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European Journal of Obstetrics,... Feb 2016To breakdown the causes of antepartum stillbirth by maternal age. (Observational Study)
Observational Study
OBJECTIVES
To breakdown the causes of antepartum stillbirth by maternal age.
STUDY DESIGN
Observational study.
SETTING
UK.
SAMPLE
Anonymised national data on 2850 cases of antepartum stillbirth in 2009.
STATISTICAL ANALYSIS
The association between cause of stillbirth and maternal age was examined using an adjusted multinomial logistic regression model. Risk ratios were calculated relative to stillbirth due to haemorrhage.
MAIN OUTCOME MEASURES
Antepartum stillbirths classified by the Centre for Maternal and Child Enquiries (CMACE) classification.
RESULTS
Stillbirths in women aged 35 years and over are more likely to be due to major congenital anomalies (relative risk ratio (RRR) 2.0, 95% CI 1.3-3.0), mechanical causes (RRR 1.6, 95% CI 1.0-2.6), maternal disorders (RRR 2.1, 95% CI 1.2-3.6) or associated obstetric factors (RRR 2.1, 95% CI 1.1-3.9) than women less than 35. Women aged 35 years and over have a statistically significant increased risk of stillbirth due to major congenital anomalies (OR relative to live birth 1.6, 95% CI 1.3-1.9) and maternal disorders (OR 1.7, 95% CI 1.2-2.4) than younger women. Women aged 35 years and over were 30% more likely to experience a term stillbirth than women <35 years (OR 1.3, 95% CI 1.1-1.5). Stillbirth due to congenital anomaly was statistically significantly more likely in women ≥ 35 years.
CONCLUSIONS
Advanced maternal age is a significant risk factor for antepartum stillbirth particularly at term. Attention should be given to stillbirth due to mechanical causes, maternal disorders and associated obstetric factors in such women.
Topics: Adult; Causality; Congenital Abnormalities; Diabetes, Gestational; Female; Humans; Hypertension; Labor Presentation; Logistic Models; Maternal Age; Odds Ratio; Pregnancy; Pregnancy Complications; Pregnancy Complications, Cardiovascular; Stillbirth; United Kingdom; Uterine Rupture
PubMed: 26717496
DOI: 10.1016/j.ejogrb.2015.11.032 -
Acta Obstetricia Et Gynecologica... Apr 2022Occult or untreated gestational diabetes (GDM) is a well-known risk factor for adverse perinatal outcomes and may contribute to antepartum stillbirth. We assessed the...
INTRODUCTION
Occult or untreated gestational diabetes (GDM) is a well-known risk factor for adverse perinatal outcomes and may contribute to antepartum stillbirth. We assessed the impact of screening for GDM on the rate of antepartum stillbirths in non-anomalous pregnancies by conducting a population-based study in 974 889 women in Austria.
MATERIAL AND METHODS
Our database was derived from the Austrian Birth Registry. Inclusion criteria were singleton live births and antepartum stillbirths ≥24 gestational weeks, excluding fetal congenital malformations, terminations of pregnancy and women with pre-existing type 1 or 2 diabetes. Main outcome measures were (a) overall stillbirth rates and (b) stillbirth rates in women at high risk of GDM (i.e., women with a body mass index ≥30 kg/m , history of previous intrauterine fetal death, GDM, previous macrosomic offspring) before (2008-2010, "phase I") and after (2011-2019, "phase II") the national implementation of universal GDM screening with a 75 g oral glucose tolerance test in Austrian pregnant women by 2011.
RESULTS
In total, 940 373 pregnancies were included between 2008 and 2019, of which 2579 resulted in intrauterine fetal deaths at 33.51 ± 5.10 gestational weeks. After implementation of the GDM screening, a statistically significant reduction in antepartum stillbirth rates among non-anomalous singletons was observed only in women at high risk for GDM (4.10‰ [95% confidence interval (CI) 3.09-5.43] in phase I vs. 2.96‰ [95% CI 2.57-3.41] in phase II; p = 0.043) but not in the general population (2.76‰ [95% CI 2.55-2.99] in phase I vs. 2.74‰ [95% CI 2.62-2.86] in phase II; p = 0.845). The number needed to screen with the oral glucose tolerance test to subsequently prevent one case of (non-anomalous) intrauterine fetal death was 880 in the high-risk and 40 000 in the general population.
