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JAMA Network Open Sep 2023Fetal death during labor at term is a complication that is rarely studied in high-income countries. There is a need for large population-based studies to examine the...
IMPORTANCE
Fetal death during labor at term is a complication that is rarely studied in high-income countries. There is a need for large population-based studies to examine the rate of term intrapartum stillbirth in high-income countries and the factors associated with its occurrence.
OBJECTIVE
To evaluate trends in term intrapartum stillbirth over time and to investigate the association between the trends and term intrapartum stillbirth risk factors from 1999 to 2018 in Norway.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study used data from the Medical Birth Registry of Norway from 1999 to 2018 to examine rates of term intrapartum stillbirth and risk factors associated with this event. A population of 1 021 268 term singleton pregnancies without congenital anomalies or antepartum stillbirths was included in analyses, which were performed from September 2022 to February 2023.
EXPOSURE
The main exposure variable was time, which was divided into four 5-year periods: 1999 to 2003, 2004 to 2008, 2009 to 2013, and 2014 to 2018.
MAIN OUTCOMES AND MEASURES
The primary study outcome was term intrapartum stillbirth. Risk ratios were calculated, and multivariable logistic regression analyses were conducted to identify factors associated with secular trends of term intrapartum stillbirth.
RESULTS
The study population consisted of 1 021 268 term singleton births (maternal mean [SD] age, 29.72 [5.01] years; mean [SD] gestational age, 39.69 [1.27] weeks). During the study period, there were 95 term intrapartum stillbirths (0.09 per 1000 births). Maternal age, the proportion of individuals born in a country other than Norway, and the prevalence of gestational diabetes, labor induction, operative vaginal delivery, and previous cesarean delivery increased over the course of the study period. Conversely, the prevalence of infants large for gestational age, hypertensive disorder in pregnancy, and spontaneous vaginal delivery and the proportion of individuals who smoked decreased. The term intrapartum stillbirth rate decreased by 87% (95% CI, 68%-95%) from 0.15 per 1000 births in 1999 to 2008 to 0.02 per 1000 births in 2014 to 2018. Three in 4 term intrapartum stillbirths (70 of 95) occurred during intrapartum operative deliveries. The increased prevalence of older maternal age and obstetric risk factors were not associated with the variation in intrapartum stillbirth rates among the time periods. The prevalence of term intrapartum stillbirth was higher for individuals who gave birth in maternity units with fewer than 3000 annual births (adjusted odds ratio, 1.67; 95% CI, 1.07-2.61) than for those who gave birth in units with 3000 or more annual births.
CONCLUSIONS AND RELEVANCE
Findings of this study suggest that, despite increases in maternal and obstetric risk factors, term intrapartum stillbirth rates substantially decreased during the study period. Reasons for this decrease may be due to improvements in intrapartum care.
Topics: Pregnancy; Infant; Humans; Female; Adult; Stillbirth; Cohort Studies; Delivery, Obstetric; Diabetes, Gestational; Norway
PubMed: 37755831
DOI: 10.1001/jamanetworkopen.2023.34830 -
BJOG : An International Journal of... Oct 2021To evaluate the recurrence risk of stillbirth.
OBJECTIVES
To evaluate the recurrence risk of stillbirth.
DESIGN
Retrospective cohort study.
SETTING AND POPULATION
All births 1992-2017, Alberta, Canada.
METHODS
Retrospective cohort study.
MAIN OUTCOME MEASURES
Stillbirth was defined as the death in utero of a fetus with gestational age ≥20 weeks or weighing ≥500 g. Stillbirths were further subdivided into those occurring before labour and those in labour.
RESULTS
We identified 744 897 births from 308 478 women. Of these, 3698 women experienced a stillbirth and, of these, 97.7%, experienced only one. For women with a small-for-gestational- age stillbirth in the first birth, their risk of a subsequent antepartum stillbirth was increased substantially: 4.09%, relative risk (RR) 10.39, 95% CI 5.81-18.59. For women with a first birth appropriate-for-gestational-age stillbirth with no risk factors such as pregnancy induced hypertension, the risk with pre-existing diabetes mellitus or hypertension was also increased but to a much lesser degree (RR 2.46, 95% CI 1.23-4.91). For women who had experienced a first birth intrapartum stillbirth, the risk of another intrapartum stillbirth was very high (3.59%, RR 36.50, 95% CI 20.17-66.05). Most of these births also occurred prior to 24 weeks' gestation: 83% (10/12).
