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Obstetrics and Gynecology Jun 2021The goal of antepartum fetal surveillance is to reduce the risk of stillbirth. Antepartum fetal surveillance techniques based on assessment of fetal heart rate (FHR)...
The goal of antepartum fetal surveillance is to reduce the risk of stillbirth. Antepartum fetal surveillance techniques based on assessment of fetal heart rate (FHR) patterns have been in clinical use for almost four decades and are used along with real-time ultrasonography and umbilical artery Doppler velocimetry to evaluate fetal well-being. Antepartum fetal surveillance techniques are routinely used to assess the risk of fetal death in pregnancies complicated by preexisting maternal conditions (eg, diabetes mellitus) as well as those in which complications have developed (eg, fetal growth restriction). The purpose of this document is to provide a review of the current indications for and techniques of antepartum fetal surveillance and outline management guidelines for antepartum fetal surveillance that are consistent with the best scientific evidence.
Topics: Blood Flow Velocity; Female; Fetal Death; Fetal Distress; Fetal Movement; Heart Rate, Fetal; Humans; Oligohydramnios; Pregnancy; Pregnancy Complications; Prenatal Diagnosis; Stillbirth; Ultrasonography, Doppler; Ultrasonography, Prenatal; Umbilical Arteries; Uterine Contraction
PubMed: 34011889
DOI: 10.1097/AOG.0000000000004410 -
Clinical Obstetrics and Gynecology Sep 2010Stillbirth affects approximately 1 in 200 pregnancies and is one of the most common serious complications of pregnancy. Stillbirth can occur as a consequence of diverse... (Review)
Review
Stillbirth affects approximately 1 in 200 pregnancies and is one of the most common serious complications of pregnancy. Stillbirth can occur as a consequence of diverse processes, including fetal abnormality, isoimmunization, infection, maternal preeclampsia, placental abruption, maternal medical conditions, complications of labor and delivery, growth restriction, and also often occurs in the absence of an apparent cause or predisposing factor. This review summarizes a number of factors which identify women at increased risk of stillbirth, including maternal characteristics, blood tests, and biophysical tests.
Topics: Biomarkers; Chorionic Gonadotropin; Female; Fetal Death; Fetal Growth Retardation; Gestational Age; Humans; Parity; Placenta; Pregnancy; Pregnancy Complications; Pregnancy-Associated Plasma Protein-A; Risk Factors; Stillbirth; Ultrasonography, Prenatal; alpha-Fetoproteins
PubMed: 20661044
DOI: 10.1097/GRF.0b013e3181eb64a6 -
Current Opinion in Obstetrics &... Dec 2006Rates of stillbirth in the developed world have been static or rising in recent years. Clinical prediction of stillbirth risk may allow interventional studies. (Review)
Review
PURPOSE OF REVIEW
Rates of stillbirth in the developed world have been static or rising in recent years. Clinical prediction of stillbirth risk may allow interventional studies.
RECENT FINDINGS
The most prevalent independent risk factors are nulliparity, advanced age and obesity. These are increasingly prevalent in the developed world. Obesity is particularly associated with stillbirth at term and after term. Pregestational diabetes is a major risk factor for stillbirth and these women are usually offered intensive surveillance during pregnancy. Despite this, a recent national study in the UK demonstrated a fourfold excess of stillbirth, with 80% unrelated to congenital abnormality. Studies of association between previous caesarean section and subsequent stillbirth risk are inconsistent, although in data sources with detailed information, the association has been confirmed. Global analyses of stillbirth risk demonstrate that 98% occur in the developing world and that many are due to potentially preventable causes. A randomized controlled trial of very simple educational interventions was associated with a 30% lower risk of stillbirth.
SUMMARY
Relatively simple interventions may be successful in reducing the global burden of stillbirth. Further biological understanding of the causes of stillbirth is required to reduce the burden of the disease in the developed world.
Topics: Cesarean Section; Diabetes, Gestational; Female; Fetal Death; Fetal Development; Humans; Obesity; Pregnancy; Pregnancy in Diabetics; Risk Factors; Stillbirth; Twins, Monozygotic
PubMed: 17099333
DOI: 10.1097/GCO.0b013e32801062ff -
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 -
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 -
Seminars in Perinatology Aug 2008Women with past histories of stillbirth have been referred for antepartum surveillance since the inception of electronic fetal monitoring. However, this approach was... (Review)
Review
Women with past histories of stillbirth have been referred for antepartum surveillance since the inception of electronic fetal monitoring. However, this approach was originally based on mid-twentieth century perinatal studies that noted an increase in adverse outcomes in pregnancies subsequent to stillbirth. When these landmark studies were done, Rh immune globulin, ultrasonography, and other important medical advances had not yet occurred. This article discusses whether women who have suffered a past stillbirth remain at increased risk for perinatal mortality and morbidity in future pregnancies and whether antepartum fetal surveillance can reduce the risk of recurrent stillbirth.
Topics: Female; Fetal Death; Humans; Infant, Newborn; Perinatal Mortality; Pregnancy; Prenatal Care; Recurrence; Risk Factors; Stillbirth
PubMed: 18652932
DOI: 10.1053/j.semperi.2008.04.014 -
International Journal of Gynaecology... Mar 2022The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 has had dramatic effects on the pregnant population worldwide,...
BACKGROUND
The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 has had dramatic effects on the pregnant population worldwide, increasing the risk of adverse perinatal outcomes.
