Personal Statement: Participated in a Nasa Space Camp Essay

At the age of five, a young boy from India boarded his first flight while travelling from Chennai to Hong Kong. He developed a strong interest in aircrafts. In the year 2008, this young boy from India was inspired when he participated in a NASA space camp. This boy and his friends were awarded the prize of the best junior scientists by Mr Steve Johnson, the Chairman of NASA. The award was given on the basis of fulfilment of various criteria based on various fascinating activities like modelling a rover and constructing a rocket that would travel upwards 250m or above. This boy was none other than me and I enjoyed every second that I spent in the space camp. The NASA space camp was a turning point in my life. My keenness to be involved with aircraft took a definite shape in the form of my wanting to become an astronaut or be involved in Aerospace Engineering. Working in an organisation like NASA as an Aerospace Engineer became my ambition for life. Since then I have been enthusiastic about gaining all kinds of knowledge regarding aviation and aerospace engineering. I also visited ISRO, the Indian Space Research Organisation, the Indian equivalent of NASA, located in Sriharikota, a place in the southern part of India. Though there was a great deal of difference in the technology used in the space centres in the US and in India, I was able to learn a great deal about Chandarayan, the first successful mission constructed by an Indian as the project director MylswamyAnnadurai gave a detailed explanation about it. By the end of Grade 10, I had understood that if I really wished to take up a career in Aeronautical Engineering I would have to further my horizons of education. The first step that I took to pursue this dream of mine was to take up an international curriculum, the International Baccalaureate in an international, residential school. It is here that I was enabled to do some research regarding the best universities that offered Aerospace Engineering and Aeronautics. I found out that though there are comparatively few universities in India in which the subject is available, the ones that do are the best. I have, since then, been putting in my best to mould myself into a suitable candidate to enter one of these highly-acclaimed universities. I took up Physics, Mathematics, and Information technology in Global Society the basic requirements to pursue Aeronautical Engineering, at the higher level and made the most of the opportunities available. Undeterred by my poor performance initially, primarily due to my weakness in English, I worked hard to become one of the toppers in these subjects in my batch. In the year of my visit to NASA, another significant event took place in my life. Being interested in hockey and having played the game for a few years, I was selected to play in the Under-14 CBSE (the most popular Indian curriculum) South Zone hockey tournament. My success in the game led to my being selected in the All-India Under-14 Hockey team. However, a serious injury prevented my playing any match as part of the team. The game I have picked up since is Badminton which I play well enough to be part of the school team. Besides, I enjoy watching Tamil movies. My other hobbies are playing computer games and listening to m usic. As I have been brought up in a family of politicians, the wish to serve the society is an inherent part of me. My father encourages me to serve the needy and the poor especially on special days like my birthday and Diwali, the festival of lights. Hence, it was with ease that I fulfilled the requirements for acquiring the silver medal of the International Award for Young People and the service activities of CAS. Now I am poised to move ahead in life, gain all the knowledge and skills required to be able to design aircraft and set up my own industry that will cater to my needs and those of my country and countrymen by providing quality infrastructure and employment at a large scale.

Motivation and Unionization

Political philosophers, sociologists, economists and psychologists have been formulating theories to account for social organization. Man is a social being, one if his basic needs is to belong, and so it is but natural to him to organize institutions, organizations and groups. Motivation is a general term referring to the regulation of need-satisfying and goal-seeking behavior (Atkinson et al., 1993). Economists and political philosophers have studied social organization motivations basically to understand their role in commerce and industry, particularly labor organization. Unionization is act of forming labor unions, which are groups or organizations that are organized to represent the labor work force as a collective, whose objectives are to protect workers from unjust labor practices, to improve working conditions, and to look after the general welfare. Unionization is often viewed as negative from the perspective of management. Managing unions can only be done if there is through understanding of the motivations behind it. It is the objective of this paper to understand the concepts of motivation and unionization and to deduce an appropriate proposition to the management of labor unions. Understanding Unionization Industrialization fathered labor unions. Unions were to begin with organized to monitor pay levels and increase and working conditions and through it safety regulations were developed, and standardized, child labor was abolished, and work day and work week were shortened, and started non-wage benefits like pensions and health insurance (Feinman, 2006). Basically, unions gave workers bargaining power against unfair labor practices, safety measures in the lack of protective labor laws and allowed a venue to voice concerns of workers. Unions are not oppositions to management but a safeguard when workers become unheard, ignored or disregarded. The statement that â€Å"A company that deserves a union gets one† is not absolute but it is undeniable that it can greatly influence workers to organize unions. Unions may be organized even if there are optimum working conditions but the original motives for forming unions in the 19th century can be very become the motives for forming them today. It has to be recognized that unionization has significantly suffered a decline in the last 30 years (Clemens et al., 2003). Feinman (2006) reasons that the decline in unionization is the development of automation in factories, thus lessening those engaged in the industry, but there are still sectors that are in need of unions, particularly the service sector, to represent worker needs and concerns. Understanding Leadership and Motivation Leadership is a powerful motivator. Bad leadership can trigger unwanted responses in the workforce causing them to form defensive groups that may be having an attitude range of indifference to hostility. Confidence in management allows for open communication channels facilitating the discussion and resolution of concerns or disputes. Sound directives from management lead to responsiveness to company culture and inspire loyalty to the company. When workers feel secure, properly represented and involved in the company, the desire for collective action is not as significant (Dong-One and Voos, 1997). Sound leadership and motivation is able to guide the members of the organization towards the accomplishment of the major goal which is profits, efficiency and effectivity of the company. To achieve these, one has to be able to manage labor relations well. So, if workers turn to union organization as a means of communication and solving their concerns, considering the decline in unionization by workers, it may very well mean indeed that leadership and motivation strategies that are being implemented is not effective or enough to develop optimum labor relations. Deserving a Union What kind of companies has labor unions? Labor unions are present in all industries. The popular notion is that unionization is that it is only common blue collar workers but the reality is that even white collar workers need the protection against unfair labor practices, lack of labor legislation and oppressive conditions. The presence of unions does not increase labor liabilities, it only unifies the individual responsibility or management to workers. Surprisingly, there are even situations where the organization of a union should be encouraged by a company. Labor organizations have two faces according to Dong-One and Voos (1997) that â€Å"unions possess both a collective voice face and a monopoly face†. In the event that there are several groups in the workforce who have various concerns, it is to the benefit of management for workers to unionize into one group instead of the company having to deal with several groups instead (Flanagan, 1999). It can also make easier the assessment of workers’ dispositions and moods. In one way it can also contribute to labor stability, workers and management are bound by the collective bargaining agreements that are established thus providing specifics for operations, alleviation of concerns and improvement of the company as a whole. Conclusion The suggestion that if proper leadership and motivation techniques are employed and desirable policies devised, workers will not want to unionize is not absolutely conclusive. Workers may still not unionize even if their working conditions are less than desirable when there are legal impediments to do so or there is too much risk associated with the act of unionization. Conversely, workers of companies with good management may still opt to unionize in the vent that they desire an organized representation of themselves, unionize as a means if creating other institutions like cooperatives or lobby groups, or are required by the company or the state to unionize. The statement that â€Å"a company that deserves a union gets one† implies that the organization of labor unions a consequence is also misleading. It suggests that unionization is purely a deterrent to a company. Unionization can improve communication between workers and management, allow management greater access to workforce conditions, and promote the company as a preferred employer thus enhancing public image. There exists a duality in the existence of labor unions in their benefit and burden to an organization. It is important to understand that since individual motivations drive the organization of labor unions, there is no real straightforward judgment on its worth or price. Equally as influential in the organization of labor unions are macroeconomic factors that stem from national labor policies, service and product demands and national productivity. It is therefore the conclusion of this paper inefficient leadership and motivation is a significant factor in the formation of unions but it is not a conclusive reason for it is important to consider other contributing factors that can either encourage or inhibit unionization. Reference Atkinson, Rita L., Atkinson, Richard C., Smith, Edward E., Bem, Daryl J. (1993). Introduction to Psychology, 11th edition. Orlado, FA: Harcourt and Brace Publishers Bertola, Giuseppe (1999). Microeconomic Perspectives on Aggregate Labor Markets, in Handbook of Labor Economics vol.3B, Amsterdam: North-Holland, pp.2985-3028. Blau, F.D. and L.M. Kahn (1999). Institutions and Laws in the Labor Market, in Handbook of Labor Economics, Vol. 3C, Amsterdam: Elsevier, 1399-1461. Clemens, Jason, Karabegovià ¦, Amela and Veldhuis, Niels (2003). Unionization: The Facts Please. Dong-One,   Kim and Voos (1997). Unionization, Union Involvement and the Performance of Gain Sharing Programs. Feinman, Robert D. (2006). Does Unionization Matter?. Retrieved on August 18, 2006 from http://robertdfeinman.com/society/unionization.html. Flanagan, R.J. (1999), Macroeconomic Performance and Collective Bargaining: An International Perspective, Journal of Economic Literature 37, 1150-1175.      

Dark Dreams Essay

In the novel Dark Dreams page 47 â€Å"The Waves to Freedom: The Story of Nga-Huynh Diep† (by Gracia Diep, aged 15), it tell us how the Vietnamese were treated. It says that the communist parties were to come and strip away everything that was precious in Vietnam from its people. The Vietnamese were forced to live without any freedom either under the tough supervision of the communist party or in a re-education camp. It also says that the only happiness these people have was hope of escaping the country to have another chance at freedom in another land. In this story Nga-Huynh’s family risked their lives to escape Vietnam and she was only twenty-one years of age. They went through an emotional and a painful journey. The only way to travel to Australia was by boat and they had to follow the smugglers. The smugglers not only let her family travel by boat but also other families as well. So it was risky. The boat may sink and they will run out of food. Nga-Huynh sacrificed a lot for a chance at freedom and has come out maintaining her strong character. It says that the experiences of her escape from Vietnam haven’t weakened her they have made her into an even stronger person. Anyways she is now happily married, working woman with two daughters. She also lives in Melbourne and has found life in Australia very pleasant and would even call it her â€Å"home. † However she would like to go back to Vietnam and see what has happened to the country since she left it in 1979.