CONCLUSIONS
The risk of recurrent antepartum stillbirth is low. The increase in risk in instances where the antepartum stillbirth was not growth-restricted is not clinically meaningful. Given the very low risk in any given gestational week, fetal surveillance is unlikely to be effective and may lead to unnecessary interventions. Intrapartum stillbirth has a very high recurrence risk but may not be preventable.
TWEETABLE ABSTRACT
Stillbirth recurrence is rare.
Topics: Adult; Alberta; Female; Fetal Death; Gestational Age; Humans; Infant, Newborn; Infant, Small for Gestational Age; Pregnancy; Prenatal Care; Recurrence; Retrospective Studies; Risk Assessment; Risk Factors; Stillbirth
PubMed: 33837600
DOI: 10.1111/1471-0528.16718 -
BMC Women's Health Sep 2021Abortion and stillbirths are the common obstetrics condition in Ethiopia and their effect on the next pregnancy was not well identified in resource limited settings. The...
BACKGROUND
Abortion and stillbirths are the common obstetrics condition in Ethiopia and their effect on the next pregnancy was not well identified in resource limited settings. The aim of the study was to assess the effect of stillbirth and abortion on the next pregnancy.
METHODS
A prospective cohort study design was implemented. The study was conducted in Mecha demographic surveillance and field research center catchment areas. The data were collected from January 2015 to March 2019. Epi-info software was used to calculate the sample size. The systematic random sampling technique was used to select stillbirth and abortion women. Poison regression was used to identify the predictors of MCH service utilization; descriptive statistics were used to identify the prevalence of blood borne pathogens. The Kaplan Meier survival curve was used to estimate survival to pregnancy and pregnancy related medical disorders.
RESULTS
1091 stillbirth and 3,026 abortion women were followed. Hepatitis B was present in 6% of abortion and 3.2% of stillbirth women. Hepatitis C was diagnosed in 4.7% of abortion and 0.3% of stillbirth women. HIV was detected in 3% of abortion and 0.8% of stillbirth women. MCH service utilization was determined by knowledge of contraceptives [IRR 1.29, 95% CI 1.18-1.42], tertiary education [IRR 4.29, 95% CI 3.72-4.96], secondary education. [IRR 3.14, 95% CI 2.73-3.61], married women [IRR 2.08, 95% CI 1.84-2.34], family size [IRR 0.67, 95% CI 1.001-1.01], the median time of pregnancy after stillbirth and abortion were 12 months. Ante-partum hemorrhage was observed in 23.1% of pregnant mothers with a past history of abortion cases and post-partum hemorrhage was observed in 25.6% of pregnant mothers with a past history of abortion. PREGNANCY INDUCED DIABETES MELLITUS was observed 14.3% of pregnant mothers with a past history of stillbirth and pregnancy-induced hypertension were observed in 9.2% of mothers with a past history of stillbirth.
CONCLUSION
Obstetric hemorrhage was the common complications of abortion women while Pregnancy-induced diabetic Mellitus and pregnancy-induced hypertension were the most common complications of stillbirth for the next pregnancy.
Topics: Abortion, Induced; Abortion, Spontaneous; Female; Humans; Longitudinal Studies; Pregnancy; Prospective Studies; Stillbirth
PubMed: 34563190
DOI: 10.1186/s12905-021-01485-0 -
American Journal of Obstetrics &... May 2019Stillbirth complicates 1 in 160 pregnancies in the United States. We sought to determine the rate of cesarean delivery in pregnancies complicated by antepartum...
OBJECTIVE
Stillbirth complicates 1 in 160 pregnancies in the United States. We sought to determine the rate of cesarean delivery in pregnancies complicated by antepartum stillbirth and to identify characteristics associated with cesarean delivery.
STUDY DESIGN
This was a population-based retrospective cohort study of all stillbirths in the United States during the year of 2014. Frequency of cesarean delivery was stratified by week of gestation. Maternal, obstetric, and fetal characteristics were compared between women with antepartum stillbirth who underwent cesarean delivery compared with vaginal delivery. Multivariate logistic regression estimated the relative influence of maternal, obstetric, and fetal factors on the outcome of cesarean delivery.
