --> 04:20:02,080 LEADS TO INTERPARTUM DEATH. 5336 04:20:02,080 --> 04:20:04,640 OFTEN IF MOM GOES INTO LABOR AND 5337 04:20:04,640 --> 04:20:10,360 28 WEEKS WE'LL DO AN EMERGENCY 5338 04:20:10,360 --> 04:20:12,560 INTERVENTION, CAESAREAN AND MAY 5339 04:20:12,560 --> 04:20:16,320 RESULT IN A STILLBIRTH AND OFTEN 5340 04:20:16,320 --> 04:20:18,000 THEY'RE ASSOCIATED WITH 5341 04:20:18,000 --> 04:20:28,280 MICROPLASMAS. 5342 04:20:32,840 --> 04:20:35,400 AND STREPT CAN CAUSE PNEUMONIA 5343 04:20:35,400 --> 04:20:37,600 BUT IT'S SO OVERWHELMING FOR THE 5344 04:20:37,600 --> 04:20:39,960 BABY YOU DON'T SEE HISTOLOGIC 5345 04:20:39,960 --> 04:20:42,720 EVIDENCE OF INFLAMMATION. 5346 04:20:42,720 --> 04:20:45,560 AND CULTURES DON'T PROVE 5347 04:20:45,560 --> 04:20:45,840 CAUSALITY. 5348 04:20:45,840 --> 04:20:48,360 MANY ARE INFECTIONS. 5349 04:20:48,360 --> 04:20:50,600 THEY ARE ASYMPTOMATIC AND THEIR 5350 04:20:50,600 --> 04:20:52,400 BABIES ARE COMPLETELY 5351 04:20:52,400 --> 04:20:52,720 UNAFFECTED. 5352 04:20:52,720 --> 04:20:54,640 AND THERE MAY BE OTHER CAUSES OF 5353 04:20:54,640 --> 04:20:56,640 STILLBIRTH AT PRESENT AS WELL. 5354 04:20:56,640 --> 04:20:57,360 INFECTION MAY CONTRIBUTE BUT NOT 5355 04:20:57,360 --> 04:20:59,760 BE CAUSATIVE OF WHAT YOU DO IN 5356 04:20:59,760 --> 04:21:03,200 CASE OF A DOWN SYNDROME BABY 5357 04:21:03,200 --> 04:21:06,400 WHERE THERE'S STREPT PNEUMONIA 5358 04:21:06,400 --> 04:21:08,840 AND HAMPERED BY A LACK OF 5359 04:21:08,840 --> 04:21:19,200 SYSTEMATIC EVALUATION. 5360 04:21:20,920 --> 04:21:25,520 DEF AND WE SHOULD ASK THE 5361 04:21:25,520 --> 04:21:26,600 QUESTION DOES DATA SUPPORT AN 5362 04:21:26,600 --> 04:21:29,240 ASSOCIATION BETWEEN INFECTIONS 5363 04:21:29,240 --> 04:21:30,000 AND STILLBIRTH. 5364 04:21:30,000 --> 04:21:32,440 IS THERE BIOLOGIC PLAUSIBILITY? 5365 04:21:32,440 --> 04:21:34,040 THESE ARE QUESTIONABLE IN TERMS 5366 04:21:34,040 --> 04:21:44,560 OF HOW RIGOROUS THEY ARE BUT IS 5367 04:21:44,920 --> 04:21:47,280 THERE A DOSE-RESPONSE 5368 04:21:47,280 --> 04:21:48,720 RELATIONSHIP AND IS IT 5369 04:21:48,720 --> 04:21:50,560 ASSOCIATED WITH FETAL COMPROMISE 5370 04:21:50,560 --> 04:21:54,760 AND WOULD THE STILLBIRTH HAVE 5371 04:21:54,760 --> 04:21:55,840 OCCURRED WITHOUT THE INFECTION? 5372 04:21:55,840 --> 04:21:58,640 IF THE ANSWER IS TRUE THEN IT 5373 04:21:58,640 --> 04:22:09,080 PROBABLY WAS THE CAUSE. 5374 04:22:12,880 --> 04:22:23,360 AND INFECTIONS CALL STILLBIRTH. 5375 04:22:23,720 --> 04:22:27,280 THESE WERE OLDER STUDIES IN 5376 04:22:27,280 --> 04:22:28,640 HIGH-INCOME COUNTRIES WHERE 5377 04:22:28,640 --> 04:22:29,760 INFECTION CAUSED 15% OF 5378 04:22:29,760 --> 04:22:30,680 STILLBIRTHS IN ONE STUDY AND 9% 5379 04:22:30,680 --> 04:22:34,320 IN ANOTHER. 5380 04:22:34,320 --> 04:22:38,040 AND IT TURNS OUT IN SCRN WAS 5381 04:22:38,040 --> 04:22:38,560 13%. 5382 04:22:38,560 --> 04:22:40,520 IT'S A PRETTY CONSISTENT NUMBER 5383 04:22:40,520 --> 04:22:42,320 IN SURVEY STUDIES AND HIGH 5384 04:22:42,320 --> 04:22:43,680 INCOME COUNTRIES. 5385 04:22:43,680 --> 04:22:45,880 IT'S IMPORTANT TO NOTE IT'S MUCH 5386 04:22:45,880 --> 04:22:47,280 HIGHER IN LOW RESOURCE SETTINGS 5387 04:22:47,280 --> 04:22:51,720 IT CAN BE AS HIGH AS 50% IN 5388 04:22:51,720 --> 04:22:53,520 AREAS WHERE SYPHILIS AND MALARIA 5389 04:22:53,520 --> 04:22:55,400 ARE ENDEMIC. 5390 04:22:55,400 --> 04:22:56,840 IN HIGH INCOME COUNTRIES THERE'S 5391 04:22:56,840 --> 04:22:58,640 VARIATION IN TERMS OF THE TIMING 5392 04:22:58,640 --> 04:23:02,520 OF GESTATION AND THE OLDER STUDY 5393 04:23:02,520 --> 04:23:04,600 ABOUT 20% OF INFECTION 5394 04:23:04,600 --> 04:23:06,400 STILLBIRTH WERE LESS THAN 28 5395 04:23:06,400 --> 04:23:09,720 WEEKS ARE RELATIVELY SMALL 5396 04:23:09,720 --> 04:23:12,360 BETWEEN 28 AND 36 WEEKS AND A 5397 04:23:12,360 --> 04:23:13,120 COUPLE PERCENT AT TERM. 5398 04:23:13,120 --> 04:23:16,760 AND IF YOU LOOK AT THE BARS ON 5399 04:23:16,760 --> 04:23:18,720 THE RIGHT OF THE INFECTIOUS 5400 04:23:18,720 --> 04:23:20,840 CASES MOST OCCURRED IN THE 20 TO 5401 04:23:20,840 --> 04:23:21,800 24 WEEK GESTATION. 5402 04:23:21,800 --> 04:23:24,560 THERE WAS A BUMP AT 37 PLUS AND 5403 04:23:24,560 --> 04:23:25,120 RELATIVELY SMALL NUMBERS IN 5404 04:23:25,120 --> 04:23:30,360 BETWEEN. 5405 04:23:30,360 --> 04:23:32,800 ALSO I SHOWED THE SLIDE 5406 04:23:32,800 --> 04:23:35,640 PREVIOUSLY BUT THERE IS 5407 04:23:35,640 --> 04:23:38,160 DISPARITIES WITH REGARD TO THE 5408 04:23:38,160 --> 04:23:39,040 PERCENTAGE OF CASES OF 5409 04:23:39,040 --> 04:23:41,240 STILLBIRTH DUE TO INFECTION WITH 5410 04:23:41,240 --> 04:23:44,800 A HIGHER PERCENTAGE IN BLACK 5411 04:23:44,800 --> 04:23:45,640 WOMEN AND AS THE ANOTHER 5412 04:23:45,640 --> 04:23:46,120 OPPORTUNITY TO ADDRESS 5413 04:23:46,120 --> 04:23:52,400 DISPARITIES SO AGAIN, I DON'T 5414 04:23:52,400 --> 04:23:54,720 WANT TO READ THE PHONE BOOK AND 5415 04:23:54,720 --> 04:23:58,560 WE WON'T GO OVER ALL THE 5416 04:23:58,560 --> 04:24:01,120 INDIVIDUAL INFECTIOUS CAUSES OF 5417 04:24:01,120 --> 04:24:02,080 STILLBIRTH BUT VIRAL INFECTION 5418 04:24:02,080 --> 04:24:03,360 WE DON'T KNOW WHAT PROPORTION OF 5419 04:24:03,360 --> 04:24:06,520 STILLBIRTHS THEY CAUSE. 5420 04:24:06,520 --> 04:24:08,000 IT'S A LACK OF SYSTEMATIC 5421 04:24:08,000 --> 04:24:11,040 APPROACH HARD TO CULTURE. 