Ethical Analysis of Eight Mile Road Hearsay Accident Essay

Ethical Analysis of Eight Mile Road Hearsay Accident - Essay Example As a result, an engineer is under pressure to explain the causes and consequences of such actions. The incident has raised major concerns within the ECCS Analysis. The primary reason for this concern is the termination of High Pressure Injection, a situation that places the power plant in major trouble (Barbour 12). Facts A pressure valve opened so that it can relieve steam hence decrease pressure due to a minor over-pressurization passing. As a result, the pressure valve failed to close. When the plant operator noticed this inaccuracy, he terminated high pressure injection. It is worth noting that this was a faulty move from the operator because the system was on a two-phase state. High pressure injection is only applicable when the primary system stood in a sub cooled state. Within 20 to 30 minutes after high pressure injection was terminated, the pressurizer level collapsed showing that this was a wrong move. As a result, the operator was forced to reintroduce injection. Significa nt fluid inventory was lost in the 30 minutes that injection was terminated. The engineer reported back to superiors with the facts as required. However, the superiors did not take the nuclear engineer seriously. Instead, they dismissed this as hearsay. It is worth noting that nuclear engineering is governed by a strict code of conduct. ... The engineer ought to make sure that the power plant operations are smooth flowing. This is because the emotions from a nuclear power plant are harmful to the people around and environment as a whole. Residents of Toledo are also major stakeholders. This is because they are the key focus of my decision. The value of life is important to any ethical organization. Moreover, the operator had to know what to do in case of incidences. However, in this case, he took a wrong decision more than once. This risked the lives of all persons in and around the power plant. Moreover, the ethics of the top management are also at stake here because they failed to take action just because they believed that it was from an incredible source (Shrader-Frechette 84). Regulations and Laws Any nuclear power plant is complex. As a result, it ought to be well-designed and engineered to reduce incidences. It is worth noting that it cannot be deemed to be a failure proof. This is clearly seen in the Eight Mile Road nuclear power plant when the pressure valve failed to close. The accident exposed serious shortages in a scheme that was destined to safeguard public well-being and safety. Failure modes ought to be present in any nuclear plant. This is because a commercial nuclear reactor can explode like a bomb. It is worth noting that, in this case, the fail-safe mechanisms were evidently not present. Moreover, the location of nuclear power plants is critical (Maxey 123). This is because emissions from such plants are powerfully harmful to the public health surrounding it. In this case, we are not told where the plant was specifically located. As a result, we hope it was located in a place where its emissions

Questions Essay Example | Topics and Well Written Essays - 500 words - 21

Questions - Essay Example Contingent liability is the company’s potential debts that arise from the past transactions. Company’s can only verify the existence of this liability by the occurrence of the expected event that the business cannot control. This liability should not be incorporated in the balance sheet. An example of this liability includes the product warranty. If a company promises to replace good with defects without charging the customers, the amount of the returned goods will be contingent liability. It is vital for businesses to distinguish the liabilities. This is because it will make it simple for investors and creditors to evaluate the risks the liabilities caused in the business in the future (Porter & Norton, 2011). The Time Value of Money is the sum of interest a certain amount of money earns within a definite time. According to the concept of time value of money, a certain amount of money one has today has more value than the same amount one expects to get in the future. This is because one can invest the money he has today and earn interests (Peavler, 2012). It is vital for accountants to comprehend the current and the future value concept. This is because it enables them to know the precise worth of the current business money. Furthermore, the concept enables accountants to know the value of the money the business is expecting (Lieuallen, 2008). The concept also enables them to differentiate between the values of savings opportunities that offer returns at varied durations. The accountants should also understand the concepts to advice the business on the amount of money the business should invest by calculating the values of the investments (Storer &Usinger, 2008). The present and future value concepts are applicable to business decisions in various ways. For instance, it is applicable in the business decision regarding the amount of the money the business should put in the

Campus (college and university) speech codes and the First Amendment Research Paper

Campus (college and university) speech codes and the First Amendment (topic and - Research Paper Example Because of the growing number of students using online communication and incidents involving students having been disciplined through the use of code of conduct in colleges and universities, it is important that there be an analysis made on the said issue. This paper will focus on public colleges and universities and cite some incidents wherein these institutions have disciplined their students based on a cyberspeech made. A presentation of case laws will then be made as to how the US Supreme Court, federal courts and district courts have ruled on First Amendment challenges on penalizing speeches on the basis of the codes of conduct. An analysis will then be made as to the impact of these rulings and finally will attempt to conclude that there has been minimal guidance on how federal courts have addressed this specific issue (Beckstrom, 2008, p.261). Conduct codes for students are ground rules or guidelines promoted in various institutions â€Å"in an effort to maintain a safe, yet productive, campus environment† (Berenson, 2005, p. 803). The purpose of these conduct codes generally are the following: â€Å"(1) to guide student behavior and (2) to establish procedural mechanisms that safeguard the rights of the students accused of conduct that violates a campus code† (Bach, 2003, p.1). Since public colleges and universities are considered as state entities, they are obliged to follow the US Constitution by providing procedural due process and other rights to its students, (Goss v. Lopez, 419 U.S. 565 (1975), including the right to free speech provided in the First Amendment of the US Constitution (Beckstrom, 2008, p. 261). However, there have been moves to â€Å"revisit student conduct codes† for the purpose of examining â€Å"whether off-campus conduct by students should be disciplined by the university† (DeJong & Vehige, 2008). This was to address the increasing â€Å"amount of purposeless

Marketing. Definition of strategies Essay Example | Topics and Well Written Essays - 1000 words

Marketing. Definition of strategies - Essay Example Markets: The markets for BAT have expanded many times over. Though a section of the smoking population may have shifted over to cheaper variants or quit, due to overbearing tarrifs and taxed, newer clients have lined up in greater numbers. The organisation has also benefitted by taking a Glocal approach - where the global strategies have been implemented through skillful local initiatives. Political factors: These refer to the different policies of the government such as the degree of intervention, the political stability and the trade relations enjoyed by the economy. Political decisions can impact on many vital areas for business such as the education of the workforce, the health of the nation and the quality of the infrastructure of the economy such as the road and rail system. The political system in a nation also decides the face of the business in that economy. The political factors surrounding BAT are influential. The immense pressures being put on the restrictions of the sale of tobacco products as against the pro-tobacco lobbying presents a high stake game. International trade regulations have also meant that BAT products are available all across the globe and hence have a growing clientele to access. Social fSocial factors: Changes in social trends can impact on the demand for a firm's products and the availability and willingness of individuals to work and it can cause products and services to go out of fashion. Advertisement, surrogate at times, are being used to divert the youth towards cigarettes and other BAT products. This is also being aided by an 'ape the west' attitude being adopted by the Asian nations. Legal factors: These are related to the legal environment in which firms operate. Different categories of law include: consumer laws; these are designed to protect customers against unfair practices such as misleading descriptions of the product competition laws; these are aimed at protecting small firms against bullying by larger firms and ensuring customers are not exploited by firms with monopoly power employment laws; these cover areas such as redundancy, dismissal, working hours and minimum wages. They aim to protect employees against the abuse of power by managers health and safety legislation; these laws are aimed at ensuring the workplace is as safe as is reasonably practical. They cover issues such as training, reporting accidents and the appropriate provision of safety equipment It is here that BAT is facing the maximum resistance. Though the intensities are different, almost all the nations that the tobacco major operates in has anti smoking legalities involved. Huge investments have been made by consumer groups and pressures being created so asto engage the corporation into

Freud's Psychoanalytic Theory and Existential Psychology Essay

Freud's Psychoanalytic Theory and Existential Psychology - Essay Example Freud thinks that the human mind is made up of three components—the id, the ego, and the superego. Through his actual experience with mentally ill individuals, Freud realized that unconscious needs and childhood experiences determine behavioral patterns. From these observations, Freud created a theory that portrayed development in the form of psychosexual stages. Freud’s theory explains that as children grow or mature, they move through psychosexual stages. At every stage, the pleasure-oriented drive of the libido is concentrated on a specific body part. The effective completion of every stage results in a stable, strong personality later in life. But if a conflict stays unsettled at any specific stage, the person may stay absorbed or trapped at that specific developmental stage (Mitchell & Black 49). An obsession may arise. For instance, an individual with an ‘oral obsession’ is thought to be trapped at the oral developmental stage. Indications of an oral obsession may involve too much dependence on oral activities like eating or smoking (Cavell 214). Freud believes that conflicts in every stage can have a permanent impact on behavior and personality (Guntrip 33). ... Freud’s psychoanalytic theory had a massive influence on twentieth-century knowledge, influencing the field of psychology and mental health. Although a large number of his ideas are criticized or treated with skepticism nowadays, his impact on or contribution to psychology is unquestionable. Psychoanalytic theory was very influential at the time and until now. Those influenced by the ideas of Freud tried to expand his theory and create their own. The theories of Erik Erikson, who is considered a neo-Freudian, have been possibly the most widely recognized. Erikson’s psychosocial development stages explain change and progress all over the lifespan, placing emphasis on conflicts and social relations that emerge during each stage of development (Guntrip 29). One of the Freudian psychoanalytic concepts that was very influential was the structure of personality—the id, the ego, and the superego. According to Freud’s psychoanalytic theory, the mind is composed of two major components—the unconscious and conscious. The unconscious part involves all those external to an individual’s awareness, such as memories, impulses, desires, and aspirations that reside outside the awareness but keep on affecting behavior. On the contrary, the conscious part involves those things that an individual is aware of (Mitchell & Black 48). Freud thinks that the mind is like an iceberg. The visible part of the iceberg, which is the tip, comprises only a small fraction of the mind, while the massive portion of submerged ice embodies the much bigger unconscious part. Besides these two key portions of the mind, Freud classifies human personality into three key parts—the id, the ego, and the superego. The id is the basic component of personality that

Public Opinion Essay Example | Topics and Well Written Essays - 500 words

Public Opinion - Essay Example These associations also seek to influence public opinion as a way to achieve their ends. In democracies like the US where operations of the government are dependent on the people’s consent in an election, leaders are obligated to take public opinion into account. Indeed, major policy change shifts tend to coincide with the occurrence of major public opinion shifts (Lowi et al, 2013). Generally, therefore, both Congress and the Executive respond to the preferences of the public, for example regarding government spending, welfare reform, and foreign policy issues. Still, the government should be responsive to public opinion because it needs the backing of the public for re-election. Essentially, therefore, government actions are consistent with public opinion with a study finding that significant shifts in public opinion tend to be followed by shifts in government policy within a year consistent with popular opinion shifts (Lowi et al, 2013). Still, this does not mean that the government panders to all the preferences of the public. This is caused by inconsistency between commitment of the nominal majority and adherents of minority viewpoints, as well as inconsistency between public opinion and the character of the US system of government (Lowi et al, 2013). Overall, however, government actions do not digress from popular opinion for extended periods due to the electoral process. However, the government is also able to take leeway in its response to public opinion because the latter is not specific, while its measurement is not always accurate. To meet this challenge, public interest groups representing a select population have risen in prominence. These associations attempt to pressure government through various methods, including mobilizing public opinion (Lowi et al, 2013). This involves the use of resources at their disposal to persuade a majority of the public to