RESULTS
There were 16,160 nonlaboring women diagnosed with stillbirth during 2014 in the United States. Of the 16,160 stillbirths, 2449 (15.2%) underwent cesarean delivery. At 20-23, 24-27, 28-31, 32-36, and >36 weeks of gestation, the cesarean delivery rate was 4.0%, 16.2%, 23.7%, 30.8%, and 28.8%, respectively. Factors associated with cesarean delivery included gestational diabetes, preeclampsia, use of assisted reproductive technology, history of prior cesarean delivery, and increasing gestational age at delivery.
CONCLUSION
Approximately 15% of women diagnosed with a stillbirth after 16 weeks of gestation underwent a cesarean delivery in 2014. The stillbirth cesarean delivery rate peaked during the third trimester, during which more than 1 in 4 women underwent a cesarean birth.
Topics: Adult; Cesarean Section; Cohort Studies; Death Certificates; Delivery, Obstetric; Female; Fetal Death; Gestational Age; Humans; Population Surveillance; Pregnancy; Retrospective Studies; Stillbirth; United States
PubMed: 33345821
DOI: 10.1016/j.ajogmf.2019.03.008 -
Obstetrics and Gynecology Dec 2018Unexpected antepartum fetal demise remains one of the most tragic complications of pregnancy. Various approaches to antepartum fetal assessment have been developed as a...
Unexpected antepartum fetal demise remains one of the most tragic complications of pregnancy. Various approaches to antepartum fetal assessment have been developed as a means of either reassuring the clinician of fetal well-being or identifying potential fetal jeopardy and the need for delivery. As additional high-risk groups of women are identified, indications for antenatal testing continue to expand despite a paucity of good-quality data linking such testing to improved outcomes for women with these additional risk factors. The expansion of established antepartum testing protocols to include women with conditions such as advanced maternal age or obesity without additional, well-established indications for testing is not warranted, particularly because baseline rates of stillbirth seen with these conditions before 39 weeks of gestation are already lower than stillbirth rates achieved with current antepartum testing protocols. Beyond 39 weeks of gestation, if the established risks of stillbirth are deemed unacceptable, delivery is a more rational and evidence-based approach than antepartum testing.
Topics: Female; Fetal Death; Gestational Age; Heart Rate, Fetal; Humans; Maternal Age; Pregnancy; Prenatal Care; Prenatal Diagnosis; Risk Factors; Stillbirth
PubMed: 30399110
DOI: 10.1097/AOG.0000000000002967 -
Clinics in Perinatology Jun 2018There is growing evidence from randomized trials that induction of labor at or near term does not increase cesarean delivery; observational data show that the optimal... (Review)
Review
There is growing evidence from randomized trials that induction of labor at or near term does not increase cesarean delivery; observational data show that the optimal gestation for spontaneous delivery for the baby is 39 weeks. Elective cesarean at these gestations is also sometimes considered, but evaluating the associated risks is complex. For the baby, although cesarean obviates the risks of labor, it carries a risk of respiratory problems, which may be severe. For the mother, cesarean is more dangerous than vaginal and emergency cesarean is more dangerous than elective. The authors consider the evidence base for near-term induction of labor and cesarean for a range of scenarios.
Topics: Cesarean Section; Clinical Decision-Making; Delivery, Obstetric; Elective Surgical Procedures; Female; Gestational Age; Humans; Infant, Newborn; Labor, Induced; Male; Pregnancy; Risk Assessment; Stillbirth; Term Birth; Time Factors
PubMed: 29747883
DOI: 10.1016/j.clp.2018.01.004 -
BJOG : An International Journal of... Oct 2015To determine whether caesarean delivery in the first pregnancy is a risk factor for unexplained antepartum stillbirth in a second pregnancy. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To determine whether caesarean delivery in the first pregnancy is a risk factor for unexplained antepartum stillbirth in a second pregnancy.
DESIGN
A population-based retrospective cohort study and meta-analysis.
SETTING
All maternity units in Scotland.
PARTICIPANTS
A cohort of 128 585 second births, 1999-2008.
METHODS
Time-to-event analysis and random-effects meta-analysis.
MAIN OUTCOME MEASURE
Risk of unexplained antepartum stillbirth in a second pregnancy.