CONCLUSIONS
The implementation of a universal GDM screening program in Austria in 2011 has not led to any significant reduction in antenatal stillbirths among non-anomalous singletons in the general population. More international data are needed to strengthen our findings.
Topics: Austria; Diabetes, Gestational; Female; Fetal Death; Glucose Tolerance Test; Humans; Pregnancy; Stillbirth
PubMed: 35195277
DOI: 10.1111/aogs.14334 -
Minerva Ginecologica Aug 2005Antepartum stillbirth is the single most common cause of perinatal death. Antepartum stillbirth is associated with fetal abnormality, congenital infection, rhesus... (Comparative Study)
Comparative Study Review
Antepartum stillbirth is the single most common cause of perinatal death. Antepartum stillbirth is associated with fetal abnormality, congenital infection, rhesus isoimmunisation, maternal medical conditions, and complications of pregnancy, such as pre-eclampsia and placental abruption. However, the majority have no direct obstetric cause and are referred to as unexplained. Many of these so-called unexplained deaths are associated with growth restriction. Maternal characteristics, such as age and smoking, are associated with an increased risk of antepartum stillbirth. The risk of stillbirth in late pregnancy is related to the function of the placenta in early pregnancy. Placental function can be assessed using circulating markers in the mothers blood, such as pregnancy associated plasma protein A and alpha-fetoprotein. Invasion of the trophoblast into the uterine vessels is associated with decreased resistance to flow in the uterus and impaired placentation is reflected in high resistance Doppler flow velocity waveforms in the utero-placental circulation. Both circulating placental markers and Doppler indices of resistance to flow are predictive of the risk of antepartum stillbirth. However, none of these tools has sufficient positive predictive value to justify population based screening. Future research in unexplained stillbirth should be directed towards developing better predictive tests to identify women at high risk and the evaluation of interventions in large scale trials.
Topics: Adult; Female; Gestational Age; Humans; Infant, Newborn; Maternal Age; Odds Ratio; Predictive Value of Tests; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnancy Proteins; Pregnancy, Multiple; Prognosis; Research; Risk Factors; Smoking; Socioeconomic Factors; Stillbirth; Ultrasonography, Doppler
PubMed: 16170285
DOI: No ID Found -
The Journal of Maternal-fetal &... Oct 2010In literature, there is a paucity of information about the management of the subsequent pregnancy after stillbirth (SB). we undertook a systematic review of the... (Review)
Review
In literature, there is a paucity of information about the management of the subsequent pregnancy after stillbirth (SB). we undertook a systematic review of the literature focusing on the evidence for antenatal interventions with the potential to prevent SB and we try to summarise the management of the pregnancy subsequent to a SB. The diverse interventions and their efficacy will be reported according to the possible causes and/or conditions associated to the previous SB. Few of the studies reported SB as an outcome and the evidence was frequently conflicting. Several interventions showed clear evidence of impact on SB, including the scrupulous control of blood sugar by using multiple doses of insulin, frequent antenatal foetal monitoring and timing of delivery in diabetic women; the prophylaxis with low dose of aspirin in high-risk women; or serial sonograms for foetal growth, Doppler studies and antepartum foetal testing in women with previous growth restricted foetus. Other interventions instead reduced know risk factors for SB but failed to show statistically significant impact on SB rate. Overall, early access to care, at least three ultrasounds examinations, screening for the main pregnancy-related disorders and timely delivery are the milestone of appropriate antenatal care in women with previous SB.
Topics: Antiphospholipid Syndrome; Female; Fetal Death; Fetal Growth Retardation; Humans; Hypertension, Pregnancy-Induced; Parity; Pregnancy; Pregnancy in Diabetics; Prenatal Care; Stillbirth; Thrombophilia
PubMed: 20504070
DOI: 10.3109/14767051003678036 -
PLOS Global Public Health 2023Antepartum stillbirth is a public health problem in a low-income country like Ethiopia. Quality antenatal care (ANC) is supposed to reduce the risk of many bad outcomes....
BACKGROUND
Antepartum stillbirth is a public health problem in a low-income country like Ethiopia. Quality antenatal care (ANC) is supposed to reduce the risk of many bad outcomes. Thus the main objective of this study was to identify the effect of quality antenatal care on antepartum stillbirth in Public health facilities of Hossana town Hadiya zone south Ethiopia.