Sales and marketing in communication industry Essay

Sales and marketing in communication industry - Essay Example This has resulted from immense marketing by marketers who have worked tirelessly in search for new markets, which has revolutionized African continent hence increasing its mobile usage to a rate of 65% annually that is double the global average. Economists argue that, for a product to reach the market there must be sales people since for them to exist there must be the need to market a product and finally make a sale. Therefore, scholars describe marketing as the activities undertaken to generate leads that plays a major role in bringing in a sale. Where else the act of turning a prospect to a buyer and thereafter a repeat customer can describe selling. The intense cross-border marketing done in some countries in Asian continent reveal, mobile wholesalers in China and India have greatly influenced mobile exporters and importers from other countries through international trade. With the increasing demand for mobile phones, distributors are working tirelessly to meet the rising demand and in the process maintain the will to ensure international and domestic trade continues well. Wholesalers on the other hand are ensuring enough stock in their depots as a sign of rising need for these communication tools (Naresh, 2011:32). At the same time, sales and marketing is essential in ensuring availability of products and concrete information about the market. Moreover, no any movement of commodities could occur if it were not for both overseas and local marketing. Intensive marketing together with sales has helped China gain great deals of profit in handset sales and revenue obtained from such trade. Online marketing through Internet has increased demand raising revenues levied from internet users. International sales and marketing plans, as well as strategies set by mobile phone manufacturers and distributors all over the world, more than half a billion mobile phones were sold worldwide in 2009. In fact, analysts expect the number to double within a period of not more th an five years. Sales relates to marketing in a way that is very simple to understand yet very complicated in explaining. Exporters and importers in UK, France, and Germany expressed great need for faster internet enabled mobile phones. How did they come up with such a radical need? Experts have painted an ideal picture to describe the relationship between sales and marketing. It functions in an extremely miner percentage of potential customers willing and ready to buy a product. It also functions in merely those who would possibly buy at a future date as well as those others who are mildly interested in buying. For those expressing will or wish to buy at a future date, a company must assemble and assign sales representatives to create a friendly and informative follow up where this might be in form of a mail or voice broadcast. In order to reap maximum benefits through marketing and selling, investors must express will to take broad marketing measures. They might take the form of or ganizing inter-business marketing conferences, road shows, and advertising on televisions or over the radio (Naresh, 2011:43). This is evident in countries like Japan where mobile service providers have partnered with banking firms to provide mobile banking services hence this has seen the Japan claim the most vast share of mobile banking and money transfers. For them to realize this, the information technology marketers must have worked hard

Legalize cocaine to art students Essay Example | Topics and Well Written Essays - 1000 words

Legalize cocaine to art students - Essay Example Users of cocaine have claimed that cocaine helps them feel more confident, excited, energetic, alert, and creative among others. Even though there are many negative consequences of cocaine especially on users, there are many benefits of cocaine use. Some of the benefits of using cocaine like creativity, self-confidence and being alert help art students to successfully paint very unique and outstanding pictures. Universities should allow art students to use cocaine so as to develop a strange mood to help them paint unique pictures. Primarily, cocaine provides the feeling of being high and relaxed and this is very important when it comes to artwork. Cocaine helps individuals to motivate to be productive. If given cocaine, these students will be able to feel highly relaxed to help them be creative and come up with unique and attractive pictures. Secondly, the use of cocaine enhances individuals’ self-confidence. Everyone needs to be confident in order to be effective and successful in whatever they are doing; therefore, developing self-confidence is very important to enable students create unique pictures. Based on the research findings particularly on the perception of cocaine users, this substance enables individuals to be self-confident, a necessary quality needed in this discipline. For instance, students can only be able to come up with unique and attractive pictures when they are confident in themselves and what they are doing. Thirdly, cocaine plays a significant role in enhancing individuals’ creativity. It makes individuals be open minded, to concentrate more when performing tasks and more creative. Agreeably, artwork is all about creativity. Being creative and coming up with more unique and outstanding pictures is the major concern of artists and this is what make the discipline of art more effective and interesting. In addition, cocaine also helps individuals to

Problems with Nazi Support Essay Example for Free

Problems with Nazi Support Essay Using your own knowledge and the evidence of the sources identify the problems we face when looking to identify Nazi support in the period up to 1933. In the 1932 Reichstag elections, the NSDAP became Germanys largest political party with approximately 37% of the total electoral vote. In contrast to the relatively small party of 1928, this was a dramatic rise in party popularity. What is even more interesting is how Hitler and the NSDAP did not usurp power in a military sense. Instead, Hitler was voted into power by millions of unsuspecting citizens from a range of sociological, economical and ideological backgrounds. However, due to this new consensus among modern historians (post -1980), the stress on the individual as oppose to the class has led to a more complex understanding of who essentially favoured the Nazi party; deeming it even harder to identify empirical evidence from sources. Initially, before 1928, the NSDAP had failed to make a significant impact in German politics and they were merely a group with little popular support. However, due to the collapse of the Wall Street Crash and the subsequent recall of loans back to the USA, unemployment had risen dramatically in Germany and latent discontent with the Weimar government was rife. The socio-economic dislocation caused by the Wall Street Crash began to deepen, which acted as the catalyst for the marked rise in those changing their political allegiance to the more radical political groups. These people included self employed businessmen, artisans, retailers, peasant farmers and industrial workers, who had previously voted for the other parties but had now turned to the Nazi regime who offered what the then current Weimar system could not. Therefore, traditionalist interpretations of the support held by historians such as Childers and Noakes assert that it was a combination of the petty bourgeoisie and Protestants who overwhelmingly represented the support for Nazis. As Childers states in his book entitled The Nazi Voter, being a Protestant in rural Germany greatly increased such a propensity, essentially stating that there was a specific trend of rural Protestants who fuelled the support for Hitler. However, Childer does acknowledge that the Nazi Party was a Volkspartei (Peoples Party) whose levels of support were actually from a broad range of social groups. In addition, Childer argues that when analysing this ambiguity, it is important to contextualise the provenance of the election polls and the specific grievances of those who [chose] the NSDAP to speak for them. For example, it is important to contextualise the extent of support acquired from the middle classes under the 2nd Reich, contrasting with the support fr om the new middle classes after the election. Dick Geary in his book entitled Who Voted for the Nazis? somewhat opposes the view of Childer, who basically argues that the timing of when a specific poll was made is arbitrary because of the lack of reliability in studying percentages. Hence, this is why many believe that modern opinion polls are necessary in the search for definitive evidence on the subject. Geary explains how in a particular county 28% of the artisans voted for Nazis. However, he argues that the difficulty lies in how the people who voted cannot be specified, as he states what if it [the votes] came from the farmers plus people in business, rendering the statistical evidence somewhat invalid. Other difficulties historians face involve the lack of depth to many contemporary foreign journals and accounts, which often neglect the question of who supported the Nazis. In order to gather evidence about why the individuals voted, one survey from Abel documents over 580 Nazi member autobiographies. Although still significant today, one potential problem which is discussed by the historian Brustein is how one cannot accurately surmise whether or not the individual actually believes in his/her sentiments towards voting for the Nazi party. In his book entitled The Logic of Evil, Brustein, from a modern perspective, argues that regardless of the idea of support gathering as a result of a peoples movement, the support was only an inch deep. In addition, Brustein asserts that all who voted fell under the underlying principles of dissatisfaction, resentment and fear; exposing the Nazi support to mere superficiality. This severe lack of genuine support for the Nazis even resounds in the opposition to the Hitler Youth; namely the Navajos, Pirates and the Black gang, who would attack anyone in the Hitler Youth because of their following of the Nazi regime. In the last twenty years, a number of problems have been countered when analysing the statistical methodology and sources of the Nazi era. This has inevitably given birth to the complex views proposed by Falter and Brustein, who posit that German workers were far more attracted to the Nazis than many have argued in the past. However, one fundamental issue that cannot be solved is the difficulty in measuring the honest thoughts of the German public and whether or not the lack of any pre-existing loyalties (political or religious) aided the Nazis significantly. Having said this, there is an overwhelming amount of evidence which still stresses that the Mittelstand and the Protestant communities voted disproportionately in favour of the Nazis more so than any other class.

Thoroughbred Horses Racing

Thoroughbred Horses Racing Thoroughbred Horses and Racing Horses and racing have been around since prehistoric times. Eohippus is the earliest forerunner of our present day horse. Racing can be dated back to nomadic tribesmen of Central Asia. The horse has evolved throughout time from being hunted to being a pet. Racing is still the same as it used to be. Over the centuries racing has evolved into being one of the greatest sports in America, England, and many other countries. From this history of racing some great horses have been identified. Thoroughbred horses were developed in the 18th century England. The English men needed a long distance runner. They imported three Arabian stallions. (Staples) Darley, Godolphin, and Byerly Turk Arabian were bred to English mares. All of our modern thoroughbreds can trace their lines back to there three Arabian Stallions. Samuel Gist brought the first thoroughbred to the American Colonies in 1730. The thoroughbred horse was named Bulle Rock. A thoroughbred was first used in an advertisement in Kentucky. The advertisement describes the New Jersey stallion Pilgarlick. (NA) Thoroughbreds can stand 15-18 hands tall and weigh 900-1200lbs. The colorings are bay, chestnut, brown, grey, roan, and black. The head is clean cut and fined bone. The neck should be longer and lighter than other breeds. Withers should be high and well defined. They have a curved back. The shoulders are deep, well muscled and slope along the parallel that the head is carried. They have long legs and a powerful hindq uarter. They should look like a champion. (Staples) They travel at the speed of 35-40mph. Thoroughbred are used in many thing like show jumping, endurance racing, dressage, and of course racing. Thoroughbred horses start racing when they are at the age of 2. (NA) (Parker) Prehistoric nomadic tribesmen of Central Asia created what we call racing. Ancient Greece is known to be the time and place when the first recorded mounted horse race. During Roman times they were racing in chariots and occasionally on the back of the horse. Horse racing is known to be the sport of kings. It is that because in England owner were wealthiest member in society. (Parker) In 1665 the first racetrack was created in the North America. The track was structured in Long Island. The primary places where they were racing were New York, Pennsylvania, Virginia, Maryland, and the Carolinas. The tracks are 1mile of oval railing with sand inside of it. The middle contains grass. The horses race counterclockwise. Thoroughbred racing has six major types of racing. Stakes, handicap, allowance, claiming, match and walkover. In Stakes racing horses the same age are all assigned to be the same weight. The owner must pay the entry fee. The handicap race is an event among all differ ent type of age groups. Where the horse with the best chance is assigned the highest weight. The horse that is least likely to win gets a lighter weight. In Allowance races horse are judge on their last years performances. Horses with the same ability are matched against each other. A Claiming race is when the owner is trying to sell the horse. The owner puts the horse in the claiming race and people can put a claim down on it. Match racing is a duel between two horses. A Walkover race; it rare is only happens when a horse hasnt been scratched or withdrawn from a race. They have to run the distance of the remaining horse. The last time there was a walkover was at Belmont Park 1980s. There are three famous tracks that hold the Triple Crown. (Encyclopedia) The Kentucky Derby is at Churchill Downs in Louisville, Kentucky it was started in 1875. The Preakness Stake in Pimlico near Baltimore was open in 1873 and the Belmont Stake in Belmont Park at Elmont, New York began in 1867. There h ave only been 11 horses to be Triple Crown winners. (Horse) Between 1919-1920 America racing was dominated by the performance of an American Colt named Man O War. He set records and was defeated only once out of 21 starts. Man O War was bred by premiere sportsmen August Belmont II. Man O War was sold to Samuel Riddle. Man O War was a big chestnut colt. When Man O War was unleashed by Louis Feustel during the World War I sports scene he got to business. Man O Wars first race was at Belmont Park on June 6, 1919. He won by 6 lengths. With in a couple days he stepped to stakes companies and won five others in the Keene Memorial Stakes. When Man O War was 2 he had won nine of the ten races. He was defeated by Whitneys Upset in 1919 in the Sanford Stakes. Man O Wars final race was in Kenilworth Gold Cup by seventh. Man O War never went to the Kentucky Derby. He won 20 of his 21 races and earned the record of $249,465. Man O War died in this 30is back in 1947. The statue was placed at the Kentucky Horse Park. Man O Wars speed, courage, and potency i s still appropriate today. (Duke, 10) One of the 11 Triple Crown Winners was War Admiral. War Admiral was the son of the famous Man O War. He was the only son of Man O War to win the Triple Crown. Samuel Riddle raced War Admiral also. War Admiral at the age 2 only won one stakes out of six races. He finished second in two stakes races at Richard Johnson Handicap. At the Pompoons National Stallion Stakes he took third. At age 3 War Admiral swung in to action. War Admiral won the Horse of the Year in 1937 Riddle decided that the Derby might not be a risk. George Conway entered War Admiral. War Admiral won all three races, which made him the Triple Crown winner. At Belmont track War Admiral had stumbled when the gate opened and put a gash in his foot. He finished first in the race and had blood dripping from his belly. War Admiral didnt race again until the fall. At the age of 4 War Admiral raced Seabiscuit. He lost the race by four lengths. War Admiral only won one race at the age 5. He was retired after an ankle injury. W ar Admiral passed in 1959 at the age of 25. They buried him by Man O War and Brushup at Faraway Farm. (Duke, 58) After losing seventeen races in his career Seabiscuit made a remarkable come back. (Duke, 98) Seabiscuit is consider the Cinderella story of the horse racing industry. (Lovgren) Seabiscuit was also related to Man O War horse. Seabiscuit won only three of his races. Until Red Pollard became his rider. Then the horse had a remarkable change. Seabiscuit became known as the best oldest horse. He won seven consecutive stake races and set four track records. 1938 he won six of eleven starts including the match race with Bing Crosbys Ligaroti. Seabiscuit met War Admiral on November 1, 1938 he won the race by 4 lengths. He also set a track record. Seabiscuit won the champion handicap and the Horse of the year in 1938. In 1939 Seabiscuit only raced once pulling up lame after the gate flew open. When he returned to the track it was for the Santa Anita Handicap race. He won easily. Seabiscuit retired with the winnings of $437,730. (Duke, 98) By the 21st century the first and only horse to win the Triple Crown while still undefeated was Seattle Slew. Castleman bred Seattle Slew. A young man named Billy Turner trained Seattle Slew. Seattle Slew won his championship for juvenile males. After winning the Triple Crown the owner kept racing him. He finally lost at the Hollywood Park, where he placed 4th. In 1977 he was named Horse of the year and also the champion 3 year old. Seattle Slew had the first battle against the 1978 Triple Crown winner Affirmed. He won the race. Ending his racing career at Stuyvesant Handicap, he won. Seattle Slew was elected into Racing Hall of Fame back in 1981. (Duke, 42) Thoroughbreds and racing will continue to evolve throughout time. Horseracing is all over the United States. There will be more great horses like Man O War that never make it to the Kentucky Derby. Then you will have horses that will make and win the Triple Crown with a few losses like War Admiral, or you will have a horse like Seattle Slew that will make it undefeated. Another great comeback horse like Seabiscuit will come along. Thoroughbreds and racing will be around until the end. Work Cited Duke, Jacqueline. Thoroughbred Champions Top 100 Racehorses of the 20th century. Lexington, Kentucky: The Blood-Horse Inc, 1999. Encyclopedia: Lincoln, Abraham. 2004. The History Channel website. 09 May 2006, 19:13 http://www.history.com/encyclopedia.do?articleId=212170 horse racing. Comptons by Britannica. Encyclopedia Britannica. 2005. eLibrary. Proquest CSA. IDAHO COMMISSION FOR LIBRARIES. 07 Feb 2008. http://elibrary.bigchalk.com/libweb/curriculum/do/document?set=searchgroupid=1requestid=lib_standardresultid=1edition=ts=797AEBBF0F6E34B3EF27250E3C430C58_1202404496286start=1urn=urn%3Abigchalk%3AUS%3BBCLib%3Bdocument%3B121713270 Lovgren, Stefan. From Nag to Riches: The story of Seabiscuit. From Nag to Riches: The story of Seabiscuit June 28 2003 February 06 2008 . NA, NA. Thoroughbreds. Breeding of Livestock . 28 Feb 2002. Oklahoma State University. 6 Feb 2008 . Parker, Mike. History of Horse Racing. History of Horse Racing. 1996. Old Fashion Service. 6 Feb 2008 . Staples, Michelle. The Thoroughbred . For real horse power. 2008. Equiworld. 31 Jan 2008 .