RESULTS
There were 88 stillbirths among 23 688 women with a previous caesarean delivery (2.34 per 10 000 women per week) and 288 stillbirths in 104 897 women who had previously delivered vaginally (1.67 per 10 000 women per week, P = 0.002). When analysed by cause, women with a previous caesarean delivery had an increased risk of unexplained stillbirth (hazard ratio, HR 1.47; 95% confidence interval, 95% CI 1.12-1.94; P = 0.006) and, as previously observed, the excess risk was apparent from 34 weeks of gestation onwards. The risk did not differ in relation to the indication of the caesarean delivery, and was independent of maternal characteristics and previous obstetric complications. We identified three other comparable studies (two in North America and one in Europe), and meta-analysis of these studies showed a statistically significant association between previous caesarean delivery and the risk of antepartum stillbirth in the second pregnancy (pooled HR 1.40; 95% CI 1.10-1.77; P = 0.006).
CONCLUSIONS
Women who have had a previous caesarean delivery are at increased risk of unexplained stillbirth in the second pregnancy.
TWEETABLE ABSTRACT
Caesarean first delivery is associated with an increased risk of unexplained stillbirth in the next pregnancy.
Topics: Adult; Cesarean Section; Cohort Studies; Female; Gestational Age; Gravidity; Humans; Pregnancy; Registries; Retrospective Studies; Risk; Scotland; Stillbirth; Term Birth
PubMed: 26033155
DOI: 10.1111/1471-0528.13461 -
BMC Pregnancy and Childbirth Nov 2022There is a renewed call to address preventable foetal deaths in high-income countries, especially where progress has been slow. The Centers for Disease Control and...
BACKGROUND
There is a renewed call to address preventable foetal deaths in high-income countries, especially where progress has been slow. The Centers for Disease Control and Prevention released publicly, for the first time, the initiating cause and estimated timing of foetal deaths in 2014. The objective of this study is to describe risk and characteristics of antepartum versus intrapartum stillbirths in the U.S., and frequency of pathological examination to determine cause.
METHODS
We conducted a cross-sectional study of singleton births (24-43 weeks) using 2014 U.S. Fetal Death and Natality data available from the National Center for Health Statistics. The primary outcome was timing of death (antepartum (n = 6200), intrapartum (n = 453), and unknown (n = 5403)). Risk factors of interest included maternal sociodemographic, behavioural, medical and obstetric factors, along with foetal sex. We estimated gestational week-specific stillbirth hazard, risk factors for intrapartum versus antepartum stillbirth using multivariable log-binomial regression models, conditional probabilities of intrapartum and antepartum stillbirth at each gestational week, and frequency of pathological examination by timing of death.
RESULTS
The gestational age-specific stillbirth hazard was approximately 2 per 10,000 foetus-weeks among preterm gestations and > 3 per 10,000 foetus-weeks among term gestations. Both antepartum and intrapartum stillbirth risk increased in late-term and post-term gestations. The risk of intrapartum versus antepartum stillbirth was higher among those without a prior live birth, relative to those with at least one prior live birth (RR 1.32; 95% CI 1.08-1.61) and those with gestational hypertension, relative to those with no report of gestational hypertension (RR 1.47; 95% CI 1.09-1.96), and lower among Black, relative to white, individuals (RR 0.70; 95% CI 0.55-0.89). Pathological examination was not performed/planned in 25% of known antepartum stillbirths and 29% of known intrapartum stillbirths.
CONCLUSION
These findings suggest greater stillbirth risk in the late-term and post-term periods. Primiparous mothers had greater risk of intrapartum than antepartum still birth, suggesting the need for intrapartum interventions for primiparous mothers in this phase of pregnancy to prevent some intrapartum foetal deaths. Efforts are needed to improve understanding, prevention and investigation of foetal deaths as well as improve stillbirth data quality and completeness in the United States.
Topics: United States; Female; Pregnancy; Infant, Newborn; Humans; Stillbirth; Cross-Sectional Studies; Hypertension, Pregnancy-Induced; Sex Factors; Parturition
PubMed: 36447143
DOI: 10.1186/s12884-022-05185-x -
PloS One 2021The incidence of stillbirth has decreased marginally or remained stable during the past decades in high income countries. A recent report has shown Stockholm to have a...
