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Obstetrics and Gynecology Nov 2010To identify possible prepregnancy risk factors for antepartum stillbirth and to determine whether these factors identify women at higher risk for term stillbirth.
OBJECTIVE
To identify possible prepregnancy risk factors for antepartum stillbirth and to determine whether these factors identify women at higher risk for term stillbirth.
METHODS
This retrospective cohort study of prepregnancy risk factors compared 712 singleton antepartum stillbirths with 174,097 singleton live births at or after 23 weeks of gestation. The risk of term antepartum stillbirth then was assessed in a subset of 155,629 singleton pregnancies.
RESULTS
In adjusted multivariable analyses, African-American race, Hispanic ethnicity, maternal age 35 years or older, nulliparity, prepregnancy body mass index (BMI) 30 or higher, preexisting diabetes, chronic hypertension, smoking, and alcohol use were independently associated with stillbirth. Prior cesarean delivery and history of preterm birth were associated with increased stillbirth risk in multiparous women. The risk of a term stillbirth for women who were white, 25-29 years old, normal weight, multiparous, no chronic hypertension, and no preexisting diabetes was 0.8 per 1,000. Term stillbirth risk increased with the following conditions: preexisting diabetes (3.1 per 1,000), chronic hypertension (1.7 per 1,000), African-American race (1.8 per 1,000), maternal age 35 years or older (1.3 per 1,000), BMI 30 or higher (1 per 1,000), and nulliparity (0.9 per 1,000).
CONCLUSION
There are multiple independent risk factors for antepartum stillbirth. However, the value of individual risk factors of race, parity, advanced maternal age (35-39 years old), and BMI to predict term stillbirth is poor. Our results do not support routine antenatal surveillance for any of these risk factors when present in isolation.
LEVEL OF EVIDENCE
II.
Topics: Adult; Body Mass Index; Cesarean Section; Female; Humans; Insurance; Marital Status; Maternal Age; Parity; Pregnancy; Pregnancy Complications; Racial Groups; Risk Factors; Stillbirth; Term Birth; United States; Young Adult
PubMed: 20966697
DOI: 10.1097/AOG.0b013e3181f903f8 -
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 -
International Journal of Gynaecology... Dec 2018Cesarean delivery (CD) may be associated with stillbirth in future pregnancies. We investigated prior CD as a risk factor for stillbirth in Lusaka, Zambia.
OBJECTIVE
Cesarean delivery (CD) may be associated with stillbirth in future pregnancies. We investigated prior CD as a risk factor for stillbirth in Lusaka, Zambia.
METHODS
We conducted a retrospective cohort analysis of women with only one prior pregnancy who delivered between February 1, 2006, and May 31, 2013. We analysed data from the Zambia Electronic Perinatal System. Maternal and infant characteristics were analyzed for association with stillbirth using Pearson's χ test or the Wilcoxon rank-sum test. We calculated risk ratios for the relationship between stillbirth (antepartum vs intrapartum) and prior CD, with a log Poisson model to adjust for confounding.
RESULTS
Of 57 320 women in our cohort, 1933 (3.4%) reported a prior CD. There were 1012 (1.8%) stillbirths in the no prior CD group and 81 (4.2%) in the prior CD group (P<0.001). In multivariate models adjusting for stillbirth risk factors, prior CD was associated with antepartum (adjusted risk ratio 1.56, 95% confidence interval 1.08-2.24) and intrapartum (adjusted risk ratio 3.26, 95% confidence interval 2.40-4.42) stillbirth compared with no prior CD. The difference between groups was most apparent at 36-37 weeks' gestation (log-rank P<0.001).
CONCLUSION
Prior CD was associated with increased risk of stillbirth. Improved monitoring during labor and safe methods for induction are urgently needed in low-resource settings.