Causes of Stillbirth

Causes of Stillbirth Abstract: Feto-infant mortality is increasing worldwide. Stillbirth is defined as uterofetal death at 20 weeks of gestation or greater. Stillbirths contribute as a primary factor to the growing magnitude of feto-infant mortality. The reasons for stillbirth are usually not reported. In many cases, the specific cause of fetal death remains unknown. The key risk factors include smoking, increased maternal age, being overweight, fetal-maternal hemorrhage. Even though there has been remarkable development in prenatal and intranatal care, stillbirths have been consistently increasing and remain an important problem in obstetrics and gynecology. Current research studies focus mainly on the epidemiology of stillbirths. I review the known and suspected causes of stillbirth. It also describes the recommended diagnostic tests to evaluate definite cause of stillbirth. In this paper, I also review analysis of stillbirths in the United States (US). The National Center of Health Statistics recorded 26,359 stillbirths in 2001. The number of stillbirths can be greatly reduced if the specific reasons for stillbirth are understood. Introduction: A pregnancy ending in stillbirth can be mentally devastating to a patient and her family. The most widely accepted definition of stillbirth is death of the fetus inside the uterus at 20 weeks of gestation or greater (Cartlidge et al., 1995). Much information is available on protocols for evaluating other types of postmortem examination but little work has been done on the evaluation of the causes of stillbirths (Mirlene et al., 2004). No universally followed protocol is available to guide the evaluation of stillbirths. In part because a wide variety of causes can be involved in stillbirths and it can be difficult to designate a specific cause of death. A stillbirth might result from various diseases, infections, trauma or genetic defects in the mother or fetus (Gardosi et al., 2005). In many cases, a specific reason is not known. Even though stillbirths are a serious problem, few resources have been focused on them and most obstetricians lack a sound method of evaluating of stillbirths (Petersson, 2002). In this document, I will review the accepted causes of still birth and the suggested diagnostic tests for evaluating the reason behind stillborn infants. In the year 2001 in the US, the National Center of Health Statistics recorded 26,359 stillbirths (Ananth et al., 2005). When compared to 27,568 infant deaths were reported in the same year. More than half of the stillbirths are before 28 weeks of gestation and almost 20% are close to the term. If a history of stillbirth exists then there is a 5-fold increase for subsequent stillbirth to occur. Prominent racial discrimination occurs in the rates of stillbirths. Stillbirths are almost three times more prevalent in African Americans when compared to whites (Puza et al., 2006). In 2001, the rate of stillbirths among white mothers was 5.5 per 1000 live births and 12.1 per 1000 among the black mothers. According to an analysis of U.S. vital statistics between 1995 and 1998, the increased risk of black, compared with white, stillbirths is greatest among singleton stillbirths (Puza et al., 2006). Reduction of proportion of fetal deaths at gestation of 20weeks or longer to 4.1 per 1000 live births and also reduction of fetal deaths for all racial and ethnic groups are the objectives of U.S. National Health for 2010. Categorization of Stillbirths: Different attempts were made in order to classify causes of stillbirth. Baird and his colleagues were among the first to classify the causes of perinatal death from the available clinical information. Depending on the British perinatal mortality survey, in 1958 Butler and Bonham designed a classification scheme that included the results of postmortem examinations. The most widely used is the 9 category classification system formulated by Wigglesworth and his coworkers (Wigglesworth, 1980). A new classification scheme which does not include neonatal deaths was proposed by Gardosi and his colleagues known as the ReCoDe Classification which focuses on the relevant conditions at the time of death in the uterus. It includes factors which affect the fetus followed by the factors which affect the mother (Gardosi et al., 2005). When compared with the Wigglesworth classification, a remarkable decrease in the number of unclassified stillbirth was achieved using this classification. One of the most vital aspects is to develop a proper definition of the factors that lead to death of the fetus. The basic definition for the â€Å"cause of death† is injury or disease responsible for a death. Froendefined cause of death in stillbirth as â€Å"an event or condition of sufficient severity, magnitude, and duration for death to be expected in a majority of such cases in a continued pregnancy in the clinical setting where it was observed† (Froen, 2002). When the definition of â€Å"cause of death† is reviewed, it is observed that only a few disorders are directly responsible for fetal death while many others are not. Causes of Stillbirth: Infection: Infections such as viral, protozoal and bacterial are linked with stillbirth. Almost 10-25% of stillbirths result from feto-maternal infections in the developed countries where as bacterial infections are common in developing countries (Goldenberg et al., 2003). Stillbirths that result from infection might be due to various factors which include direct infection, placental damage, and severe maternal illness. Usually the stillbirths in the initial weeks of gestation are linked with infection. Bacterial infections caused by Escherichia coli, group B streptococci, and Ureaplasma urealyticum are a cause of stillbirth in developed countries (Goldenberg et al., 2003). If syphilis epidemic occurs in an area then it might be the cause of a considerable proportion of stillbirths. If women come in contact with a parasite like malaria for the first time then stillbirth might be attributed to it. Toxoplasma gondii, leptospirosis, Listeria monocytogenes, Q fever, and Lyme disease are associated with the occurrence of stillbirth (Goldenberg et al., 2003). The magnitude of stillbirths due to viral infections is not known mainly due to the absence of a well defined systematic evaluation of infections in stillborn infants. The problem lies behind the fact that these viruses are difficult to culture and moreover, a positive viral serological diagnostic test identifying the DNA or RNA of the virus in the fetal tissue or placental tissue does not definitely determine that infection was the reason behind death. In most of the cases, infection is linked with stillbirth in early gestational weeks around twenty weeks. If molecular diagnostic technology (DNA and RNA polymerase chain reaction [PCR]) is utilized, it will help in diagnosis of viral infections without any error. Parvovirus B-19 appears to have the strongest association with stillbirth. According to a Swedish survey, in 8%of stillbirths B-19 PCR positive tissues were observed (Enders et al., 2004). In the United States, less than 1% of all stillbirths are reported to be due to parvovirus infection Parvovirus B19 moves across the placenta spreading the infection to fetal erythropoetic tissue resulting in fetal anemia leading to fetal death (Wapner et al., 2002). Myocardial damage may also occur due to Parvovirus B19. Here the virus directly attacks the fetal cardiac tissue. Parvovirus infection that leads to stillbirth usually occurs before 20 weeks of gestation (Wapner et al., 2002). Enteroviruses which include Coxsackie A and B, echoviruses and other enteroviruses are associated with stillbirth. Coxsackie viruses can cross the placenta and lead to villous necrosis, inflammatory cell infiltration, calcific pancarditis, and hydrops. Echovirus infection begins with severe maternal illness and finally ends with stillbirth. Cytomegalovirus (CMV) belongs to herpesvirus family and it is a congenital viral infection. Initially, the mother is infected and then it is transmitted to the fetus. CMV causes placental damage leading to intrauterine fetal growth restriction, but an association with stillbirth remains controversial (Goldenberg et al., 2003). Viral infections in the mother like rubella, mumps and measles are linked with stillbirth. If the vaccinations are administered on time then the proportion of stillbirths occurring due to infections can be reduced greatly. Genetics: Genetic causes are responsible for a considerable magnitude of stillbirths. 6- 12% of stillbirths attributed to genetic etiologies are due to karyotyping abnormalities. Due to the fact that in some of the cases cells cannot be cultured, karyotyping is not possible. Such factors alter the exact estimate of stillbirths resulting from chromosomal abnormalities. In stillborn fetuses which show apparent structural defects the probability of chromosomal abnormality is much higher when compared to normal stillborn fetuses. The usually focused abnormalities include monosomy X (23%), trisomy 21 (23%), trisomy 18 (21%), and trisomy 13 (8%). There are many instances where the karyotype of the stillborn is normal yet the cause of death is a genetic abnormality. Indeed, 25-35% of stillborn infants undergoing autopsy have intrinsic abnormalities (Wapner et al., 2002) .These include single malformations (40%), multiple malformations (40%), and deformations or dysplasia (20%) (Wapner et al., 2002). Almost 25% ofstillborns due to intrinsic defects show an abnormal karyotype whereas the rest of the 75% may have genetic defects which are not identifiable by the regular cytogenetic tests. This holds good for fetuses with multiple abnormalities. Single gene mutations may be responsible for death of the fetus in early weeks of development. Stillbirths in the midgestational weeks might be due to abnormal placental growth, development, or angiogenesis. Some autosomal recessive disorders including glycogen storage diseases and hemoglobinopathies have been reported as the cause of stillbirth (Wapner et al., 2002). In male fetuses, X-linked disorders may prove to be fatal. Many other genetic defects that are not recognized by the conventional cytogenetic diagnostics may lead to stillbirth. For example, conventional karyotype cannot identify chromosomal microdeletions that are linked with unexplained mental retardation. Confined placental mosaicism has also been associated with fetal growth impairment and stillbirth (Kalousek et al., 1994). Heritable Thrombophilia is another probable etiology of stillbirth.It is thought that placental infarction occurs due to thrombosis in the uteroplacental circulation leading to death. This poses concern over other thrombophilic defects and their effects on stillbirth. It is noteworthy that many heritable thrombophilias are common in normal individuals without a history of thrombosis or pregnancy loss (Rey et al., 2003). Even though many studies relate thrombophilias to fetal loss, most of the women with thrombophilias have healthy pregnancies with no lethal complications. It can be said that in the absence of any previous obstetric problems, thrombophilia will not result in stillbirth. Feto-maternal Hemorrhage: Feto-maternal hemorrhage has been linked to almost 3- 14% of all stillbirths which implies that it is responsible for a considerable number of stillbirths. Obstetric procedures such as external cephalic version and cesarean section lead to fetal maternal hemorrhage. Hemorrhage can also result due to placental abruption and/or abdominal trauma during pregnancy. Fetal maternal hemorrhage must be identified and quantitated using a proper dependable diagnostic test to attribute this reason behind the death of fetus. Hypoxia and anemia are indicators of death due to fetal hemorrhage. So, they should be confirmed by autopsy as in some normal cases too, few fetal cells can be seen in maternal blood. Maternal Features: Delayed child bearing or increased maternal age, prepregnancy obesity and stress are found to have their effects on the occurrence of stillbirth. The underlying mechanisms of action are unknown; however, with both obesity and delayed child-bearing on the rise, their importance as potential causes of stillbirth deserves greater attention (Cnattingius et al., 2002). Women whose only risk factor is being overweight have about a 2-fold increased risk of stillbirth (Nohr et al., 2005). Likewise, compared with women younger than 35 years of age, the stillbirth rate is increased 2- fold for women 35-39 years of age, and 3- to 4-fold for women aged 40 years old or olderwhereas