5422 04:24:11,040 --> 04:24:12,840 WE CAN CULTURE BACTERIA EASIER 5423 04:24:12,840 --> 04:24:15,360 THAN VIRUSES AND YOU HAVE TO 5424 04:24:15,360 --> 04:24:16,840 CULTURE WITH INTENT. 5425 04:24:16,840 --> 04:24:18,440 IT'S ALSO HARD TO PROVE 5426 04:24:18,440 --> 04:24:18,680 CAUSATION. 5427 04:24:18,680 --> 04:24:24,840 IN MANY CASES YOU HAVE POS 5428 04:24:24,840 --> 04:24:26,680 SEROLOGY BUT WAS NOT THE CAUSE 5429 04:24:26,680 --> 04:24:28,000 OF STILLBIRTH AND IMPORTANT 5430 04:24:28,000 --> 04:24:32,040 VIRUSES CMB, PARVOVIRUS AND 5431 04:24:32,040 --> 04:24:36,760 IMPROVEMENT IN OUTCOMES AND 5432 04:24:36,760 --> 04:24:39,160 RESEARCH GOING ON 5433 04:24:39,160 --> 04:24:40,560 COXSACKIEVIRUSES ARE MORE 5434 04:24:40,560 --> 04:24:41,480 PREVALENT THAN THOUGHT 5435 04:24:41,480 --> 04:24:42,040 PREVIOUSLY AND INTEREST IN 5436 04:24:42,040 --> 04:24:49,920 CORONAVIRUS. 5437 04:24:49,920 --> 04:24:52,240 OVER 130 BACTERIAL INFECTIONS 5438 04:24:52,240 --> 04:24:54,600 HAVE BEEN ASSOCIATED WITH 5439 04:24:54,600 --> 04:24:54,880 STILLBIRTH. 5440 04:24:54,880 --> 04:24:58,680 SOME OCCUR THROUGH WISTERIA AND 5441 04:24:58,680 --> 04:25:00,480 SYPHILIS BEING THE BEST EXAMPLES 5442 04:25:00,480 --> 04:25:10,560 AND THEY REACH THE BABY BY 5443 04:25:10,560 --> 04:25:12,680 UMBILI 5444 04:25:12,680 --> 04:25:16,640 UMBILICAL VEIN AND LUNG IS 5445 04:25:16,640 --> 04:25:20,840 AFFECTS. 5446 04:25:20,840 --> 04:25:31,440 AND MALARIA IS IMPORTANT AND 5447 04:25:33,640 --> 04:25:39,440 TREATMENT WITH ANTI-MARLARIALS 5448 04:25:39,440 --> 04:25:42,320 AND USING NETS APPEARS TO 5449 04:25:42,320 --> 04:25:44,280 IMPROVE OUTCOMES AND SEEMS 5450 04:25:44,280 --> 04:25:44,880 PREVENTIBLE FROM WHAT WE KNOW 5451 04:25:44,880 --> 04:25:55,000 TODAY. 5452 04:25:56,920 --> 04:26:04,840 E. COLI AT 18 CASES OF GROUP E 5453 04:26:04,840 --> 04:26:10,560 STREP AND PARVOVIRUS AND 5454 04:26:10,560 --> 04:26:13,880 SYPHILIS AND HERPES. 5455 04:26:13,880 --> 04:26:16,840 BECAUSE OF SO MANY ORGANISMS AND 5456 04:26:16,840 --> 04:26:18,440 EACH CAUSE ONLY A FEW 5457 04:26:18,440 --> 04:26:18,760 STILLBIRTHS. 5458 04:26:18,760 --> 04:26:19,920 A VARIETY OF STRATEGIES BUT 5459 04:26:19,920 --> 04:26:23,640 THERE'S NO QUESTION WE CAN 5460 04:26:23,640 --> 04:26:23,960 REDUCE SOME. 5461 04:26:23,960 --> 04:26:30,920 SYPHILIS SCREENING AND CHLAMYDIA 5462 04:26:30,920 --> 04:26:32,840 TREATMENT AND WE'RE NOT SURE 5463 04:26:32,840 --> 04:26:33,880 WHETHER WHAT WE'RE DOING HELPS 5464 04:26:33,880 --> 04:26:35,680 BUT THERE'S OPPORTUNITY FOR 5465 04:26:35,680 --> 04:26:38,200 RESEARCH AND IMPROVEMENT AND 5466 04:26:38,200 --> 04:26:41,920 ANTIBIOTICS FOR MEMBRANES AND 5467 04:26:41,920 --> 04:26:43,920 IMMUNIZATIONS FOR VIRUSES 5468 04:26:43,920 --> 04:26:44,640 ESPECIALLY WITH THE CURRENT 5469 04:26:44,640 --> 04:26:46,320 CLIMATE WE MAY SEE AN INCREASE 5470 04:26:46,320 --> 04:26:49,280 IN ADVERSE PREGNANCY OUTCOMES. 5471 04:26:49,280 --> 04:26:52,680 SOME PUBLIC HEALTH MEASURES TO 5472 04:26:52,680 --> 04:26:54,080 REDUCE WISTERIA AND RESEARCH 5473 04:26:54,080 --> 04:27:00,280 FOCUSSED ON INFECTION. 5474 04:27:00,280 --> 04:27:01,960 PREVENTION IN LOW AND MIDDLE 5475 04:27:01,960 --> 04:27:03,800 INCOME COUNTRIES BUT MALARIA 5476 04:27:03,800 --> 04:27:05,880 PREVENTION AND TREATMENT AND HIV 5477 04:27:05,880 --> 04:27:06,960 PREVENTION AND TREATMENT ARE 5478 04:27:06,960 --> 04:27:17,400 ALSO INCREDIBLY IMPORTANT. 5479 04:27:18,480 --> 04:27:19,720 WE NEED MORE RESEARCH. 5480 04:27:19,720 --> 04:27:22,760 THERE'S AN OPPORTUNITY TO ASSESS 5481 04:27:22,760 --> 04:27:25,880 THE MICROBIOME USING MOLECULAR 5482 04:27:25,880 --> 04:27:26,560 TECHNIQUES. 5483 04:27:26,560 --> 04:27:32,160 YOU CAN SEQUENCE THE DNA AND RNA 5484 04:27:32,160 --> 04:27:34,240 AND WE NEED PROPER COLLECTION OF 5485 04:27:34,240 --> 04:27:36,480 TISSUES TO ALLOW FOR DNA 5486 04:27:36,480 --> 04:27:39,240 EXTRACTION TO STUDY THIS IN 5487 04:27:39,240 --> 04:27:39,520 STILLBIRTH. 5488 04:27:39,520 --> 04:27:44,440 THERE'S A HIGH DEGREE OF RNA 5489 04:27:44,440 --> 04:27:45,720 DEGRADATION AND NEED TO BE 5490 04:27:45,720 --> 04:27:48,320 CORRELATED WITH HISTOLOGY AND 5491 04:27:48,320 --> 04:27:48,720 NEED INTERNATIONAL 5492 04:27:48,720 --> 04:27:51,520 COLLABORATIONS. 5493 04:27:51,520 --> 04:27:52,320 I'LL STOP THERE. 5494 04:27:52,320 --> 04:27:54,320 I APOLOGIZE I KNOW THAT WAS WAY 5495 04:27:54,320 --> 04:27:55,560 TOO FAST AND WE'LL HAVE TIME FOR 5496 04:27:55,560 --> 04:27:55,840 QUESTIONS. 5497 04:27:55,840 --> 04:27:56,840 THANK YOU. 5498 04:27:56,840 --> 04:27:59,040 >>THANK YOU. 5499 04:27:59,040 --> 04:28:02,160 NOW YOU CAN BREATHE. 5500 04:28:02,160 --> 04:28:12,600 SORRY WE MADE YOU GO LAST. 5501 04:28:18,720 --> 04:28:22,240 >>FIRST, THANK YOU FOR 5502 04:28:22,240 --> 04:28:24,040 TREMENDOUS TALKS. 5503 04:28:24,040 --> 04:28:25,520 SUMMARIZED A HUGE AMOUNT OF 5504 04:28:25,520 --> 04:28:33,160 INFORMATION IN A SHORT TIME. 5505 04:28:33,160 --> 04:28:35,280 I'LL TRY TO SUMMARIZE THE MAIN 5506 04:28:35,280 --> 04:28:37,840 TAKE HOME POINTS AND HEAR WHERE 5507 04:28:37,840 --> 04:28:40,480 THE RESEARCH SHOULD BE GOING. 5508 04:28:40,480 --> 04:28:44,520 A LOT OF THE RESEARCH HAS BEEN 5509 04:28:44,520 --> 04:28:46,320 BASED ON INVESTIGATION OF 5510 04:28:46,320 --> 04:28:46,640 STILLBIRTH. 