Topics: Adult; Cesarean Section; Female; Gestational Age; Humans; Infant, Newborn; Perinatal Death; Pregnancy; Retrospective Studies; Risk Factors; Stillbirth; Young Adult; Zambia
PubMed: 30207602
DOI: 10.1002/ijgo.12668 -
Clinical Obstetrics and Gynecology Sep 2010Stillbirth is one of the most common adverse pregnancy outcomes in the United States. Although there are certain maternal medical conditions that increase the risk of... (Review)
Review
Stillbirth is one of the most common adverse pregnancy outcomes in the United States. Although there are certain maternal medical conditions that increase the risk of antepartum fetal death, advances in medical and obstetric care have decreased its incidence. The objective of this review was to examine the current stillbirth rates reported in pregnancies complicated by common medical diseases such as hypertension, diabetes, obesity, systemic lupus erythematosus, chronic renal disease, thyroid disorders, and cholestasis of pregnancy. Early diagnosis remains the key to provide increased surveillance and possible intervention to further decrease the likelihood of stillbirth.
Topics: Cholestasis; Diabetes Complications; Female; Fetal Death; Humans; Hypertension; Kidney Diseases; Lupus Erythematosus, Systemic; Obesity; Pregnancy; Pregnancy Complications; Stillbirth; Thyroid Diseases
PubMed: 20661045
DOI: 10.1097/GRF.0b013e3181eb2ca0 -
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.
PubMed: 34011881
DOI: 10.1097/AOG.0000000000004411 -
Journal of Perinatal Medicine Jul 2022This study aimed to assess parents' satisfaction with received care and support when experiencing stillbirth.
OBJECTIVES
This study aimed to assess parents' satisfaction with received care and support when experiencing stillbirth.
METHODS
This was a questionnaire survey conducted at Helsinki University Hospital, Helsinki, Finland during 2016-2020. Separate questionnaires were sent to mothers and partners who had experienced an antepartum singleton stillbirth at or after 22 gestational weeks during 2016-2019. The questionnaire covered five major topics: stillbirth diagnosis, delivery, information on postmortem examinations, aftercare at the ward, and follow-up appointment.
RESULTS
One hundred nineteen letters were sent and 57 (47.9%) of the mothers and 46 (38.7%) of their partners responded. Both mothers and their partners felt well supported during delivery. They were also satisfied with the time holding their newborn. Partners reported even higher satisfaction in this aspect with a significant within-dyad difference (p=0.049). Parents were generally pleased with the support at the ward. However, both groups were less satisfied with social worker counseling (mothers 53.7%, partners 61.0%). The majority felt that the follow-up visit was helpful. Nonetheless, a remarkable proportion felt that the follow-up visit increased their anxiousness (25.9%, 14.0%, p=0.018). Partners rated their mood higher than mothers (p=0.001). Open feedback revealed that the support received after discharge from hospital was often insufficient.
CONCLUSIONS
Our study showed that the parents who experience stillbirth in our institution receive mostly adequate care and support during their hospital stay. However, there is room for further training of healthcare professionals and other professionals contributing in stillbirth aftercare.
Topics: Aftercare; Female; Humans; Infant, Newborn; Mothers; Parents; Pregnancy; Stillbirth; Surveys and Questionnaires
PubMed: 35700452
DOI: 10.1515/jpm-2022-0246 -
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 -
Population Health Metrics Feb 2021Household surveys remain important sources of stillbirth data, but omission and misclassification are common. Classifying adverse pregnancy outcomes as stillbirths...
BACKGROUND
Household surveys remain important sources of stillbirth data, but omission and misclassification are common. Classifying adverse pregnancy outcomes as stillbirths requires accurate reporting of vital status at birth and gestational age or birthweight for every pregnancy. Further categorisation, e.g. by sex, or timing (intrapartum/antepartum) improves data to understand and prevent stillbirth.
METHODS
We undertook a cross-sectional population-based survey of women of reproductive age in five health and demographic surveillance system sites in Bangladesh, Ethiopia, Ghana, Guinea-Bissau and Uganda (2017-2018). All women answered a full birth history with pregnancy loss questions (FBH+) or a full pregnancy history (FPH). A sub-sample across both groups were asked additional stillbirth questions. Questions were evaluated using descriptive measures. Using an interpretative paradigm and phenomenology methodology, focus group discussions with women exploring barriers to reporting birthweight for stillbirths were conducted. Thematic analysis was guided by an a priori codebook.