some age-associated risk is due to higher rates of maternal complications, in uncomplicated pregnancies there may be a 50% increased risk associated only with maternal age 35 years or older (Nohr et al., 2005). Stress is a suspected cause of stillbirth which might occur as a result of a major life event (such as loss or poverty) (Huang et al., 2000) or through unexplained health changes related to adverse childhood experiences (Hillis et al., 2004). Different exposures are attributed to stillbirth. One of the most prevalent and preventable cause of stillbirth is cigarette smoking (Hillis et al., 2004). Smoking negatively affects fetal growth and oxygen supply to the tissues as it produces high levels of carboxyhemoglobin and decreases blood supply to the placenta. Smoking is also associated with increased risks of placenta previa and placental abruption and women who stop smoking in the first trimester have stillbirth rates equivalent to women who never smoked which indicates that quitting smoking in early pregnancy may significantly reduce the chances of occurrence of stillbirth (Hillis et al., 2004). A variety of complications result due to continuous exposure of different recreational drugs. Consumption of cocaine during pregnancy is also linked with stillbirth because it causes fetal growth restriction and/or abruption. The use of meth amphetamines leads to premature deliveries and stunted growth but its association with stillbirth remains unknown. In some cases, alcohol consumption during pregnancy has been associated with an increased risk of stillbirth (Mary et al., 2006). According to a study in Scandinavia, for women who consume less than 1 drink per week, the rate of stillbirth is 1.37 per 1000 births while the rate increases to 8.83 per 1000 births in women who consume 5 drinks or more per week. If smoking habits, caffeine intake, prepregnancy body mass index, marital status, occupational status, education, parity, and fetal gender are considered, the risk of stillbirth for women consuming 5 drinks or more per week was 2.96 (95% confidence interval 1.37 to 6.41) (Mary et al., 2006). Some studies show a protective effect on both stillbirth and fetal growth restriction rates if small amounts of alcohol are consumed during pregnancy (Mary et al., 2006). A link between pesticide exposure and stillbirth was observed by Pastore and his colleagues in 1997. Occupational exposures prove to be deleterious compared to residential exposure because the occupational exposures cause congenital abnormalities in addition to risk of stillbirth. A noteworthy fact is that the use of fertility drugs is also associated with stillbirths. This finding is problematic due to the fact that many women make use of fertility treatments to conceive. However, data on stillbirths due to exposures is obtained from retrospective studies which are prone to bias. The link between exposures and stillbirth should therefore be dealt with great attention and care. Maternal Diseases: Diabetes: There is always an increased danger of stillbirths in second and third trimester for mothers who are affected with type I or type II diabetes mellitus (DM) pregestationally. Even with modern obstetric care and diabetes management, stillbirth rates in women with type 2 DM have been reported to be 2.5-fold higher than nondiabetic women (Mary et al., 2006). The rate of stillbirth is the same between women with gestational diabetes (GDM) as well as normal women when the whole population is taken into account. The magnitude of danger involved with fetal death in women with type II DM is identical to women with GDM who in fact entered the pregnancy with undiagnosed type II DM. Therefore, women with GDM who have an undiagnosed type II DM are usually at a greater danger of encountering stillbirth. Examples of women with undiagnosed type II DM include history of GDM in previous pregnancies, high fasting glucose values;random glucose values greater than 200mg/dL or diagnosis of GDM early in pregnancy. The reason behind fetal death in late gestation in diabetic women is not known precisely. In addition to an increased risk of fetal death in diabetic women, there also exists a higher magnitude of danger associated with fetal abnormalities in these women compared to healthy women. Stress, hypertension and obesity complement each other in DM patients. In women with DM, there is a higher risk of stillbirth as it may lead to fetal abnormalities which may be either abnormally increased growth rate or retarded growth. To maintain the physiological range of the plasma glucose level, tremendous amounts of insulin is produced by the fetus resulting in fetal hyperglycemia. This fetal hyperglycemia is acquired from maternal hyperglycemia which finally results in fetal death due to excessive growth. The precise limit of plasma glucose level which poses a threat to the fetal life is not well defined. The most that could be done is to detect and deal with it using needed medications to lower the incidents of stillbirths.Many other maternal diseases have been linked to stillbirth, including thyroid disease, cardiovascular disease, asthma, kidney disease, and systemic lupus erythematosus (Simpson, 2002). These are subclinical diseases which in many cases has not been proven to be direct causes of stillbirth and women had normal pregnancies giving birth to healthy babies. Multiple Gestation and Stillbirth: Nearly 3% of all births and 10% of all stillbirths result from multiple pregnancies. According to national vital statistics, 1.8% of twin, 2.4% of triplet, 3.7% of quadruplet, and 5.6% of quintuplet fetuses suffered intrauterine fetal deaths (Salihu et al., 2003). The stillbirth rate among singleton pregnancies is approximately 0.5%. The reason behind fetal death in multiple pregnancies is difficult to be resolved when compared to singleton pregnancies. The broad causes of fetal death in multiple pregnancies include fetal growth retardation, preclamsia, abruption and cord accidents. It is vital to determine the chorionicity of multiple gestations as the rate of stillbirth is higher in monochorionic multiple gestations (Salihu et al., 2003) (Lynch et al., 2007). Assisted Reproductive Technology (ART) is an essential aspect in the occurrence of multiple pregnancies and stillbirth (Helmerhorst et al., 2004). Complications in Fetus: Fetal Growth Restriction: Some stillbirths result from fetuses which are smaller for a particular gestational age (SGA) compared to normal fetuses. Birth weight and risk of stillbirth are inversely proportional. If one increases, the other decreases. The main fact behind stillbirths in this condition is retardation of fetal growth and not the small size of fetus. An obstacle that occurs in determining the precise time of death of fetus due to SGA is the fact that the death might have occurred a long time before but the gestational age at the time of delivery is considered to be the time of death. This gives a false implication of the magnitude of stillbirths resulting from SGA. This problem can be solved by analysis of early and mid pregnancy placental hormones which are very specific for gestational periods (Smith et al., 2004). An evaluation of the amounts of these hormones relates directly to the time of death. Umbilical Cord Accidents: An increased number of stillbirths are due to â€Å"accidents† of umbilical cord like cord occlusion or blockage due to true knots, nuchal cords and compression of the cord. In almost 30% of normal healthy infant deliveries, nuchal cord and true knots in umbilical cords are observed. According to a study in Sweden, 9% of stillbirths were due to cord accidents (Petersson, 2002). Determination of cord accidents leading to fetal death by autopsy is smaller in proportion (up to 2.5%) (Horn et al., 2004). This difference indicates that in the absence of a proper cause, many times fetal death is attributed to cord entanglement. Due to the increased load of complications with live infants, little concern is expressed towards dead fetuses. In order to precisely relate a fetal death to cord accident, a clear indication of either hypoxic tissue injury or cord occlusion must be observed in autopsy. As nuchal cords are observed in normal deliveries also, the exact proportion of stillbirths due to cord accidents is biased. Obstetric Complications: Some of the obstetric complications are preclampsia, preterm premature rupture of membranes, preterm labor, cervical insufficiency, abruption, placenta previa, and vasa previa. These may either be direct or primary causes or may be indirect or secondary causes of stillbirth. Almost 10-19% of stillbirths occur due to abruption. Since cervical insufficiency or preterm labor lead to neonatal death, their role in causing stillbirth is not well defined. Evaluation of Stillbirth Stillbirth in itself may be emotionally devastating to many patients and their families. There the likelihood of carrying out genetic testing or autopsy on the fetus may not be readily agreeable from the family and culture. Lastly the procedures for evaluation must be cost effective and within reach. The two important facts that should be kept in mind while deciding which tests would prove as the most useful ones are primarily the consideration of cost of that test. It should not be beyond limits. Secondarily, if this test would be helpful in prevention of recurrent or sporadic stillbirths. In recurrent stillbirths, medical interference may prove helpful by preventing them in future. Analyzing the etiology of sporadic stillbirths might lead to reassurance and avoid irrelevant diagnostic tests in future pregnancies. The single most useful diagnostic test is a fetal autopsy (Peterson et al., 1999). Not only does the visible genetic and structural abnormalities but also an autopsy would be of great help in relating specific etiologies to stillbirth. The frequency of fetal autopsy is very less due to the fact that it is costly, not many trained pathologists are available and also it may be of great discomfort to the family and clinicians to deal with such a case. If autopsy is refused, partial autopsy or postmortem magnetic resonance imaging (MRI) scans may provide the necessary data. Embryonic membranes, placenta and umbilical cord must be physically and histologically examined while evaluating stillbirth etiology. This would give a precise cause of fetal death and might also provide clues for death due to secondary causes like infections, thrombophilia, and anemia. In most cases, families do not object on placental evaluation. In the cases where autopsy is not performed karyotyping the fetus would prove helpful. Cells and tissues from placenta (especially chorionic plate), fascia lata, skin from the nape of the neck, and tendons can be isolated and cultured and used for diagnostic tests like karyotyping. Comparative genomic hybridization shows tremendous promise for the identification of chromosomal abnormalities in stillbirths wherein fetal cells cannot be successfully cultured (Silver et al., 2006). An autopsy followed by a careful histological examination might help in relating stillbirths that result due to infections from the bacteria or virus. Parvovirus serology may be useful because this virus has been implicated in a meaningful proportion of cases (Erik et al., 2002). Diagnostic tests are performed for the detection of syphilis also since it contributes to the list of accepted causes of stillbirth. For various viral and protozoal agents like toxoplasmosis, rubella, cytomegalovirus (CMV) and herpes simplex virus (HSV) {TORCH}, serological screening is carried out. For bacterial and viral infections in the fetus, nucleic acid based tests are more helpful when compared to tissue cultures. Feto-maternal hemorrhage can be detected using Kleihauer – Betke test (KBT). Most laboratories use manual KBT which is prone to error. It has been found that flow cytometry is a better tool in detecting fetal erythrocytes in maternal blood. In order to eliminate red cell alloimmunization as an etiology of stillbirth, an indirect Coomb’s test is performed. Autopsy and examination of placenta are helpful in this situation. During the initial prenatal visits, if the antibody screen comes out to be negative then there is a need for recurrent testing. Diagnostic tests for conditions like diabetes and heritable thrombophilias must be carried out on a regular basis to prevent any complications which may lead to stillbirth. The treatment of such conditions at the appropriate time may prevent similar complications in subsequent pregnancies. Heritable thrombophilia might be of concern in