5511 04:28:46,640 --> 04:28:48,600 DR. SILVER DID A GREAT REVIEW OF 5512 04:28:48,600 --> 04:28:52,680 THE MANY RISK FACTORS AND 5513 04:28:52,680 --> 04:28:55,760 CONDITIONS ASSOCIATED WITH 5514 04:28:55,760 --> 04:28:56,080 STILLBIRTHS. 5515 04:28:56,080 --> 04:28:58,200 WE'RE NOT AT A POINT EVEN IF YOU 5516 04:28:58,200 --> 04:28:59,160 TAKE EVERYTHING WE KNOW WITH THE 5517 04:28:59,160 --> 04:29:07,920 RISK FACTORS WE CAN'T PREDICT 5518 04:29:07,920 --> 04:29:10,640 AND YOU WANT TO PREDICT 5519 04:29:10,640 --> 04:29:12,920 STILLBIRTH AND CAN INTERVENE 5520 04:29:12,920 --> 04:29:18,920 WITHOUT CAUSING PRE TERM BIRTH 5521 04:29:18,920 --> 04:29:22,680 AND HIGHLIGHTING BIO MARKERS AND 5522 04:29:22,680 --> 04:29:24,240 WE DIDN'T HAVE A CHANCE TO GET 5523 04:29:24,240 --> 04:29:26,080 INTO WHAT'S GOING ON IN TERMS OF 5524 04:29:26,080 --> 04:29:29,440 ISOLATING PLACENTAL CELLS AND 5525 04:29:29,440 --> 04:29:31,520 PRODUCTS OF MATERNAL CIRCULATION 5526 04:29:31,520 --> 04:29:39,440 AND ULTRASOUND AND IDENTIFYING 5527 04:29:39,440 --> 04:29:41,000 THE MICROBIOME AND WE CANNOT 5528 04:29:41,000 --> 04:29:43,000 PREDICT PATIENTS AT HIGH ENOUGH 5529 04:29:43,000 --> 04:29:50,920 RISK AND IF I SUMMARIZE IT WRONG 5530 04:29:50,920 --> 04:29:52,000 CAN JUMP IN AND THE LAST TWO 5531 04:29:52,000 --> 04:29:56,600 SLIDES WERE KEY. 5532 04:29:56,600 --> 04:29:59,080 THE SLIDE SHOWED HOW BMI 5533 04:29:59,080 --> 04:30:01,280 TRANSLATES BY ITSELF TO A HIGHER 5534 04:30:01,280 --> 04:30:02,680 RISK OF STILLBIRTH THROUGH 5535 04:30:02,680 --> 04:30:06,000 BIOMARKERS IS A THEME OF 5536 04:30:06,000 --> 04:30:08,600 BIOMARKERS AND THE FRAMEWORK 5537 04:30:08,600 --> 04:30:10,160 SLIDE HOW DO WE TAKE THAT KIND 5538 04:30:10,160 --> 04:30:12,840 OF APPROACH TO TACKLE THE 5539 04:30:12,840 --> 04:30:15,120 PROBLEM OF STILLBIRTH. 5540 04:30:15,120 --> 04:30:15,880 YOU INTRODUCED SOCIAL 5541 04:30:15,880 --> 04:30:17,960 DETERMINATES OF HEALTH WHICH ARE 5542 04:30:17,960 --> 04:30:20,760 VERY IMPORTANT FACTORS BECAUSE 5543 04:30:20,760 --> 04:30:24,840 OBVIOUSLY THAT LEADS TO HEALTH 5544 04:30:24,840 --> 04:30:25,760 INEQUITY. 5545 04:30:25,760 --> 04:30:32,840 IT'S AN IMPORTANT ROLE NOT ONLY 5546 04:30:32,840 --> 04:30:35,680 IN BIOLOGIC AND IN HEALTH 5547 04:30:35,680 --> 04:30:38,120 INEQUITIES AND CARE AND HOW DOES 5548 04:30:38,120 --> 04:30:42,600 THAT ALL LEAD TO STILLBIRTH. 5549 04:30:42,600 --> 04:30:44,840 THEN THE TALK ON GENOMIC TAKING 5550 04:30:44,840 --> 04:30:48,880 US THROUGH GENETICS AND GENOMICS 5551 04:30:48,880 --> 04:30:51,240 AND PROGRESSING DOWN TO GENOMIC 5552 04:30:51,240 --> 04:30:55,840 SEQUENCING AND HOW IMPORTANT IT 5553 04:30:55,840 --> 04:31:00,600 IS TO UNDERSTAND TO DO GENOMIC 5554 04:31:00,600 --> 04:31:04,680 SEQUENCING AND HOW IT CAN HELP 5555 04:31:04,680 --> 04:31:07,880 MANAGE PREGNANCIES AND FINALLY 5556 04:31:07,880 --> 04:31:08,840 DR. ROBERTS BEAUTIFUL TALK ON 5557 04:31:08,840 --> 04:31:11,560 THE PLACENTAL LESIONS ASSOCIATED 5558 04:31:11,560 --> 04:31:13,520 WITH STILLBIRTH AND IMPORTANT TO 5559 04:31:13,520 --> 04:31:14,600 UNDERSTAND THE HOW AND WHY 5560 04:31:14,600 --> 04:31:20,160 BECAUSE WE WANT TO PREDICT THOSE 5561 04:31:20,160 --> 04:31:20,360 LESIONS. 5562 04:31:20,360 --> 04:31:26,440 WE HAVE TO HAVE THEM DEFINED AND 5563 04:31:26,440 --> 04:31:26,800 CHARACTERIZED. 5564 04:31:26,800 --> 04:31:28,920 I'LL TURN IT OVER TO EACH OF YOU 5565 04:31:28,920 --> 04:31:31,880 TO SAY WHERE DO YOU SEE THE 5566 04:31:31,880 --> 04:31:34,640 RESEARCH NEEDS TO GO BASED ON 5567 04:31:34,640 --> 04:31:35,520 WHAT YOU PRESENTED. 5568 04:31:35,520 --> 04:31:38,680 I'LL START WITH DR. SILVER. 5569 04:31:38,680 --> 04:31:39,480 >>SURE. 5570 04:31:39,480 --> 04:31:44,440 SO I WAS GOING RESPOND TO THE 5571 04:31:44,440 --> 04:31:44,640 CHAT. 5572 04:31:44,640 --> 04:31:47,960 THERE'S A QUESTION IN THERE FOR 5573 04:31:47,960 --> 04:31:48,840 DR. ROBERTS. 5574 04:31:48,840 --> 04:31:51,360 I DON'T WANT TO ANSWER FOR HER 5575 04:31:51,360 --> 04:31:54,960 BUT I THINK THAT'S REALLY AN 5576 04:31:54,960 --> 04:31:56,840 IMPORTANT -- HAS THERE BEEN AN 5577 04:31:56,840 --> 04:31:58,480 EFFORT TO ASSESS PLACENTAL 5578 04:31:58,480 --> 04:32:03,640 FUNCTION WITH IMAGING. 5579 04:32:03,640 --> 04:32:05,120 THERE'S BEEN TERRIFIC EFFORTS 5580 04:32:05,120 --> 04:32:11,200 AND AGAIN CREDIT TO NICHD AND 5581 04:32:11,200 --> 04:32:14,200 THERE'S AMAZING DATA WITH MRI 5582 04:32:14,200 --> 04:32:16,680 ASSESSING BLOOD FLOW IN SUB SETS 5583 04:32:16,680 --> 04:32:22,680 OF PLACENTAL FUNCTION AND MET 5584 04:32:22,680 --> 04:32:24,440 METABOLISM AND THERE'S GREAT 5585 04:32:24,440 --> 04:32:27,760 STUFF WITH ULTRASOUND. 5586 04:32:27,760 --> 04:32:32,800 I'D LIKE TO EMPHASIZE BIOMARKERS 5587 04:32:32,800 --> 04:32:34,640 AND ULTRASOUND. 5588 04:32:34,640 --> 04:32:38,800 I THINK WE NEED TO DO A TON BUT 5589 04:32:38,800 --> 04:32:45,000 THE ONE TOOL IN OUR TOOLBOX D 5590 04:32:45,000 --> 04:32:46,680 TODAY IS DELIVERY AND DECIDING 5591 04:32:46,680 --> 04:32:48,640 WHETHER 36 WEEKS IS THE OPTIMAL 5592 04:32:48,640 --> 04:32:51,040 TIME FOR DELIVERY AND GETTING 5593 04:32:51,040 --> 04:32:55,360 BETTER AT DIFFERENTIATING AGAIN 5594 04:32:55,360 --> 04:32:58,280 A 1 AND 3,000 STILLBIRTH RISK IS 5595 04:32:58,280 --> 04:33:01,320 WHAT I'M MOST EXCITED ABOUT. 