METHOD
About 1123 mothers with a gestational age of less than 16 weeks were identified and followed using an observational longitudinal study to determine whether the quality of ANC influences antepartum stillbirth or not. Standardized and pretested observation checklists and participants' interview questionnaires were employed to obtain the necessary information after getting both written and verbal consent from the concerned bodies and study participants. In this study, quality was measured by the process attributes of quality to measure the acceptable standard of quality of antenatal care. Women who received ≥75% of essential ANC services (from 1st-4th visit) were categorized under received good quality antenatal care. General estimating equation analysis was done to determine the effect of quality antenatal care on antepartum stillbirth.
RESULT
A total of 121 (12.3%) 95% CI (10.3%, 14.5%) mothers who were observed during delivery had encountered antepartum stillbirth. In this study, the overall quality of antenatal care service that was provided in the whole visit (1st -4th) was 1230 (31.38%). Higher quality ANC decreases the odds of antepartum stillbirth by almost 81%, after controlling other factors (0.19 (AOR 0.19 at 95% CI; 0.088 to 0.435). There is a change in the odds of developing antepartum stillbirth as the level of education of mothers increases. Moreover, mothers with a history of preexisting hypertension were more like to have antepartum stillbirth AOR = 3.1, 95%CI (1.44, 6.77)].
CONCLUSION AND RECOMMENDATION
Therefore, having a good quality of ANC significantly reduces antepartum stillbirth. Strategies need to be developed on the problems identified to improve the quality of ANC and reduce antepartum stillbirth significantly.
PubMed: 36963030
DOI: 10.1371/journal.pgph.0001468 -
BJOG : An International Journal of... Aug 2018To identify risk factors for antepartum stillbirth, including fetal growth restriction, among women with well-dated pregnancies and access to antenatal care. (Observational Study)
Observational Study
OBJECTIVES
To identify risk factors for antepartum stillbirth, including fetal growth restriction, among women with well-dated pregnancies and access to antenatal care.
DESIGN
Population-based, prospective, observational study.
SETTING
Eight international urban populations.
POPULATION
Pregnant women and their babies enrolled in the Newborn Cross-Sectional Study of the INTERGROWTH-21 Project.
METHODS
Cox proportional hazard models were used to compare risks among antepartum stillborn and liveborn babies.
MAIN OUTCOME MEASURES
Antepartum stillbirth was defined as any fetal death after 16 weeks' gestation before the onset of labour.
RESULTS
Of 60 121 babies, 553 were stillborn (9.2 per 1000 births), of which 445 were antepartum deaths (7.4 per 1000 births). After adjustment for site, risk factors were low socio-economic status, hazard ratio (HR): 1.6 (95% CI, 1.2-2.1); single marital status, HR 2.0 (95% CI, 1.4-2.8); age ≥40 years, HR 2.2 (95% CI, 1.4-3.7); essential hypertension, HR 4.0 (95% CI, 2.7-5.9); HIV/AIDS, HR 4.3 (95% CI, 2.0-9.1); pre-eclampsia, HR 1.6 (95% CI, 1.1-3.8); multiple pregnancy, HR 3.3 (95% CI, 2.0-5.6); and antepartum haemorrhage, HR 3.3 (95% CI, 2.5-4.5). Birth weight <3rd centile was associated with antepartum stillbirth [HR, 4.6 (95% CI, 3.4-6.2)]. The greatest risk was seen in babies not suspected to have been growth restricted antenatally, with an HR of 5.0 (95% CI, 3.6-7.0). The population-attributable risk of antepartum death associated with small-for-gestational-age neonates diagnosed at birth was 11%.
CONCLUSIONS
Antepartum stillbirth is a complex syndrome associated with several risk factors. Although small babies are at higher risk, current growth restriction detection strategies only modestly reduced the rate of stillbirth.
TWEETABLE ABSTRACT
International stillbirth study finds individual risks poor predictors of death but combinations promising.
Topics: Cross-Sectional Studies; Female; Fetal Growth Retardation; Fetal Weight; Gestational Age; Humans; Infant, Newborn; Pregnancy; Proportional Hazards Models; Prospective Studies; Risk Factors; Stillbirth; Syndrome
PubMed: 28029221
DOI: 10.1111/1471-0528.14463 -
American Journal of Obstetrics and... Oct 2017Many stillbirths of normally formed fetuses in the third trimester could be prevented via delivery if reliable means to anticipate this outcome existed. However, because...