the cases where there is recurrent fetal loss or there is a history of thrombosis or with complications involving placental insufficiency like placental infarction and intrauterine growth restriction. Administration of illicit drugs through various modes may be a cause of stillbirth in many cases. Toxicological examination may reveal the results for women who are subjected to such exposures. A simple urinary examination may prove helpful. The advanced and cost effective technology like ELISA (Enzyme Linked Immuno Sorbent Assay) can be used to detect a variety of metabolites like steroids in various tissues like blood, hair, and homogenized umbilical cord. Conclusion: Many medical and nonmedical agents govern the best approach to evaluate a stillbirth. The obstacles faced by obstetricians in solving these issues include the fact that in most of the cases the reason behind fetal death is unknown. Also the magnitude of stillbirths resulting from a single cause is not known precisely. Here there arises a need for population based studies to attribute stillbirths to their specific etiologies. There is a clear cut need of experts in the field of perinatal pathology and the required funding should be provided at the national level to promote it. Moreover, the clinician should be aware of the history of pregnant women in better evaluation. In cases where the local clinicians cannot reach a conclusion, the tissue samples must be sent to senior pathologists who have a thorough command on the subject and can help in reaching decisive conclusions. A universally accepted protocol is required for a systematic evaluation of stillbirths. Due to its absence a difference of opinion occurs among the obstetricians and gynecologists. The institutions like Stillbirth Collaborative Research Network should formulate guidelines for the proper judgement of stillbirth etiologies. The responsibility lies in the hands of the clinicians to do the best they can to reach a definite conclusion from the available data. It is noteworthy that the proportion of stillbirths that are â€Å"explained† is much higher in centers using systematic evaluations for recognized causes and potential causes of stillbirth (Petersson, 2002) (Horn et al., 2004). In conclusion, autopsy, placental evaluation, karyotype, Kleihauer-Betke, antibody screen, and serologic test for syphilis are useful in evaluating the etiologies of stillbirth. Depending on the case, other relative tests should be performed. The approach towards the testing of potential causes of stillbirth is not clear if it should be very specific and sequential or should it be comprehensive which means that it is targeted towards a broad spectrum of causes. Each of these has its own advantage. Sequential testing avoids false positive results and is directed to a specific cause and more over, it is cost effective. Comprehensive testing may prove helpful in cases where more than one factor is responsible for stillbirth. The problem with autopsy, placental evaluation, karyotype, screen for fetal-maternal hemorrhage, and toxicology screen is that they are dependant on time, that is, these tests should be performed immediately after the delivery. Autopsy cannot be delayed because death of the fetus already occurred and this would lead to physiological changes in the whole body and decay begins. The necessary evidence for stillbirth is easily available from fresh samples of placenta and also for toxicology screen. As the time since death increases, the physiology of fetus also changes leading to false positive or false negative results. If the time of fetal examination is delayed, fetal hemorrhage may be mistaken for postmortem lividity. Therefore a serious call for action is expected from institutions like Stillbirth Collaborative Research Network (SCRN) which would help in creating the most applicable diagnostic setting for evaluation of stillbirth (Silver et al., 2006). SCRN was developed by the National Institute of Child Health and Human Development to target the range of etiologies of stillbirth in the U.S. The aim of SCRN is to focus on the following objectives. The use of standardized surveillance in a geographic catchment area will show that the stillbirth rates are greater than those reported in the vital statistics catchment. The use of a prospectively implemented, standardized, postmortem, and placental examination protocols will improve diagnosis of fetal or placental conditions that cause or contribute to stillbirth. Maternal biologic and environmental risk factors in combination with genetic predisposition increase the risk for stillbirth. This is a population based study which is carried out in different counties of different states in the U.S. This study would take into account all the stillbirths and live births occurring in rural as well as urban areas in different racial groups. Even though occurrence of stillbirths cannot be stopped completely, yet attempts of such sort can be made atleast to prevent them to a maximum extent. Glossary Abruptio placenta totalis A placental abruption is a serious condition in which the placenta partially or completely separates from the uterus before the baby is born. Achondrogenesis Dwarfism characterized by various bone aplasias and hypoplasias of the extremities and a short trunk with delayed ossification of the lower spine. Alloimmunization Development of antibodies in response to alloantigens; antigens derived from a genetically dissimilar animal of the same species. Angiogenesis The formation of new blood vessels. Anomaly abnormality Autosome a chromosome other than the X and Y sex-determining chromosomes. Camptomelia bending of the limbs that produce a permanent curving or bowing. Cholestasis a condition caused by rapidly developing or long-term interruption in the excretion of bile (a digestive fluid that helps the body process fat). Chondrodysplasia Congenital dwarfism similar to but milder than achondroplasia, not familial and not evident until mid-childhood, in which the skull and facial features remain normal. Chorioamnionitis Inflammation of the fetal membranes. Dystocia Difficult delivery or parturition. Erythema infectiosum mild infectious disease occurring mainly in early childhood, marked by a rosy-red maculopapular rash on the cheeks, often spreading to the tr Causes of Stillbirth Causes of Stillbirth Abstract: Feto-infant mortality is increasing worldwide. Stillbirth is defined as uterofetal death at 20 weeks of gestation or greater. Stillbirths contribute as a primary factor to the growing magnitude of feto-infant mortality. The reasons for stillbirth are usually not reported. In many cases, the specific cause of fetal death remains unknown. The key risk factors include smoking, increased maternal age, being overweight, fetal-maternal hemorrhage. Even though there has been remarkable development in prenatal and intranatal care, stillbirths have been consistently increasing and remain an important problem in obstetrics and gynecology. Current research studies focus mainly on the epidemiology of stillbirths. I review the known and suspected causes of stillbirth. It also describes the recommended diagnostic tests to evaluate definite cause of stillbirth. In this paper, I also review analysis of stillbirths in the United States (US). The National Center of Health Statistics recorded 26,359 stillbirths in 2001. The number of stillbirths can be greatly reduced if the specific reasons for stillbirth are understood. Introduction: A pregnancy ending in stillbirth can be mentally devastating to a patient and her family. The most widely accepted definition of stillbirth is death of the fetus inside the uterus at 20 weeks of gestation or greater (Cartlidge et al., 1995). Much information is available on protocols for evaluating other types of postmortem examination but little work has been done on the evaluation of the causes of stillbirths (Mirlene et al., 2004). No universally followed protocol is available to guide the evaluation of stillbirths. In part because a wide variety of causes can be involved in stillbirths and it can be difficult to designate a specific cause of death. A stillbirth might result from various diseases, infections, trauma or genetic defects in the mother or fetus (Gardosi et al., 2005). In many cases, a specific reason is not known. Even though stillbirths are a serious problem, few resources have been focused on them and most obstetricians lack a sound method of evaluating of stillbirths (Petersson, 2002). In this document, I will review the accepted causes of still birth and the suggested diagnostic tests for evaluating the reason behind stillborn infants. In the year 2001 in the US, the National Center of Health Statistics recorded 26,359 stillbirths (Ananth et al., 2005). When compared to 27,568 infant deaths were reported in the same year. More than half of the stillbirths are before 28 weeks of gestation and almost 20% are close to the term. If a history of stillbirth exists then there is a 5-fold increase for subsequent stillbirth to occur. Prominent racial discrimination occurs in the rates of stillbirths. Stillbirths are almost three times more prevalent in African Americans when compared to whites (Puza et al., 2006). In 2001, the rate of stillbirths among white mothers was 5.5 per 1000 live births and 12.1 per 1000 among the black mothers. According to an analysis of U.S. vital statistics between 1995 and 1998, the increased risk of black, compared with white, stillbirths is greatest among singleton stillbirths (Puza et al., 2006). Reduction of proportion of fetal deaths at gestation of 20weeks or longer to 4.1 per 1000 live births and also reduction of fetal deaths for all racial and ethnic groups are the objectives of U.S. National Health for 2010. Categorization of Stillbirths: Different attempts were made in order to classify causes of stillbirth. Baird and his colleagues were among the first to classify the causes of perinatal death from the available clinical information. Depending on the British perinatal mortality survey, in 1958 Butler and Bonham designed a classification scheme that included the results of postmortem examinations. The most widely used is the 9 category classification system formulated by Wigglesworth and his coworkers (Wigglesworth, 1980). A new classification scheme which does not include neonatal deaths was proposed by Gardosi and his colleagues known as the ReCoDe Classification which focuses on the relevant conditions at the time of death in the uterus. It includes factors which affect the fetus followed by the factors which affect the mother (Gardosi et al., 2005). When compared with the Wigglesworth classification, a remarkable decrease in the number of unclassified stillbirth was achieved using this classification. One of the most vital aspects is to develop a proper definition of the factors that lead to death of the fetus. The basic definition for the â€Å"cause of death† is injury or disease responsible for a death. Froendefined cause of death in stillbirth as â€Å"an event or condition of sufficient severity, magnitude, and duration for death to be expected in a majority of such cases in a continued pregnancy in the clinical setting where it was observed† (Froen, 2002). When the definition of â€Å"cause of death† is reviewed, it is observed that only a few disorders are directly responsible for fetal death while many others are not. Causes of Stillbirth: Infection: Infections such as viral, protozoal and bacterial are linked with stillbirth. Almost 10-25% of stillbirths result from feto-maternal infections in the developed countries where as bacterial infections are common in developing countries (Goldenberg et al., 2003). Stillbirths that result from infection might be due to various factors which include direct infection, placental damage, and severe maternal illness. Usually the stillbirths in the initial weeks of gestation are linked with infection. Bacterial infections caused by Escherichia coli, group B streptococci, and Ureaplasma urealyticum are a cause of stillbirth in developed countries (Goldenberg et al., 2003). If syphilis epidemic occurs in an area then it might be the cause of a considerable proportion of stillbirths. If women come in contact with a parasite like malaria for the first time then stillbirth might be attributed to it. Toxoplasma gondii, leptospirosis, Listeria monocytogenes, Q fever, and Lyme disease are associated with the occurrence of stillbirth (Goldenberg et al., 2003). The magnitude of stillbirths due to viral infections is not known mainly due to the absence of a well defined systematic