5596 04:33:01,320 --> 04:33:03,480 >>THAT'S DIFFICULT IN TERMS OF 5597 04:33:03,480 --> 04:33:06,400 COMING UP WITH THE STUDIES FOR 5598 04:33:06,400 --> 04:33:07,400 PREDICTION. 5599 04:33:07,400 --> 04:33:11,440 WE'RE WORKING ON ULTRASOUND AND 5600 04:33:11,440 --> 04:33:13,280 MRI AND BIOMARKERS DURING THE 5601 04:33:13,280 --> 04:33:14,960 PREGNANCY TO HELP PREDICT RISK. 5602 04:33:14,960 --> 04:33:16,680 PROBLEM IS WITH THE COHORT YOU'D 5603 04:33:16,680 --> 04:33:22,680 HAVE TO HAVE A HUGE COHORT TO 5604 04:33:22,680 --> 04:33:33,000 PREDICT STILLBIRTH. 5605 04:33:33,360 --> 04:33:36,720 AND LOOKING AT PATIENTS WITH 5606 04:33:36,720 --> 04:33:38,800 FETAL GROWTH RESTRICTION TO GET 5607 04:33:38,800 --> 04:33:39,240 TO THE STILLBIRTH. 5608 04:33:39,240 --> 04:33:41,880 HOW DO WE STUDY THE BIOMARKERS 5609 04:33:41,880 --> 04:33:47,200 WITHOUT HAVING TO HAVE A STUDY 5610 04:33:47,200 --> 04:33:48,840 OF LIKE -- 5611 04:33:48,840 --> 04:33:53,600 >>ALL THE ABOVE. 5612 04:33:53,600 --> 04:33:55,960 IT'S INCREDIBLY HARD AND I DON'T 5613 04:33:55,960 --> 04:33:58,200 WANT TO MONOPOLIZE MORE THAN I 5614 04:33:58,200 --> 04:33:59,040 ALREADY AM. 5615 04:33:59,040 --> 04:34:01,720 THE HOLY GRAIL OF BIOMARKER 5616 04:34:01,720 --> 04:34:03,400 PREDICTION AND ULTRASOUND 5617 04:34:03,400 --> 04:34:04,240 ASSESSMENT HAVE BEEN IN THE 5618 04:34:04,240 --> 04:34:08,080 FIRST TRIMESTER THINKING IF WE 5619 04:34:08,080 --> 04:34:10,720 CAN IDENTIFY RISK EARLY ON WE 5620 04:34:10,720 --> 04:34:12,600 CAN MODIFY THE RISK AND IT'S A 5621 04:34:12,600 --> 04:34:13,960 GOOD HOLY GRAIL BUT RIGHT NOW 5622 04:34:13,960 --> 04:34:19,240 WE'RE LIMITED TO THINGS LIKE 5623 04:34:19,240 --> 04:34:23,320 ASPIRIN AND THERE'S VALUE AND 5624 04:34:23,320 --> 04:34:23,640 LIMITATIONS. 5625 04:34:23,640 --> 04:34:25,280 WE HAVEN'T FOCUSSED AS MUCH ON 5626 04:34:25,280 --> 04:34:25,600 36 WEEKS. 5627 04:34:25,600 --> 04:34:27,520 I THINK THAT'S A REAL 5628 04:34:27,520 --> 04:34:27,840 OPPORTUNITY. 5629 04:34:27,840 --> 04:34:29,520 SECOND, YOU'RE RIGHT, THE 5630 04:34:29,520 --> 04:34:31,640 STUDIES ARE INCREDIBLY EXPENSIVE 5631 04:34:31,640 --> 04:34:32,840 TO DO. 5632 04:34:32,840 --> 04:34:39,480 SOME COMBINATION OF A PREGNANCY 5633 04:34:39,480 --> 04:34:42,000 OUTCOME AND THERE'S PATHOLOGY IN 5634 04:34:42,000 --> 04:34:45,840 THE HYPERTENSIVE DISORDERS AND 5635 04:34:45,840 --> 04:34:47,440 CREATIVITY AND COMBINING COHORTS 5636 04:34:47,440 --> 04:34:49,640 SO THAT NO SINGLE ENTITY HAS TO 5637 04:34:49,640 --> 04:34:52,960 FUND THE ENTIRE THING. 5638 04:34:52,960 --> 04:34:56,840 YOU'RE RIGHT, IT'S EASY TO SAY 5639 04:34:56,840 --> 04:35:00,800 AND HARD TO DO. 5640 04:35:00,800 --> 04:35:04,040 >>DO WE DO IT AT THE TIME OF 5641 04:35:04,040 --> 04:35:06,120 FETAL GROWTH RESTRICTION AND 5642 04:35:06,120 --> 04:35:06,560 PREECLAMPSIA. 5643 04:35:06,560 --> 04:35:09,280 >>FIRST WE HAVE TO PROVE 5644 04:35:09,280 --> 04:35:11,800 THERE'S AN ASSOCIATION IN 5645 04:35:11,800 --> 04:35:12,320 REPRODUCIBILITY. 5646 04:35:12,320 --> 04:35:14,160 THERE'S SO MANY THINGS WE CAN 5647 04:35:14,160 --> 04:35:18,680 ASSESS IN ULTRASOUND AND HAVE TO 5648 04:35:18,680 --> 04:35:21,880 DO SMALLER STUDIES TO JUSTIFY 5649 04:35:21,880 --> 04:35:23,760 LARGER STUDIES AND SO ON AND SO 5650 04:35:23,760 --> 04:35:26,160 FORTH AND PROBABLY SOME 5651 04:35:26,160 --> 04:35:27,440 COMBINATION OF SMALLER STUDIES 5652 04:35:27,440 --> 04:35:31,280 IN VERY SELECTED HIGH RISK 5653 04:35:31,280 --> 04:35:35,920 PATIENTS LIKE FETAL GROWTH 5654 04:35:35,920 --> 04:35:37,720 RESTRICTION BUT I'M GLAD WE'RE 5655 04:35:37,720 --> 04:35:40,920 HAVING THE CONVERSATION. 5656 04:35:40,920 --> 04:35:51,080 >>GREAT. 5657 04:35:58,240 --> 04:36:00,040 >>I'VE BEEN AROUND BOB LONG 5658 04:36:00,040 --> 04:36:01,960 ENOUGH TO KNOW I SHOULD AGREE 5659 04:36:01,960 --> 04:36:02,680 WITH BOB. 5660 04:36:02,680 --> 04:36:04,160 I DO, IT TURNS OUT. 5661 04:36:04,160 --> 04:36:05,640 THERE'S NOT ONE OPTIMAL DESIGN 5662 04:36:05,640 --> 04:36:08,840 TO ADDRESS THIS BUT I MENTIONED 5663 04:36:08,840 --> 04:36:12,720 IN MY TALK, I THINK TAKE LESS 5664 04:36:12,720 --> 04:36:19,960 ADVANTAGE OF THE COMMONALITY OF 5665 04:36:19,960 --> 04:36:20,840 HOW BIOLOGICAL TRANSDUCTION 5666 04:36:20,840 --> 04:36:25,880 OCCURS IN THE UTERUS AND HOW 5667 04:36:25,880 --> 04:36:28,280 ADVERSE OUTCOMES TAKE AWAY AND I 5668 04:36:28,280 --> 04:36:32,360 UNDERSTAND THE REASONS WHY WE DO 5669 04:36:32,360 --> 04:36:33,840 SPONTANEOUS BIRTH RESEARCH AND 5670 04:36:33,840 --> 04:36:38,080 PRE TERM AND PREECLAMPSIA. 5671 04:36:38,080 --> 04:36:44,720 THERE IS ENOUGH CONVERGENCE THAT 5672 04:36:44,720 --> 04:36:47,640 I THINK WE CAN IMPACT THE 5673 04:36:47,640 --> 04:36:50,360 OUTCOMES BY APPRECIATING THEIR 5674 04:36:50,360 --> 04:36:50,800 COMMONALITY. 5675 04:36:50,800 --> 04:36:56,480 THERE'S ENOUGH COMMONALITY OF 5676 04:36:56,480 --> 04:37:00,480 RISK FACTORS AND BIOLOGICAL 5677 04:37:00,480 --> 04:37:04,640 DESCRIPTION IN THE SUBOPTIMAL 5678 04:37:04,640 --> 04:37:06,640 MILIEU. 5679 04:37:06,640 --> 04:37:10,680 THAT APPROACH AND DESIGN PEOPLE 5680 04:37:10,680 --> 04:37:12,080 HAVE PHILOSOPHIZED BUT IT'S 5681 04:37:12,080 --> 04:37:20,840 POSSIBLE TO DO IN COHORT STUDY 5682 04:37:20,840 --> 04:37:26,400 WITH AND CREATING A COHORT STUDY 5683 04:37:26,400 --> 04:37:28,440 BY OVER SAMPLING LATE PREGNANCY 5684 04:37:28,440 --> 04:37:39,000 AT THE TIME OF ADVERSE OUTCOMES. 