OBJECTIVE
To assess the incidence of antepartum stillbirth (aSB) during the COVID-19 pandemic in Austria.
METHODS
We collected epidemiological data from the Austrian Birth Registry and compared the rate of aSB (i.e., fetal death at or after 24 gestational weeks) during the pandemic period (March-December 2020) and in the respective pre-pandemic months (2015-2019).
RESULTS
In total, 65 660 pregnancies were included, of which 171 resulted in aSB at 33.7 ± 4.8 gestational weeks. During the pandemic, the aSB rate increased from 2.49‰ to 2.60‰ (P = 0.601), in contrast to the significant decline in preterm deliveries at or before 37 gestational weeks from 0.61‰ to 0.56‰ (relative risk [RR] 0.93; 95% confidence interval [CI] 0.91-0.96; P < 0.001). During the first lockdown, the aSB rate significantly increased from 2.38‰ to 3.52‰ (P = 0.021), yielding an adjusted odds ratio of 1.57 (95% CI 1.08-2.27; P = 0.018). The event of aSB during the COVID-19 pandemic was strongly related with increased fetal weight and maternal obesity.
CONCLUSION
In Austria, there has been an overall increase in the incidence of aSB during the pandemic with a significant peak during the first lockdown.
Topics: Austria; COVID-19; Communicable Disease Control; Female; Humans; Infant, Newborn; Pandemics; Pregnancy; Pregnancy Outcome; Premature Birth; SARS-CoV-2; Stillbirth
PubMed: 34669186
DOI: 10.1002/ijgo.13989 -
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 -
American Journal of Perinatology Jan 2020To determine if women with an antepartum admission for hypertensive diseases of pregnancy (HDP) were at increased risk for stillbirth.
OBJECTIVE
To determine if women with an antepartum admission for hypertensive diseases of pregnancy (HDP) were at increased risk for stillbirth.
STUDY DESIGN
This study utilized the 2010 to 2014 Nationwide Readmissions Database. Antepartum admissions with HDP were identified and linked to subsequent delivery hospitalizations. Delivery hospitalizations with HDP without a preceding antepartum HDP admission were also identified. Risk for stillbirth, abruption, or both was compared between these two groups.
RESULTS
An estimated 382,621 deliveries with an HDP diagnosis were identified of which 14,857 (3.9%) had a preceding antepartum admission for HDP. Stillbirth occurred in 7.8 per 1,000 delivery hospitalizations complicated by HDP with risk higher with a preceding HDP antepartum admission in both unadjusted (1.1 vs. 0.8%, risk ratios [RR] 1.46, 95% confidence interval [CI] 1.24-1.70) and adjusted (adjusted risk ratios [aRR] 1.24, 95% CI 1.06, 1.46) analyses. Abruption occurred in 19.6 per 1,000 delivery hospitalizations complicated by HDP with risk higher with a preceding HDP antepartum admission in both unadjusted (2.5 vs. 1.9%, RR 1.30, 95% CI 1.17-1.44) and adjusted (aRR 1.24, 95% CI 1.11, 1.37) analyses. Risk for combined abruption and stillbirth did not differ significantly.
CONCLUSION
In this analysis, prior antenatal hospitalization was associated with increased risk for stillbirth among women with HDP.
Topics: Abruptio Placentae; Adolescent; Adult; Female; Hospitalization; Humans; Hypertension, Pregnancy-Induced; Middle Aged; Odds Ratio; Patient Readmission; Pregnancy; Prenatal Care; Risk; Stillbirth; Young Adult
PubMed: 31563137
DOI: 10.1055/s-0039-1697589 -
BMJ Global Health 2019Globally, every year 1.1 million antepartum stillbirths occur with 98% of these deaths taking place in countries where the health system is poor. In this paper we...
BACKGROUND
Globally, every year 1.1 million antepartum stillbirths occur with 98% of these deaths taking place in countries where the health system is poor. In this paper we examine the burden of misclassification of antepartum stillbirth in hospitals of Nepal and factors associated with misclassification.
METHOD
A prospective observational study was conducted in 12 hospitals of Nepal for a period of 6 months. If fetal heart sounds (FHS) were detected at admission and during the intrapartum period, the antepartum stillbirth (fetal death ≥22 weeks prior labour) recorded in patient's case note was recategorised as misclassified antepartum stillbirth. We further compared sociodemographic, obstetric and neonatal characteristics of misclassified and correctly classified antepartum stillbirths using bivariate and multivariate analysis.
RESULT
A total of 41 061 women were enrolled in the study and 39 562 of the participants' FHS were taken at admission. Of the total participants whose FHS were taken at admission, 94.8% had normal FHS, 4.7% had abnormal FHS and 0.6% had no FHS at admission. Of the total 119 recorded antepartum stillbirths, 29 (24.4%) had FHS at admission and during labour and therefore categorised as misclassified antepartum stillbirths. Multivariate analysis performed to adjust the risk of association revealed that complications during pregnancy resulted in a threefold risk of misclassification (adjusted OR-3.35, 95% CI 1.95 to 5.76).
CONCLUSION
Almost 25% of the recorded antepartum stillbirths were misclassified. Improving quality of data is crucial to improving accountability and quality of care. As the interventions to reduce antepartum stillbirth differ, accurate measurement of antepartum stillbirth is critical.
TRIAL REGISTRATION NUMBER
ISRCTN30829654.
PubMed: 31908870
DOI: 10.1136/bmjgh-2019-001936