evaluation of infections in stillborn infants. The problem lies behind the fact that these viruses are difficult to culture and moreover, a positive viral serological diagnostic test identifying the DNA or RNA of the virus in the fetal tissue or placental tissue does not definitely determine that infection was the reason behind death. In most of the cases, infection is linked with stillbirth in early gestational weeks around twenty weeks. If molecular diagnostic technology (DNA and RNA polymerase chain reaction [PCR]) is utilized, it will help in diagnosis of viral infections without any error. Parvovirus B-19 appears to have the strongest association with stillbirth. According to a Swedish survey, in 8%of stillbirths B-19 PCR positive tissues were observed (Enders et al., 2004). In the United States, less than 1% of all stillbirths are reported to be due to parvovirus infection Parvovirus B19 moves across the placenta spreading the infection to fetal erythropoetic tissue resulting in fetal anemia leading to fetal death (Wapner et al., 2002). Myocardial damage may also occur due to Parvovirus B19. Here the virus directly attacks the fetal cardiac tissue. Parvovirus infection that leads to stillbirth usually occurs before 20 weeks of gestation (Wapner et al., 2002). Enteroviruses which include Coxsackie A and B, echoviruses and other enteroviruses are associated with stillbirth. Coxsackie viruses can cross the placenta and lead to villous necrosis, inflammatory cell infiltration, calcific pancarditis, and hydrops. Echovirus infection begins with severe maternal illness and finally ends with stillbirth. Cytomegalovirus (CMV) belongs to herpesvirus family and it is a congenital viral infection. Initially, the mother is infected and then it is transmitted to the fetus. CMV causes placental damage leading to intrauterine fetal growth restriction, but an association with stillbirth remains controversial (Goldenberg et al., 2003). Viral infections in the mother like rubella, mumps and measles are linked with stillbirth. If the vaccinations are administered on time then the proportion of stillbirths occurring due to infections can be reduced greatly. Genetics: Genetic causes are responsible for a considerable magnitude of stillbirths. 6- 12% of stillbirths attributed to genetic etiologies are due to karyotyping abnormalities. Due to the fact that in some of the cases cells cannot be cultured, karyotyping is not possible. Such factors alter the exact estimate of stillbirths resulting from chromosomal abnormalities. In stillborn fetuses which show apparent structural defects the probability of chromosomal abnormality is much higher when compared to normal stillborn fetuses. The usually focused abnormalities include monosomy X (23%), trisomy 21 (23%), trisomy 18 (21%), and trisomy 13 (8%). There are many instances where the karyotype of the stillborn is normal yet the cause of death is a genetic abnormality. Indeed, 25-35% of stillborn infants undergoing autopsy have intrinsic abnormalities (Wapner et al., 2002) .These include single malformations (40%), multiple malformations (40%), and deformations or dysplasia (20%) (Wapner et al., 2002). Almost 25% ofstillborns due to intrinsic defects show an abnormal karyotype whereas the rest of the 75% may have genetic defects which are not identifiable by the regular cytogenetic tests. This holds good for fetuses with multiple abnormalities. Single gene mutations may be responsible for death of the fetus in early weeks of development. Stillbirths in the midgestational weeks might be due to abnormal placental growth, development, or angiogenesis. Some autosomal recessive disorders including glycogen storage diseases and hemoglobinopathies have been reported as the cause of stillbirth (Wapner et al., 2002). In male fetuses, X-linked disorders may prove to be fatal. Many other genetic defects that are not recognized by the conventional cytogenetic diagnostics may lead to stillbirth. For example, conventional karyotype cannot identify chromosomal microdeletions that are linked with unexplained mental retardation. Confined placental mosaicism has also been associated with fetal growth impairment and stillbirth (Kalousek et al., 1994). Heritable Thrombophilia is another probable etiology of stillbirth.It is thought that placental infarction occurs due to thrombosis in the uteroplacental circulation leading to death. This poses concern over other thrombophilic defects and their effects on stillbirth. It is noteworthy that many heritable thrombophilias are common in normal individuals without a history of thrombosis or pregnancy loss (Rey et al., 2003). Even though many studies relate thrombophilias to fetal loss, most of the women with thrombophilias have healthy pregnancies with no lethal complications. It can be said that in the absence of any previous obstetric problems, thrombophilia will not result in stillbirth. Feto-maternal Hemorrhage: Feto-maternal hemorrhage has been linked to almost 3- 14% of all stillbirths which implies that it is responsible for a considerable number of stillbirths. Obstetric procedures such as external cephalic version and cesarean section lead to fetal maternal hemorrhage. Hemorrhage can also result due to placental abruption and/or abdominal trauma during pregnancy. Fetal maternal hemorrhage must be identified and quantitated using a proper dependable diagnostic test to attribute this reason behind the death of fetus. Hypoxia and anemia are indicators of death due to fetal hemorrhage. So, they should be confirmed by autopsy as in some normal cases too, few fetal cells can be seen in maternal blood. Maternal Features: Delayed child bearing or increased maternal age, prepregnancy obesity and stress are found to have their effects on the occurrence of stillbirth. The underlying mechanisms of action are unknown; however, with both obesity and delayed child-bearing on the rise, their importance as potential causes of stillbirth deserves greater attention (Cnattingius et al., 2002). Women whose only risk factor is being overweight have about a 2-fold increased risk of stillbirth (Nohr et al., 2005). Likewise, compared with women younger than 35 years of age, the stillbirth rate is increased 2- fold for women 35-39 years of age, and 3- to 4-fold for women aged 40 years old or olderwhereas some age-associated risk is due to higher rates of maternal complications, in uncomplicated pregnancies there may be a 50% increased risk associated only with maternal age 35 years or older (Nohr et al., 2005). Stress is a suspected cause of stillbirth which might occur as a result of a major life event (such as loss or poverty) (Huang et al., 2000) or through unexplained health changes related to adverse childhood experiences (Hillis et al., 2004). Different exposures are attributed to stillbirth. One of the most prevalent and preventable cause of stillbirth is cigarette smoking (Hillis et al., 2004). Smoking negatively affects fetal growth and oxygen supply to the tissues as it produces high levels of carboxyhemoglobin and decreases blood supply to the placenta. Smoking is also associated with increased risks of placenta previa and placental abruption and women who stop smoking in the first trimester have stillbirth rates equivalent to women who never smoked which indicates that quitting smoking in early pregnancy may significantly reduce the chances of occurrence of stillbirth (Hillis et al., 2004). A variety of complications result due to continuous exposure of different recreational drugs. Consumption of cocaine during pregnancy is also linked with stillbirth because it causes fetal growth restriction and/or abruption. The use of meth amphetamines leads to premature deliveries and stunted growth but its association with stillbirth remains unknown. In some cases, alcohol consumption during pregnancy has been associated with an increased risk of stillbirth (Mary et al., 2006). According to a study in Scandinavia, for women who consume less than 1 drink per week, the rate of stillbirth is 1.37 per 1000 births while the rate increases to 8.83 per 1000 births in women who consume 5 drinks or more per week. If smoking habits, caffeine intake, prepregnancy body mass index, marital status, occupational status, education, parity, and fetal gender are considered, the risk of stillbirth for women consuming 5 drinks or more per week was 2.96 (95% confidence interval 1.37 to 6.41) (Mary et al., 2006). Some studies show a protective effect on both stillbirth and fetal growth restriction rates if small amounts of alcohol are consumed during pregnancy (Mary et al., 2006). A link between pesticide exposure and stillbirth was observed by Pastore and his colleagues in 1997. Occupational exposures prove to be deleterious compared to residential exposure because the occupational exposures cause congenital abnormalities in addition to risk of stillbirth. A noteworthy fact is that the use of fertility drugs is also associated with stillbirths. This finding is problematic due to the fact that many women make use of fertility treatments to conceive. However, data on stillbirths due to exposures is obtained from retrospective studies which are prone to bias. The link between exposures and stillbirth should therefore be dealt with great attention and care. Maternal Diseases: Diabetes: There is always an increased danger of stillbirths in second and third trimester for mothers who are affected with type I or type II diabetes mellitus (DM) pregestationally. Even with modern obstetric care and diabetes management, stillbirth rates in women with type 2 DM have been reported to be 2.5-fold higher than nondiabetic women (Mary et al., 2006). The rate of stillbirth is the same between women with gestational diabetes (GDM) as well as normal women when the whole population is taken into account. The magnitude of danger involved with fetal death in women with type II DM is identical to women with GDM who in fact entered the pregnancy with undiagnosed type II DM. Therefore, women with GDM who have an undiagnosed type II DM are usually at a greater danger of encountering stillbirth. Examples of women with undiagnosed type II DM include history of GDM in previous pregnancies, high fasting glucose values;random glucose values greater than 200mg/dL or diagnosis of GDM early in pregnancy. The reason behind fetal death in late gestation in diabetic women is not known precisely. In addition to an increased risk of fetal death in diabetic women, there also exists a higher magnitude of danger associated with fetal abnormalities in these women compared to healthy women. Stress, hypertension and obesity complement each other in DM patients. In women with DM, there is a higher risk of stillbirth as it may lead to fetal abnormalities which may be either abnormally increased growth rate or retarded growth. To maintain the physiological range of the plasma glucose level, tremendous amounts of insulin is produced by the fetus resulting in fetal hyperglycemia. This fetal hyperglycemia is acquired from maternal hyperglycemia which finally results in fetal death due to excessive growth. The precise limit of plasma glucose level which poses a threat to the fetal life is not well defined. The most that could be done is to detect and deal with it using needed medications to lower the incidents of stillbirths.Many other maternal diseases have been linked to stillbirth, including thyroid disease, cardiovascular disease, asthma, kidney disease, and systemic lupus erythematosus (Simpson, 2002). These are subclinical diseases which in many cases has not been proven to be direct causes of stillbirth and women had normal pregnancies giving birth to healthy babies. Multiple Gestation and Stillbirth: Nearly 3% of all births and 10% of all stillbirths result from multiple pregnancies. According to national vital statistics, 1.8% of twin, 2.4% of triplet, 3.7% of quadruplet, and 5.6% of quintuplet fetuses suffered intrauterine fetal deaths (Salihu et al., 2003). The stillbirth rate among singleton pregnancies is approximately 0.5%. The reason behind fetal death in multiple pregnancies is difficult to be resolved when compared to singleton pregnancies. The broad causes of fetal death in multiple pregnancies include fetal growth retardation, preclamsia, abruption and cord accidents. It is vital to determine the chorionicity of multiple gestations as the rate of stillbirth is higher in monochorionic multiple gestations (Salihu et al., 2003) (Lynch et al., 2007). Assisted Reproductive Technology (ART) is an essential aspect in the occurrence of multiple pregnancies and stillbirth (Helmerhorst et