5685 04:37:39,640 --> 04:37:43,400 I UNDERSTAND THE REASONS WHY FOR 5686 04:37:43,400 --> 04:37:46,200 RESEARCH BUT AROUND THIS SET OF 5687 04:37:46,200 --> 04:37:46,720 DECISION MAKING AROUND 5688 04:37:46,720 --> 04:37:49,000 STILLBIRTH AND THE MAJORITY OF 5689 04:37:49,000 --> 04:37:52,320 ADVERSE PREGNANCY OUTCOMES LIKE 5690 04:37:52,320 --> 04:37:54,720 LATER PRE TERM BIRTH AND 5691 04:37:54,720 --> 04:37:59,760 PREECLAMPSIA AND STILLBIRTH, 5692 04:37:59,760 --> 04:38:04,400 THERE'S MERIT STILL IN LATER 5693 04:38:04,400 --> 04:38:04,800 PREGNANCY. 5694 04:38:04,800 --> 04:38:11,760 YOU CAN CREATE A PROSPECTIVE 5695 04:38:11,760 --> 04:38:12,000 COHORT. 5696 04:38:12,000 --> 04:38:16,680 THERE'S MERIT IN THAT APPROACH. 5697 04:38:16,680 --> 04:38:19,360 THE CONTEXT IN TERMS OF DATA 5698 04:38:19,360 --> 04:38:21,880 ELEMENTS AND RESEARCH NEEDED, 5699 04:38:21,880 --> 04:38:26,240 YOU TALKED ABOUT THAT ONE SLIDE 5700 04:38:26,240 --> 04:38:30,200 FROM SDOH TO BIOLOGICAL 5701 04:38:30,200 --> 04:38:32,920 TRANSDUCTION TO OUTCOMES, YOU 5702 04:38:32,920 --> 04:38:36,480 CAN'T BE A 30-YEAR STUDY OF 5703 04:38:36,480 --> 04:38:37,400 100,000 PEOPLE AND MEASURE 5704 04:38:37,400 --> 04:38:38,600 EVERYTHING AND EVERYONE. 5705 04:38:38,600 --> 04:38:40,200 IT'S TOO BIG AND TOO BROAD IN 5706 04:38:40,200 --> 04:38:41,640 ALL THREE DIMENSIONS. 5707 04:38:41,640 --> 04:38:44,040 WE CAN HAVE ENOUGH ATTENTIVENESS 5708 04:38:44,040 --> 04:38:49,880 TO REPRESENT THEM TO A DEGREE. 5709 04:38:49,880 --> 04:38:52,160 WE COULD DO THAT IN THE CONTEXT 5710 04:38:52,160 --> 04:38:53,760 OF A COHORT CASE COHORT STUDY 5711 04:38:53,760 --> 04:38:59,280 POP 5712 04:38:59,280 --> 04:39:00,000 >>THANK YOU. 5713 04:39:00,000 --> 04:39:03,520 DR. WOJCIK. 5714 04:39:03,520 --> 04:39:05,120 >>THE TECHNOLOGY WE HAVE TODAY 5715 04:39:05,120 --> 04:39:06,880 IS SO MUCH MORE POWERFUL IN OUR 5716 04:39:06,880 --> 04:39:08,840 CAPACITY TO IDENTIFY GENETIC 5717 04:39:08,840 --> 04:39:10,080 CONDITIONS WHICH CAN CO-OCCUR 5718 04:39:10,080 --> 04:39:13,960 WITH SO MANY OTHER PREGNANCY 5719 04:39:13,960 --> 04:39:14,320 COMPLICATIONS. 5720 04:39:14,320 --> 04:39:16,240 IT'S INCREASED IN THE PAST 5721 04:39:16,240 --> 04:39:16,760 SEVERAL YEARS. 5722 04:39:16,760 --> 04:39:19,000 IT WOULD BE A REALLY POWERFUL 5723 04:39:19,000 --> 04:39:20,240 TOOL TO APPLY IN THE 5724 04:39:20,240 --> 04:39:22,880 INVESTIGATIONS TO IDENTIFY 5725 04:39:22,880 --> 04:39:25,680 PARTICULARLY FOR NON-ANOMALY 5726 04:39:25,680 --> 04:39:26,640 PREGNANCIES WHERE NO ONE 5727 04:39:26,640 --> 04:39:29,960 SUSPECTED SOMETHING GENETIC. 5728 04:39:29,960 --> 04:39:32,280 WE FIND DIAGNOSES THAT HAVE 5729 04:39:32,280 --> 04:39:33,520 IMPLICATIONS FOR FUTURE 5730 04:39:33,520 --> 04:39:33,800 PREGNANCIES. 5731 04:39:33,800 --> 04:39:35,720 THERE'S SO MUCH UNKNOWN AND 5732 04:39:35,720 --> 04:39:37,440 GIVEN OUR CAPACITY FOR 5733 04:39:37,440 --> 04:39:39,560 SEQUENCING THE MINIMAL SAMPLE 5734 04:39:39,560 --> 04:39:41,200 REQUIREMENTS I THINK GENOMIC 5735 04:39:41,200 --> 04:39:44,160 ASPECTS SHOULD BE INCLUDED IN 5736 04:39:44,160 --> 04:39:45,400 ANY STUDY INVESTIGATING 5737 04:39:45,400 --> 04:39:47,040 STILLBIRTH BECAUSE WE DON'T NOAH 5738 04:39:47,040 --> 04:39:52,600 WE DON'T KNOW AND IF THERE'S A 5739 04:39:52,600 --> 04:39:53,720 SECOND CAUSE SOMETIMES THEY CAN 5740 04:39:53,720 --> 04:39:58,680 HAVE IMPLICATIONS FOR FUTURE 5741 04:39:58,680 --> 04:39:59,200 PREGNANCIES. 5742 04:39:59,200 --> 04:40:00,040 ENCOURAGE APPLICATION OF THE 5743 04:40:00,040 --> 04:40:04,280 TOOLS WE ALREADY HAVE TO HELP 5744 04:40:04,280 --> 04:40:05,640 IDENTIFY PARTICULARLY THE 5745 04:40:05,640 --> 04:40:06,120 UNSUSPECTED DIAGNOSES. 5746 04:40:06,120 --> 04:40:12,680 >>MONICA, SHOULD EVERY 5747 04:40:12,680 --> 04:40:13,960 STILLBIRTH HAVE ULTIMATELY A 5748 04:40:13,960 --> 04:40:17,200 WHOLE GENOME SEQUENCING DONE? 5749 04:40:17,200 --> 04:40:19,600 THERE MAY BE GENETIC ISSUES WE 5750 04:40:19,600 --> 04:40:22,640 DON'T KNOW OF RIGHT NOW WE MAY 5751 04:40:22,640 --> 04:40:33,080 DISCOVER DOWN THE ROAD. 5752 04:40:34,440 --> 04:40:38,320 WE'RE TALKING HALF $500,000 AND 5753 04:40:38,320 --> 04:40:42,720 $1 MILLION PER STATE. 5754 04:40:42,720 --> 04:40:46,240 IF YOU THINK 24 TIMES $1,000 OR 5755 04:40:46,240 --> 04:40:50,760 LESS PER WHOLE GENOME SEQUENCING 5756 04:40:50,760 --> 04:40:53,520 WE'RE NOT TALKING ABOUT AN 5757 04:40:53,520 --> 04:40:55,000 ENORMOUS AMOUNT OF MONEY. 5758 04:40:55,000 --> 04:40:56,760 >>I AGREE ESPECIALLY COMPARED 5759 04:40:56,760 --> 04:41:01,880 TO THE OTHER COSTS INCURRED WITH 5760 04:41:01,880 --> 04:41:03,840 STILLBIRTH AND OTHER 5761 04:41:03,840 --> 04:41:05,920 INVESTIGATIONS BEING UNDERTAKEN. 5762 04:41:05,920 --> 04:41:09,480 THE COST NOT AS ASTRONOMICAL AS 5763 04:41:09,480 --> 04:41:11,240 IT ONCE WAS AND NOT ALL FAMILIES 5764 04:41:11,240 --> 04:41:15,720 WANT IT BUT SHOULD BE OFFERED AS 5765 04:41:15,720 --> 04:41:16,360 AN OPTION. 