BACKGROUND
Many stillbirths of normally formed fetuses in the third trimester could be prevented via delivery if reliable means to anticipate this outcome existed. However, because the etiology of these stillbirths is often unexplained and although the underlying mechanism is presumed to be hypoxia from placental insufficiency, the placentas often appear normal on histopathological examination. Gestational age is a risk factor for antepartum stillbirth, with a rapid rise in stillbirth rates after 40 weeks' gestation. We speculate that a common mechanism may explain antepartum stillbirth in both the late-term and postterm periods. Mice also show increasing rates of stillbirth when pregnancy is artificially prolonged. The model therefore affords an opportunity to characterize events that precede stillbirth.
OBJECTIVE
The objective of the study was to prolong gestation in mice and monitor fetal and placental growth and cardiovascular changes.
STUDY DESIGN
From embryonic day 15.5 to embryonic day 18.5, pregnant CD-1 mice received daily progesterone injections to prolong pregnancy by an additional 24 hour period (to embryonic day 19.5). To characterize fetal and placental development, experimental assays were performed throughout late gestation (embryonic day 15.5 to embryonic day 19.5), including postnatal day 1 pups as controls. In addition to collecting fetal and placental weights, we monitored fetal blood flow using Doppler ultrasound and examined the fetoplacental arterial vascular geometry using microcomputed tomography. Evidence of hypoxic organ injury in the fetus was assessed using magnetic resonance imaging and pimonidazole immunohistochemistry.
RESULTS
At embryonic day 19.5, mean fetal weights were reduced by 14% compared with control postnatal day 1 pups. Ultrasound biomicroscopy showed that fetal heart rate and umbilical artery flow continued to increase at embryonic day 19.5. Despite this, the embryonic day 19.5 fetuses had significant pimonidazole staining in both brain and liver tissue, indicating fetal hypoxia. Placental weights at embryonic day 19.5 were 21% lower than at term (embryonic day 18.5). Microcomputed tomography showed no change in quantitative morphology of the fetoplacental arterial vasculature between embryonic day 18.5 and embryonic day 19.5.
CONCLUSION
Prolongation of pregnancy renders the murine fetus vulnerable to significant growth restriction and hypoxia because of differential loss of placental mass rather than any compromise in fetoplacental blood flow. Our data are consistent with a hypoxic mechanism of antepartum fetal death in human term and postterm pregnancy and validates the inability of umbilical artery Doppler to safely monitor such fetuses. New tests of placental function are needed to identify the late-term fetus at risk of hypoxia to intervene by delivery to avoid antepartum stillbirth.
Topics: Animals; Blood Flow Velocity; Brain; Female; Fetal Growth Retardation; Fetal Hypoxia; Fetal Weight; Gestational Age; Heart Rate, Fetal; Liver; Lung; Mice; Models, Animal; Organ Size; Placenta; Pregnancy; Pregnancy, Prolonged; Stillbirth; Umbilical Arteries; X-Ray Microtomography
PubMed: 28619691
DOI: 10.1016/j.ajog.2017.06.009 -
The Journal of Maternal-fetal &... Aug 2004Stillbirth occurs in nearly 1% of all births in the USA, and is one of the most common but least studied adverse pregnancy outcomes. The many risk factors for and causes... (Review)
Review
Stillbirth occurs in nearly 1% of all births in the USA, and is one of the most common but least studied adverse pregnancy outcomes. The many risk factors for and causes of stillbirth are presented. Over the past several decades, the rate of stillbirth has been substantially reduced, with the reduction most apparent in those stillbirths previously occurring at term and/or in labor. Reductions have occurred because of reductions in risk factors (i.e. prevention of Rh disease and better control of diabetes), better antepartum monitoring of those with risk factors followed by early delivery for those fetuses found to be at risk (i.e. growth restriction, maternal pre-eclampsia), better intrapartum fetal monitoring, increases in Cesarean section for those at risk, and early detection of congenital anomalies followed by termination prior to the time that these early fetal deaths are classified as stillbirths. Finally, the value of using fetal autopsy and placental examination to determine the cause of death accurately, both for research purposes and for patient counseling in future pregnancies, is explored.