al., 2004). Complications in Fetus: Fetal Growth Restriction: Some stillbirths result from fetuses which are smaller for a particular gestational age (SGA) compared to normal fetuses. Birth weight and risk of stillbirth are inversely proportional. If one increases, the other decreases. The main fact behind stillbirths in this condition is retardation of fetal growth and not the small size of fetus. An obstacle that occurs in determining the precise time of death of fetus due to SGA is the fact that the death might have occurred a long time before but the gestational age at the time of delivery is considered to be the time of death. This gives a false implication of the magnitude of stillbirths resulting from SGA. This problem can be solved by analysis of early and mid pregnancy placental hormones which are very specific for gestational periods (Smith et al., 2004). An evaluation of the amounts of these hormones relates directly to the time of death. Umbilical Cord Accidents: An increased number of stillbirths are due to â€Å"accidents† of umbilical cord like cord occlusion or blockage due to true knots, nuchal cords and compression of the cord. In almost 30% of normal healthy infant deliveries, nuchal cord and true knots in umbilical cords are observed. According to a study in Sweden, 9% of stillbirths were due to cord accidents (Petersson, 2002). Determination of cord accidents leading to fetal death by autopsy is smaller in proportion (up to 2.5%) (Horn et al., 2004). This difference indicates that in the absence of a proper cause, many times fetal death is attributed to cord entanglement. Due to the increased load of complications with live infants, little concern is expressed towards dead fetuses. In order to precisely relate a fetal death to cord accident, a clear indication of either hypoxic tissue injury or cord occlusion must be observed in autopsy. As nuchal cords are observed in normal deliveries also, the exact proportion of stillbirths due to cord accidents is biased. Obstetric Complications: Some of the obstetric complications are preclampsia, preterm premature rupture of membranes, preterm labor, cervical insufficiency, abruption, placenta previa, and vasa previa. These may either be direct or primary causes or may be indirect or secondary causes of stillbirth. Almost 10-19% of stillbirths occur due to abruption. Since cervical insufficiency or preterm labor lead to neonatal death, their role in causing stillbirth is not well defined. Evaluation of Stillbirth Stillbirth in itself may be emotionally devastating to many patients and their families. There the likelihood of carrying out genetic testing or autopsy on the fetus may not be readily agreeable from the family and culture. Lastly the procedures for evaluation must be cost effective and within reach. The two important facts that should be kept in mind while deciding which tests would prove as the most useful ones are primarily the consideration of cost of that test. It should not be beyond limits. Secondarily, if this test would be helpful in prevention of recurrent or sporadic stillbirths. In recurrent stillbirths, medical interference may prove helpful by preventing them in future. Analyzing the etiology of sporadic stillbirths might lead to reassurance and avoid irrelevant diagnostic tests in future pregnancies. The single most useful diagnostic test is a fetal autopsy (Peterson et al., 1999). Not only does the visible genetic and structural abnormalities but also an autopsy would be of great help in relating specific etiologies to stillbirth. The frequency of fetal autopsy is very less due to the fact that it is costly, not many trained pathologists are available and also it may be of great discomfort to the family and clinicians to deal with such a case. If autopsy is refused, partial autopsy or postmortem magnetic resonance imaging (MRI) scans may provide the necessary data. Embryonic membranes, placenta and umbilical cord must be physically and histologically examined while evaluating stillbirth etiology. This would give a precise cause of fetal death and might also provide clues for death due to secondary causes like infections, thrombophilia, and anemia. In most cases, families do not object on placental evaluation. In the cases where autopsy is not performed karyotyping the fetus would prove helpful. Cells and tissues from placenta (especially chorionic plate), fascia lata, skin from the nape of the neck, and tendons can be isolated and cultured and used for diagnostic tests like karyotyping. Comparative genomic hybridization shows tremendous promise for the identification of chromosomal abnormalities in stillbirths wherein fetal cells cannot be successfully cultured (Silver et al., 2006). An autopsy followed by a careful histological examination might help in relating stillbirths that result due to infections from the bacteria or virus. Parvovirus serology may be useful because this virus has been implicated in a meaningful proportion of cases (Erik et al., 2002). Diagnostic tests are performed for the detection of syphilis also since it contributes to the list of accepted causes of stillbirth. For various viral and protozoal agents like toxoplasmosis, rubella, cytomegalovirus (CMV) and herpes simplex virus (HSV) {TORCH}, serological screening is carried out. For bacterial and viral infections in the fetus, nucleic acid based tests are more helpful when compared to tissue cultures. Feto-maternal hemorrhage can be detected using Kleihauer – Betke test (KBT). Most laboratories use manual KBT which is prone to error. It has been found that flow cytometry is a better tool in detecting fetal erythrocytes in maternal blood. In order to eliminate red cell alloimmunization as an etiology of stillbirth, an indirect Coomb’s test is performed. Autopsy and examination of placenta are helpful in this situation. During the initial prenatal visits, if the antibody screen comes out to be negative then there is a need for recurrent testing. Diagnostic tests for conditions like diabetes and heritable thrombophilias must be carried out on a regular basis to prevent any complications which may lead to stillbirth. The treatment of such conditions at the appropriate time may prevent similar complications in subsequent pregnancies. Heritable thrombophilia might be of concern in the cases where there is recurrent fetal loss or there is a history of thrombosis or with complications involving placental insufficiency like placental infarction and intrauterine growth restriction. Administration of illicit drugs through various modes may be a cause of stillbirth in many cases. Toxicological examination may reveal the results for women who are subjected to such exposures. A simple urinary examination may prove helpful. The advanced and cost effective technology like ELISA (Enzyme Linked Immuno Sorbent Assay) can be used to detect a variety of metabolites like steroids in various tissues like blood, hair, and homogenized umbilical cord. Conclusion: Many medical and nonmedical agents govern the best approach to evaluate a stillbirth. The obstacles faced by obstetricians in solving these issues include the fact that in most of the cases the reason behind fetal death is unknown. Also the magnitude of stillbirths resulting from a single cause is not known precisely. Here there arises a need for population based studies to attribute stillbirths to their specific etiologies. There is a clear cut need of experts in the field of perinatal pathology and the required funding should be provided at the national level to promote it. Moreover, the clinician should be aware of the history of pregnant women in better evaluation. In cases where the local clinicians cannot reach a conclusion, the tissue samples must be sent to senior pathologists who have a thorough command on the subject and can help in reaching decisive conclusions. A universally accepted protocol is required for a systematic evaluation of stillbirths. Due to its absence a difference of opinion occurs among the obstetricians and gynecologists. The institutions like Stillbirth Collaborative Research Network should formulate guidelines for the proper judgement of stillbirth etiologies. The responsibility lies in the hands of the clinicians to do the best they can to reach a definite conclusion from the available data. It is noteworthy that the proportion of stillbirths that are â€Å"explained† is much higher in centers using systematic evaluations for recognized causes and potential causes of stillbirth (Petersson, 2002) (Horn et al., 2004). In conclusion, autopsy, placental evaluation, karyotype, Kleihauer-Betke, antibody screen, and serologic test for syphilis are useful in evaluating the etiologies of stillbirth. Depending on the case, other relative tests should be performed. The approach towards the testing of potential causes of stillbirth is not clear if it should be very specific and sequential or should it be comprehensive which means that it is targeted towards a broad spectrum of causes. Each of these has its own advantage. Sequential testing avoids false positive results and is directed to a specific cause and more over, it is cost effective. Comprehensive testing may prove helpful in cases where more than one factor is responsible for stillbirth. The problem with autopsy, placental evaluation, karyotype, screen for fetal-maternal hemorrhage, and toxicology screen is that they are dependant on time, that is, these tests should be performed immediately after the delivery. Autopsy cannot be delayed because death of the fetus already occurred and this would lead to physiological changes in the whole body and decay begins. The necessary evidence for stillbirth is easily available from fresh samples of placenta and also for toxicology screen. As the time since death increases, the physiology of fetus also changes leading to false positive or false negative results. If the time of fetal examination is delayed, fetal hemorrhage may be mistaken for postmortem lividity. Therefore a serious call for action is expected from institutions like Stillbirth Collaborative Research Network (SCRN) which would help in creating the most applicable diagnostic setting for evaluation of stillbirth (Silver et al., 2006). SCRN was developed by the National Institute of Child Health and Human Development to target the range of etiologies of stillbirth in the U.S. The aim of SCRN is to focus on the following objectives. The use of standardized surveillance in a geographic catchment area will show that the stillbirth rates are greater than those reported in the vital statistics catchment. The use of a prospectively implemented, standardized, postmortem, and placental examination protocols will improve diagnosis of fetal or placental conditions that cause or contribute to stillbirth. Maternal biologic and environmental risk factors in combination with genetic predisposition increase the risk for stillbirth. This is a population based study which is carried out in different counties of different states in the U.S. This study would take into account all the stillbirths and live births occurring in rural as well as urban areas in different racial groups. Even though occurrence of stillbirths cannot be stopped completely, yet attempts of such sort can be made atleast to prevent them to a maximum extent. Glossary Abruptio placenta totalis A placental abruption is a serious condition in which the placenta partially or completely separates from the uterus before the baby is born. Achondrogenesis Dwarfism characterized by various bone aplasias and hypoplasias of the extremities and a short trunk with delayed ossification of the lower spine. Alloimmunization Development of antibodies in response to alloantigens; antigens derived from a genetically dissimilar animal of the same species. Angiogenesis The formation of new blood vessels. Anomaly abnormality Autosome a chromosome other than the X and Y sex-determining chromosomes. Camptomelia bending of the limbs that produce a permanent curving or bowing. Cholestasis a condition caused by rapidly developing or long-term interruption in the excretion of bile (a digestive fluid that helps the body process fat). Chondrodysplasia Congenital dwarfism similar to but milder than achondroplasia, not familial and not evident until mid-childhood, in which the skull and facial features remain normal. Chorioamnionitis Inflammation of the fetal membranes. Dystocia Difficult delivery or parturition. Erythema infectiosum mild infectious disease occurring mainly in early childhood, marked by a rosy-red maculopapular rash on the cheeks, often spreading to the tr