5766 04:41:16,360 --> 04:41:19,360 MAYBE I'M BIASSED BUT I FEEL 5767 04:41:19,360 --> 04:41:21,240 LIKE EVERYONE WHO LOSES A 5768 04:41:21,240 --> 04:41:22,400 PREGNANCY SHOULD BE OFFERED TO 5769 04:41:22,400 --> 04:41:24,160 ACCESS AS BROAD GENETIC TESTING 5770 04:41:24,160 --> 04:41:28,480 AS WE CAN. 5771 04:41:28,480 --> 04:41:31,840 >>I'M REMINDED FROM THE FIRST 5772 04:41:31,840 --> 04:41:36,120 SESSION WE HAD WHEN ONE OF THE 5773 04:41:36,120 --> 04:41:37,480 MOTHERS WHO GAVE A PRESENTATION 5774 04:41:37,480 --> 04:41:40,680 SAID YEARS LATER SHE STILL 5775 04:41:40,680 --> 04:41:42,920 REGRET THE FACT NO AUTOPSY WAS 5776 04:41:42,920 --> 04:41:43,960 DONE AND GENETIC INFORMATION ON 5777 04:41:43,960 --> 04:41:50,360 THE BABY THAT DIED WAS MISSING 5778 04:41:50,360 --> 04:41:55,480 FROM THEIR LIFE NOW WHICH HER 5779 04:41:55,480 --> 04:41:59,280 SUBSEQUENT PREGNANCY AND IF 5780 04:41:59,280 --> 04:42:04,680 NOTHING ELSE A NORMAL GENOME 5781 04:42:04,680 --> 04:42:07,640 WOULD GIVE COMFORT TO THE 5782 04:42:07,640 --> 04:42:08,000 PARENTS. 5783 04:42:08,000 --> 04:42:13,120 >>NICHD IS FUNDING THE STUDY ON 5784 04:42:13,120 --> 04:42:15,800 SEQUENCING AND TRIOS FOR 5785 04:42:15,800 --> 04:42:20,160 STILLBIRTHS AND PARENTS AND NGH 5786 04:42:20,160 --> 04:42:21,120 FOR THE GROWTH. 5787 04:42:21,120 --> 04:42:26,400 GETTING THAT DATA IS SO 5788 04:42:26,400 --> 04:42:29,600 IMPORTANT AND THAT WILL COMPEL 5789 04:42:29,600 --> 04:42:31,480 INSURERS TO COVER IT BECAUSE 5790 04:42:31,480 --> 04:42:32,680 IT'S DIFFICULT TO GET THE 5791 04:42:32,680 --> 04:42:34,640 COMPLETE EVALUATION COVERED BY 5792 04:42:34,640 --> 04:42:44,840 INSURANCE IN A LOT OF PLACES. 5793 04:42:44,840 --> 04:42:47,480 >>THE ANTI-NATAL PATHOLOGY 5794 04:42:47,480 --> 04:42:48,840 SHOULD BE THE FOCUS OF THE 5795 04:42:48,840 --> 04:42:53,080 PROJECT. 5796 04:42:53,080 --> 04:42:55,240 MANY THINGS ARE POSSIBLE NOW BUT 5797 04:42:55,240 --> 04:42:56,560 ARE JUST NOT BEING DONE. 5798 04:42:56,560 --> 04:42:58,640 I CAN'T TELL YOU HOW MANY 5799 04:42:58,640 --> 04:43:01,880 STUDIES I'VE BEEN ON WHERE THEY 5800 04:43:01,880 --> 04:43:02,600 DESCRIBED SOMETHING IN THE 5801 04:43:02,600 --> 04:43:08,080 PLACENTA AND I WANT TO SEE THE 5802 04:43:08,080 --> 04:43:08,840 ULTRASOUND CORRELATION BUT THEY 5803 04:43:08,840 --> 04:43:10,760 ARE DIDN'T LOOK AT THE PLACENTA 5804 04:43:10,760 --> 04:43:12,840 OR COMMENT ON THE PLACENTA AND 5805 04:43:12,840 --> 04:43:20,880 THERE'S NO CLIPS. 5806 04:43:20,880 --> 04:43:22,560 THE PLACENTAL DIAGNOSIS YOU HAVE 5807 04:43:22,560 --> 04:43:24,400 TO KNOW WHAT YOU'RE LOOKING FOR 5808 04:43:24,400 --> 04:43:28,640 BUT LOOKING FOR THAT IS WHAT 5809 04:43:28,640 --> 04:43:34,920 SHOULD BE THE FOCUS. 5810 04:43:34,920 --> 04:43:40,640 >>DR. SILVER. 5811 04:43:40,640 --> 04:43:42,000 >>YOU WANTED TO THROW OUT 5812 04:43:42,000 --> 04:43:42,200 ANOTHER. 5813 04:43:42,200 --> 04:43:45,800 IT WAS GREAT TO SEE ALL THE 5814 04:43:45,800 --> 04:43:48,120 TALKS THIS AFTERNOON AND WE 5815 04:43:48,120 --> 04:43:49,560 CAN'T LOOK AT ANY ONE OF THESE 5816 04:43:49,560 --> 04:43:50,440 IN A VACUUM. 5817 04:43:50,440 --> 04:43:54,240 IT WOULD BE GREAT FOR EVERY 5818 04:43:54,240 --> 04:43:58,640 STUDY TO HAVE THE HISTOLOGY AND 5819 04:43:58,640 --> 04:44:01,720 WHOLE GENOME SEQUENCING. 5820 04:44:01,720 --> 04:44:04,080 I HOPE THE WHOLE TESTING 5821 04:44:04,080 --> 04:44:07,240 EXERCISE LEADS TO COLLABORATION. 5822 04:44:07,240 --> 04:44:10,680 WHETHER THAT'S A NETWORK EBB OR 5823 04:44:10,680 --> 04:44:14,200 ENCOURAGEMENT OF MULTI-CENTERED 5824 04:44:14,200 --> 04:44:14,800 RO1s. 5825 04:44:14,800 --> 04:44:17,840 IF WE DO ANY IN A VACUUM WE 5826 04:44:17,840 --> 04:44:18,480 WON'T GET AS FAR AS PUTTING THEM 5827 04:44:18,480 --> 04:44:21,440 ALL TOGETHER. 5828 04:44:21,440 --> 04:44:24,280 >>UMA, ONE QUICK COMMENT I'LL 5829 04:44:24,280 --> 04:44:27,480 MAKE IS THAT BEFORE DR. BIANCHI 5830 04:44:27,480 --> 04:44:30,240 WRAPS UP THE ENTIRE CONVERSATION 5831 04:44:30,240 --> 04:44:34,440 OF THE DAY, THAT FROM A RESEARCH 5832 04:44:34,440 --> 04:44:39,560 PERSPECTIVE IT WOULD BE 5833 04:44:39,560 --> 04:44:42,400 WONDERFUL TO KNOW HOW MANY OF 5834 04:44:42,400 --> 04:44:43,920 THE STILLBIRTHS ARE PREVENTIBLE 5835 04:44:43,920 --> 04:44:46,480 AND AND WHERE THE MOST BANG FOR 5836 04:44:46,480 --> 04:44:49,760 THE BUCK ULTIMATELY WOULD BE AND 5837 04:44:49,760 --> 04:44:52,040 THAT WAY THAT COULD ACTUALLY 5838 04:44:52,040 --> 04:44:54,200 DIRECT SOME OF THE RESEARCH 5839 04:44:54,200 --> 04:44:56,200 INITIATIVES THAT ULTIMATELY 5840 04:44:56,200 --> 04:45:00,800 COULD FORM BASIS OF OUR PUBLIC 5841 04:45:00,800 --> 04:45:02,280 HEALTH INTERVENTIONS. 5842 04:45:02,280 --> 04:45:06,080 THAT'S ALWAYS HARD TO FIGURE OUT 5843 04:45:06,080 --> 04:45:08,040 WITH EVERY DIAGNOSTIC TEST WE 5844 04:45:08,040 --> 04:45:09,200 PUT IN PLACE THERE ARE 5845 04:45:09,200 --> 04:45:12,840 INTERVENTIONS THAT HAPPEN THAT 5846 04:45:12,840 --> 04:45:14,840 ARE HARMFUL TO NORMAL BABIES 5847 04:45:14,840 --> 04:45:17,200 LIKE YOU MENTIONED EARLIER IN 5848 04:45:17,200 --> 04:45:22,800 YOUR INTRODUCTION ABOUT ELECTIVE 5849 04:45:22,800 --> 04:45:27,320 C SECTIONS OR PRE TERM BIRTHS 5850 04:45:27,320 --> 04:45:28,640 TRIGGERED BY FALSE ALARM AND 5851 04:45:28,640 --> 04:45:32,200 SOMETHING TO THINK ABOUT AS WE 5852 04:45:32,200 --> 04:45:33,560 GO THROUGH THE EXERCISE. 5853 04:45:33,560 --> 04:45:35,360 WHERE WILL THE MOST BANG FOR OUR 5854 04:45:35,360 --> 04:45:38,080 BUCK BE. 5855 04:45:38,080 --> 04:45:41,440 >>ACTUALLY, THE COMPONENTS YOU 5856 04:45:41,440 --> 04:45:43,120 LISTED AND ON TOP OF THAT WE 5857 04:45:43,120 --> 04:45:44,560 HEARD ABOUT MATERNAL INTERVIEWS 5858 04:45:44,560 --> 04:45:50,320 AND TALKING TO PARENTS ABOUT 5859 04:45:50,320 --> 04:45:51,560 THEIR EXPERIENCE. 