Topics: Female; Humans; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Prenatal Care; Risk Factors; United States
PubMed: 15512717
DOI: 10.1080/14767050400003801 -
PloS One 2022To assess the risk of singleton intrauterine fetal death (IUFD) in women by the demographic setting of the online Fetal Medicine Foundation (FMF) Stillbirth Risk...
OBJECTIVE
To assess the risk of singleton intrauterine fetal death (IUFD) in women by the demographic setting of the online Fetal Medicine Foundation (FMF) Stillbirth Risk Calculator.
METHODS
Retrospective single-centre case-control study involving 144 women having suffered IUFD and 247 women after delivery of a live-born singleton. Nonparametric receiver operating characteristics (ROC) analyses were performed to predict the prognostic power of the FMF Stillbirth risk score and to generate a cut-off value to discriminate best between the event of IUFD versus live birth.
RESULTS
Women in the IUFD cohort born a significantly higher overall risk with a median FMF risk score of 0.45% (IQR 0.23-0.99) compared to controls [0.23% (IQR 0.21-0.29); p<0.001]. Demographic factors contributing to an increased risk of IUFD in our cohort were maternal obesity (p = 0.002), smoking (p<0.001), chronic hypertension (p = 0.015), antiphospholipid syndrome (p = 0.017), type 2 diabetes (p<0.001), and insulin requirement (p<0.001). ROC analyses showed an area under the curve (AUC) of 0.72 (95% CI 0.67-0.78; p<0.001) for predicting overall IUFD and an AUC of 0.72 (95% CI 0.64-0.80; p<0.001), respectively, for predicting IUFD excluding congenital malformations. The FMF risk score at a cut-off of 0.34% (OR 6.22; 95% CI 3.91-9.89; p<0.001) yielded an 82% specificity and 58% sensitivity in predicting IUFD with a positive and negative predictive value of 0.94% and 99.84%, respectively.
CONCLUSION
The FMF Stillbirth Risk Calculator based upon maternal demographic and obstetric characteristics only may help identify women at low risk of antepartum stillbirth.
Topics: Perinatology
PubMed: 35051188
DOI: 10.1371/journal.pone.0260964 -
Archives of Gynecology and Obstetrics Feb 2021To evaluate the effect of the choice growth chart and threshold used to define small for gestational age (SGA) on the predictive value of SGA for placenta-related or...
PURPOSE
To evaluate the effect of the choice growth chart and threshold used to define small for gestational age (SGA) on the predictive value of SGA for placenta-related or unexplained antepartum stillbirth.
METHODS
A retrospective cohort study of all women with a singleton pregnancy who gave birth > 24 week gestation in a single center (2000-2016). The exposure of interest was SGA, defined as birth weight < 10th or < 25th centile according to three fetal growth charts (Hadlock et al., Radiology 181:129-133, 1991; intergrowth-21st (IG21), WHO 2017, and a Canadian birthweight-based reference-Kramer et al., Pediatrics 108:E35, 2001). The outcome of interest was antepartum stillbirth due to placental dysfunction or unknown etiology. Cases of stillbirth attributed to other specific etiologies were excluded.
RESULTS
A total of 49,458 women were included in the cohort. There were 103 (0.21%) cases of stillbirth due to placental dysfunction or unknown etiology. For cases in the early stillbirth cluster (≤ 30 weeks), the detection rate was high and was similar for the three ultrasound-based fetal growth charts of Hadlock, IG21, and WHO (range 83.3-87.0%). In contrast, the detection rate of SGA for cases in the late stillbirth cluster (> 30 weeks) was low, being highest for WHO and Hadlock (36.7% and 34.7%, respectively), and lowest for IG21 (18.4%). Using a threshold of the 25th centile increased the detection rate for stillbirth by approximately 15-20% compared with that achieved by the 10th centile cutoff.
CONCLUSION
At > 30 week gestation, the Hadlock or WHO fetal growth charts provided the best balance between detection rate and false positive rate for stillbirth.
Topics: Adult; Birth Weight; Canada; Female; Fetal Development; Fetal Growth Retardation; Gestational Age; Growth Charts; Humans; Infant, Newborn; Infant, Small for Gestational Age; Placenta; Pregnancy; Retrospective Studies; Stillbirth; Ultrasonography, Prenatal
PubMed: 32803394
DOI: 10.1007/s00404-020-05747-4