INTRODUCTION
The incidence of stillbirth has decreased marginally or remained stable during the past decades in high income countries. A recent report has shown Stockholm to have a lower incidence of stillbirth at term than other parts of Sweden. The risk of antepartum stillbirth increases in late term and postterm pregnancies which is one of the factors contributing to the current discussion regarding the optimal time of induction of labor due to postterm pregnancy.
MATERIAL AND METHODS
This is a cohort study based on the Stockholm Stillbirth Database which contains all cases of stillbirth from 1998-2018 in Stockholm County. All cases were reviewed systematically and the cause of death was evaluated according to the Stockholm Stillbirth Classification. Stillbirths diagnosed between gestational week (GW) 37+0 and 40+6 n = 605 were compared to stillbirths diagnosed from GW 41+0 and onwards n = 157, according to the cause of stillbirth and pregnancy and maternal characteristics. The aim was to evaluate the incidence of stillbirth over time and the incidence of stillbirth diagnosed from GW 41+0.
RESULTS
In Stockholm County the overall incidence of stillbirth has decreased from 4.6/1000 births during the period 1998-2004 to 3.4/1000 births during the period 2014-2018, p-value <0.001. When comparing the same time periods, the incidence of stillbirth diagnosed from GW 41+0 and onwards has decreased from 0.5/1000 births to 0.15/1000 births, p-value <0.001. Among women still pregnant at GW 41+0 the incidence of stillbirth has decreased from 1.8/ 1000 to 0.5/ 1000. When comparing stillbirths diagnosed at GW 37+0-40+6 with stillbirths diagnosed from GW 41+0 and onwards infection was a more common cause of stillbirth in the latter group.
CONCLUSION
In Stockholm County there was a decreasing incidence of stillbirth overall and in stillbirths diagnosed from 41+0 weeks of gestation and onwards during the period 1998-2018. In stillbirths diagnosed from GW 41+0 and onwards infection was a more common cause of death compared to stillbirths diagnosed between GW 37+0 and 40+6.
Topics: Adult; Cause of Death; Cohort Studies; Female; Gestational Age; Humans; Labor, Obstetric; Pregnancy; Pregnancy Complications; Pregnancy, Prolonged; Stillbirth; Sweden; Young Adult
PubMed: 34033674
DOI: 10.1371/journal.pone.0251965 -
The Australian & New Zealand Journal of... Aug 2022There is scant literature about antepartum stillbirth management but guidelines usually recommend reserving caesarean sections for exceptional circumstances. However,...
BACKGROUND
There is scant literature about antepartum stillbirth management but guidelines usually recommend reserving caesarean sections for exceptional circumstances. However, little is known about caesarean section rates following antepartum stillbirth in Australia.
AIMS
We aimed to describe the onset of labour, mode of birth, and use of analgesia and anaesthesia following antepartum stillbirth and to identify factors associated with caesarean section.
MATERIAL AND METHODS
In this retrospective cohort study, we used a population-based dataset of all singleton antepartum stillbirths ≥20 weeks gestation in Western Australia between 2010-2015. The overall, primary and repeat caesarean section rates for antepartum stillbirths were calculated and multivariable Poisson regression analyses were performed to identify associated factors, and to calculate relative risks (RRs) and 95% confidence intervals (CIs).
RESULTS
This study included 634 antepartum stillbirths. Labour was spontaneous for 134 (21.1%), induced for 457 (72.1%), and 43 (6.8%) had a prelabour caesarean section. The overall, primary and repeat caesarean section rates were 8.5%, 4.6% and 23.0% respectively and increased with gestation (P trends all <0.01). Other factors associated with an increased caesarean section risk included: any placenta praevia or placental abruption, birth at a metropolitan private hospital, large-for-gestational-age birthweight, and any maternal chronic condition. During labour, the most frequently used types of analgesia were systemic narcotics (46.0%) and regional blocks (34.7%) while among those who had a caesarean section, 40.7% had a general anaesthetic.
CONCLUSIONS
In Western Australia between 2010-2015, the caesarean section rates among women with antepartum stillbirths were low, in line with current guidelines.
Topics: Cesarean Section; Female; Humans; Placenta; Pregnancy; Retrospective Studies; Stillbirth; Western Australia
PubMed: 35170023
DOI: 10.1111/ajo.13494