5860 04:45:51,560 --> 04:45:56,080 AND COME UP WITH A STUDY TO DIG 5861 04:45:56,080 --> 04:45:57,400 DEEP INTO THIS. 5862 04:45:57,400 --> 04:45:58,320 ALL RIGHT. 5863 04:45:58,320 --> 04:46:00,240 I THINK I'LL HAND IT OVER TO 5864 04:46:00,240 --> 04:46:01,880 DR. BIANCHI. 5865 04:46:01,880 --> 04:46:04,880 THANK YOU ALL FOR THE WONDERFUL 5866 04:46:04,880 --> 04:46:05,640 TALKS TODAY AND TO THE EXCELLENT 5867 04:46:05,640 --> 04:46:09,040 QUESTIONS. 5868 04:46:09,040 --> 04:46:11,760 >>THANK YOU, DR. REDDY, 5869 04:46:11,760 --> 04:46:13,640 DR. JAIN, DR. LONGO AND ALL THE 5870 04:46:13,640 --> 04:46:16,000 SPEAKERS BOTH IN THE MORNING AND 5871 04:46:16,000 --> 04:46:16,280 AFTERNOON. 5872 04:46:16,280 --> 04:46:18,880 MY JOB IS NOT TO WRAP IT UP 5873 04:46:18,880 --> 04:46:20,840 BECAUSE I THINK THE CO-CHAIRS 5874 04:46:20,840 --> 04:46:23,760 AND MODERATOR HAVE DONE A GREAT 5875 04:46:23,760 --> 04:46:25,800 JOB WRAPPING UP THE DISCUSSIONS. 5876 04:46:25,800 --> 04:46:28,640 MY JOB IS TO TELL YOU WHAT'S 5877 04:46:28,640 --> 04:46:30,840 NEXT. 5878 04:46:30,840 --> 04:46:32,840 IF I CAN HAVE THE SLIDE. 5879 04:46:32,840 --> 04:46:36,200 THE NEXT STEP IS A PUBLIC 5880 04:46:36,200 --> 04:46:40,120 LISTENING SESSION AFTER THE 5881 04:46:40,120 --> 04:46:42,640 HOLIDAYS THURSDAY JANUARY 5 5882 04:46:42,640 --> 04:46:43,560 BETWEEN 3:00 AND 5:00. 5883 04:46:43,560 --> 04:46:49,640 WE NEED YOU TO REGISTER FOR THE 5884 04:46:49,640 --> 04:46:52,640 MEETING TO BE LET IN USING THIS 5885 04:46:52,640 --> 04:46:56,920 CODE, I'LL GIVE YOU A MOMENT TO 5886 04:46:56,920 --> 04:47:00,160 LOOK AT THIS. 5887 04:47:00,160 --> 04:47:03,440 AFTER YOU REGISTER YOU'LL GET A 5888 04:47:03,440 --> 04:47:04,640 ZOOM CONFIRMATION E-MAIL 5889 04:47:04,640 --> 04:47:05,880 CONTAINING INFORMATION ABOUT 5890 04:47:05,880 --> 04:47:07,200 JOINING THE MEETING. 5891 04:47:07,200 --> 04:47:10,960 THERE WAS A QUESTION WHETHER 5892 04:47:10,960 --> 04:47:14,800 THIS WAS ESE IT SAYS EDT BUT 5893 04:47:14,800 --> 04:47:17,320 YES, THE SESSION WILL BE BETWEEN 5894 04:47:17,320 --> 04:47:27,840 3:00 AND 5:00 EAST COAST TIME. 5895 04:47:30,520 --> 04:47:32,440 WHEN YOU REGISTER WE'LL ASK 5896 04:47:32,440 --> 04:47:35,120 REGISTRANT TO IDENTIFY WHETHER 5897 04:47:35,120 --> 04:47:38,200 THEY'LL SPEAK ON BEHALF OF AN 5898 04:47:38,200 --> 04:47:40,640 ORGANIZATION OR AS AN INDIVIDUAL 5899 04:47:40,640 --> 04:47:42,440 WITH LIVED EXPERIENCE SO WE CAN 5900 04:47:42,440 --> 04:47:46,120 FIT IN AS MANY PERSPECTIVES AS 5901 04:47:46,120 --> 04:47:47,880 POSSIBLE WE'RE GOING ASK IF 5902 04:47:47,880 --> 04:47:48,640 THERE'S A REGISTERED 5903 04:47:48,640 --> 04:47:50,400 ORGANIZATION AND WE KNOW THERE 5904 04:47:50,400 --> 04:47:53,360 ARE SEVERAL IN THE SPACE, THAT 5905 04:47:53,360 --> 04:47:55,160 YOU IDENTIFY ONE SPOKESPERSON 5906 04:47:55,160 --> 04:47:56,840 WHO IS GOING TO SPEAK ON BEHALF 5907 04:47:56,840 --> 04:48:04,840 OF THAT ORGANIZATION. 5908 04:48:04,840 --> 04:48:06,920 WE WILL THEN ASSESS HOW MANY 5909 04:48:06,920 --> 04:48:08,480 PEOPLE REGISTER TO SPEAK AND 5910 04:48:08,480 --> 04:48:10,280 THAT WILL DETERMINE HOW MUCH 5911 04:48:10,280 --> 04:48:11,080 TIME EACH SPEAKER GETS. 5912 04:48:11,080 --> 04:48:12,720 SOME ORGANIZATIONS, FOR EXAMPLE, 5913 04:48:12,720 --> 04:48:14,920 THAT HAVE A LOT OF MEMBERS, 5914 04:48:14,920 --> 04:48:17,240 YOU'LL HAVE TO MAKE A DECISION 5915 04:48:17,240 --> 04:48:19,800 WHETHER YOU WANT ONE PERSON 5916 04:48:19,800 --> 04:48:21,360 SPEAKING ON BEHALF OF THE 5917 04:48:21,360 --> 04:48:23,320 ORGANIZATION AND THAT PERSON 5918 04:48:23,320 --> 04:48:25,600 WILL GET MORE TIME, FOR EXAMPLE, 5919 04:48:25,600 --> 04:48:28,480 OR IF YOU WANT EACH INDIVIDUAL 5920 04:48:28,480 --> 04:48:31,560 TO SPEAK PERSONALLY ABOUT THEIR 5921 04:48:31,560 --> 04:48:32,840 EXPERIENCE THAT WAY THERE'LL BE 5922 04:48:32,840 --> 04:48:36,520 MORE PEOPLE SPEAKING AND LESS 5923 04:48:36,520 --> 04:48:37,120 TIME PER PERSON IF THAT MAKES 5924 04:48:37,120 --> 04:48:42,440 SENSE. 5925 04:48:42,440 --> 04:48:46,040 WE ALSO ENCOURAGE YOUR WRITTEN 5926 04:48:46,040 --> 04:48:46,640 COMMENTS. 5927 04:48:46,640 --> 04:48:49,480 THERE WAS A REQUEST FOR 5928 04:48:49,480 --> 04:48:49,960 INFORMATION. 5929 04:48:49,960 --> 04:49:00,520 IF YOU GO TO THIS LINK WHICH IS 5930 04:49:00,520 --> 04:49:01,920 N-O-T--H-D-2504 IS YOUR 5931 04:49:01,920 --> 04:49:05,840 OPPORTUNITY TO PROVIDE COMMENTS 5932 04:49:05,840 --> 04:49:06,760 PERMANENT FOR THE RECORD AND WE 5933 04:49:06,760 --> 04:49:08,280 ARE SOLICITING INPUT REGARDING 5934 04:49:08,280 --> 04:49:13,600 THE DEVELOPMENT OF STRATEGIES TO 5935 04:49:13,600 --> 04:49:18,600 INCLUDE THE IMPACT OF NIH FUNDED 5936 04:49:18,600 --> 04:49:23,400 RESEARCH ON STILLBIRTHS. 5937 04:49:23,400 --> 04:49:33,920 AS DR. CERNICH COMMUNICATED OUR 5938 04:49:36,360 --> 04:49:38,360 MISSION IS TO PROVIDE EVIDENCE 5939 04:49:38,360 --> 04:49:43,600 FROM RESEARCH THAT IS THEN GIVEN 5940 04:49:43,600 --> 04:49:48,240 VIA PUBLICATIONS TO PROFESSIONAL 5941 04:49:48,240 --> 04:49:48,800 SOCIETIES WHO THEN MAKE 5942 04:49:48,800 --> 04:49:49,320 RECOMMENDATIONS REGARDING 5943 04:49:49,320 --> 04:49:56,960 TREATMENT. 5944 04:49:56,960 --> 04:49:58,800 WE CANNOT RECOMMEND A SPECIFIC 5945 04:49:58,800 --> 04:49:59,080 TREATMENT. 5946 04:49:59,080 --> 04:50:00,240 WE CAN DO IMPLEMENTATION 5947 04:50:00,240 --> 04:50:07,000 RESEARCH AND ALL KINDS OF 5948 04:50:07,000 --> 04:50:08,120 RESEARCH THIS IS YOUR CHANCE TO 5949 04:50:08,120 --> 04:50:12,400 WRITE IN REQUEST FOR 5950 04:50:12,400 --> 04:50:12,760 INFORMATION. 5951 04:50:12,760 --> 04:50:15,480 WE THINK RESEARCH IS SERIOUSLY 5952 04:50:15,480 --> 04:50:18,280 NEEDED ON A, B, C OR D. 5953 04:50:18,280 --> 04:50:20,600 WE'LL ACCEPT RESPONSES THROUGH 5954 04:50:20,600 --> 04:50:24,080 JANUARY 6 AND MUST BE SUBMITTED 5955 04:50:24,080 --> 04:50:27,080 ELECTRONICALLY TO THE FOLLOWING 5956 04:50:27,080 --> 04:50:35,640 E-MAIL ADDRESS. 5957 04:50:35,640 --> 04:50:37,400 NICHDSTILLBIRTH@MAIL.NIH.gov. 5958 04:50:37,400 --> 04:50:42,520 THEN WE'LL REVIEW THE 5959 04:50:42,520 --> 04:50:43,160 RECOMMENDATIONS FROM ALL FOUR 5960 04:50:43,160 --> 04:50:44,840 MEETINGS INCLUDING THE UPCOMING 5961 04:50:44,840 --> 04:50:50,600 PUBLIC LISTENING SESSION AND THE 5962 04:50:50,600 --> 04:50:54,080 CO-CHAIRS OF THE TASK FORCE WILL 5963 04:50:54,080 --> 04:50:55,120 PRESENT THEM TO ME FOR 5964 04:50:55,120 --> 04:50:56,840 CONSIDERATION DURING THE JANUARY 5965 04:50:56,840 --> 04:50:58,000 COUNCIL MEETING. 5966 04:50:58,000 --> 04:51:00,560 THIS IS OUR REGULARLY SCHEDULED 5967 04:51:00,560 --> 04:51:05,360 ADVISORY COUNCIL MEETING. 5968 04:51:05,360 --> 04:51:10,920 THERE IS A PUBLIC SESSION TO 5969 04:51:10,920 --> 04:51:12,840 HEAR WHAT IS SAID REGARDING THE 5970 04:51:12,840 --> 04:51:14,320 RECOMMENDATIONS AFTER ALL FOUR 5971 04:51:14,320 --> 04:51:14,760 MEETINGS. 5972 04:51:14,760 --> 04:51:16,840 THERE WILL ALSO BE A WRITTEN 5973 04:51:16,840 --> 04:51:20,160 REPORT AND AFTER THE CO-CHAIRS 5974 04:51:20,160 --> 04:51:23,600 SUBMIT THEIR WRITTEN REPORT, 5975 04:51:23,600 --> 04:51:27,520 WE'LL EXAMINE BOTH OUR CURRENT 5976 04:51:27,520 --> 04:51:28,000 SPECIFIC PRIORITIES. 5977 04:51:28,000 --> 04:51:32,840 YOU HEARD WE'RE ALREADY FUNDING 5978 04:51:32,840 --> 04:51:34,520 RESEARCH IN THE SPACE AND THE 5979 04:51:34,520 --> 04:51:35,480 CURRENT PROGRAMS WE HAVE THAT 5980 04:51:35,480 --> 04:51:36,800 ADDRESS STILLBIRTH AND THEN WILL 5981 04:51:36,800 --> 04:51:39,720 SEE WHAT'S MISSING. 5982 04:51:39,720 --> 04:51:41,680 WHERE ARE THE GAPS AND WHERE 5983 04:51:41,680 --> 04:51:44,200 WE'RE ALIGNED WITH THE 5984 04:51:44,200 --> 04:51:45,360 RECOMMENDATIONS AND WHERE THE 5985 04:51:45,360 --> 04:51:46,080 THE GAPS. 5986 04:51:46,080 --> 04:51:49,400 WE'LL ALSO SHARE THE REPORT WITH 5987 04:51:49,400 --> 04:51:50,640 OUR FEDERAL COLLEAGUES MANY OF 5988 04:51:50,640 --> 04:51:52,640 WHOM ARE PARTICIPATING AS 5989 04:51:52,640 --> 04:51:54,360 PANELISTS OR EX-OFFICIO MEMBERS 5990 04:51:54,360 --> 04:51:57,840 TODAY AND IN PREVIOUS SESSIONS 5991 04:51:57,840 --> 04:51:59,640 AND THEY CAN HELP DETERMINE 5992 04:51:59,640 --> 04:52:02,640 ACTION ITEMS WITHIN THEIR SCOPE 5993 04:52:02,640 --> 04:52:04,320 AND MISSION. 5994 04:52:04,320 --> 04:52:10,520 YOU HEARD ABOUT CDC'S ROLE IN 5995 04:52:10,520 --> 04:52:12,840 THE OVER ALL ECO SPHERE AND 5996 04:52:12,840 --> 04:52:18,640 REMEMBER IF WE GET MORE FUNDING 5997 04:52:18,640 --> 04:52:20,400 FOR RESEARCH WE CAN EXPAND 5998 04:52:20,400 --> 04:52:20,840 PROGRAMS. 5999 04:52:20,840 --> 04:52:22,640 WE CANNOT GO DIRECTLY TO 6000 04:52:22,640 --> 04:52:23,120 CONGRESS. 6001 04:52:23,120 --> 04:52:24,840 THAT IS NOT THE ROLE OF FEDERAL 6002 04:52:24,840 --> 04:52:32,000 OFFICIALS TO DO THAT. 6003 04:52:32,000 --> 04:52:34,080 IT'S CLEAR THE NRPZ SPEAK FOR 6004 04:52:34,080 --> 04:52:35,600 THEMSELVES IN TERMS OF 6005 04:52:35,600 --> 04:52:39,920 STILLBIRTH. 6006 04:52:39,920 --> 04:52:42,360 I THINK A STRONG CASE CAN AND 6007 04:52:42,360 --> 04:52:43,480 WILL BE MADE MORE NEEDS TO BE 6008 04:52:43,480 --> 04:52:43,680 DONE. 6009 04:52:43,680 --> 04:52:46,080 WE LOOK FORWARD TO YOUR INPUT. 6010 04:52:46,080 --> 04:52:50,720 WE HAVE BEEN LISTENING BUT THIS 6011 04:52:50,720 --> 04:52:52,600 WILL BE A FORMAL SESSION FOR ALL 6012 04:52:52,600 --> 04:52:55,520 OF YOU TO TELL US WHAT YOU THINK 6013 04:52:55,520 --> 04:52:57,840 WE NEED TO KNOW BOTH AT THE 6014 04:52:57,840 --> 04:52:58,680 FOURTH SESSION AND ALSO IN 6015 04:52:58,680 --> 04:53:02,360 WRITING. 6016 04:53:02,360 --> 04:53:05,600 SO WITH THAT, RECOGNIZING THAT 6017 04:53:05,600 --> 04:53:07,360 THE HOLIDAYS MAY BE A SAD TIME 6018 04:53:07,360 --> 04:53:09,000 FOR SOME OF YOU BECAUSE OF THE 6019 04:53:09,000 --> 04:53:11,680 LOSSES IN YOUR FAMILY, I DO HOPE 6020 04:53:11,680 --> 04:53:16,320 THAT EVERYONE HAS A CHANCE TO 6021 04:53:16,320 --> 04:53:20,240 ENJOY WHATEVER RITUALS YOU HAVE 6022 04:53:20,240 --> 04:53:21,680 AND EVERYONE WILL BE HEALTHY AND 6023 04:53:21,680 --> 04:53:24,760 WE'LL SEE YOU IN THE NEW YEAR. 6024 04:53:24,760 --> 04:53:26,520 THANKS AGAIN TO EVERYONE WHO'S 6025 04:53:26,520 --> 04:53:27,880 MADE THIS HAPPEN INCLUDING OUR 6026 04:53:27,880 --> 04:53:29,360 NICHD STAFF AND CONTRACTORS WHO 6027 04:53:29,360 --> 04:53:31,240 ARE HELPING US WITH THE AUDIO 6028 04:53:31,240 --> 04:53:34,240 VISUAL ASPECTS OF THE MEETING. 6029 04:53:34,240 --> 04:53:34,680 TAKE CARE EVERYBODY. 6030 04:53:34,680 --> 00:00:00,000 THANK YOU.