RESULTS
Overall 69,176 women reported 98,483 livebirths (FBH+) and 102,873 pregnancies (FPH). Additional questions were asked for 1453 stillbirths, 1528 neonatal deaths and 12,620 surviving children born in the 5 years prior to the survey. Completeness was high (> 99%) for existing FBH+/FPH questions on signs of life at birth and gestational age (months). Discordant responses in signs of life at birth between different questions were common; nearly one-quarter classified as stillbirths on FBH+/FPH were reported born alive on additional questions. Availability of information on gestational age (weeks) (58.1%) and birthweight (13.2%) was low amongst stillbirths, and heaping was common. Most women (93.9%) were able to report the sex of their stillborn baby. Response completeness for stillbirth timing (18.3-95.1%) and estimated proportion intrapartum (15.6-90.0%) varied by question and site. Congenital malformations were reported in 3.1% stillbirths. Perceived value in weighing a stillborn baby varied and barriers to weighing at birth a nd knowing birthweight were common.
CONCLUSIONS
Improving stillbirth data in surveys will require investment in improving the measurement of vital status, gestational age and birthweight by healthcare providers, communication of these with women, and overcoming reporting barriers. Given the large burden and effect on families, improved data must be made available to end preventable stillbirths.
Topics: Birth Weight; Child; Cross-Sectional Studies; Female; Gestational Age; Humans; Infant; Infant, Newborn; Perinatal Death; Pregnancy; Stillbirth
PubMed: 33557841
DOI: 10.1186/s12963-020-00239-8 -
American Journal of Perinatology Jan 2022We sought to quantify the distribution of stillbirths by gestational age (GA) in a contemporary cohort and to determine identifiable risk factors associated with...
OBJECTIVE
We sought to quantify the distribution of stillbirths by gestational age (GA) in a contemporary cohort and to determine identifiable risk factors associated with stillbirth prior to 32 weeks of gestation.
STUDY DESIGN
Population-based case-control study of all stillbirths in the United States during the year 2014, utilizing vital statistics data, obtained from the National Center for Health Statistics. Distribution of stillbirths were stratified by 20 to 44 weeks of GA, in women diagnosed with stillbirth in the antepartum period. Pregnancy characteristics were compared between those diagnosed with stillbirth <32 versus ≥32 weeks of gestation. Multivariate logistic regression estimated the relative influence of various factors on the outcome of stillbirth prior to 32 weeks of gestation.
RESULTS
There were 15,998 nonlaboring women diagnosed with stillbirth during 2014 in the United States between 20 and 44 weeks. Of them, 60.1% ( = 9,618) occurred before antenatal fetal surveillance (ANFS) is typically initiated (<32 weeks) and 39.9% ( = 6,380) were diagnosed at ≥32 weeks. Women with stillbirth prior to 32 weeks were more likely to be of non-Hispanic Black race (29.0 vs. 23.9%, < 0.001), nulliparous (53.8 vs. 50.6%, = 0.001), have chronic hypertension (CHTN; 6.0 vs. 4.3%, < 0.001), and fetal growth restriction as evidenced by small for GA (SGA < 10th%) birth weight (44.8 vs. 42.1%, < 0.001) as opposed to women with stillbirth after 32 weeks. After adjustment, SGA birth weight (adjusted odds ratio [aOR] = 1.2, 95% confidence interval [CI]: 1.1-1.3), Black race (aOR = 1.2, 95% CI: 1.1-1.3), and CHTN (aOR = 1.3, 95% CI: 1.1-1.5) were associated with stillbirth prior to 32 weeks of gestation as opposed to stillbirth after 32 weeks.
CONCLUSION
More than 6 out of 10 stillbirths in this study occurred <32 weeks of gestation, before ANFS is typically initiated under American College of Obstetricians and Gynecologists recommendations. Among identifiable risk factors, CHTN, Black race, and fetal growth restriction were associated with higher risk of stillbirth before 32 weeks of gestation. Earlier ANFS may be warranted at in certain "at risk" women.
KEY POINTS
· Six out of 10 stillbirths occur before 32 weeks of gestation.. · We evaluated factors associated with stillbirth <32 weeks.. · Hypertension and fetal growth restriction were associated with early stillbirth..
Topics: Black or African American; Case-Control Studies; Chronic Disease; Female; Fetal Growth Retardation; Gestational Age; Humans; Hypertension; Hypertension, Pregnancy-Induced; Infant, Small for Gestational Age; Logistic Models; Pregnancy; Pregnancy in Diabetics; Risk Factors; Stillbirth; United States
PubMed: 32736406
DOI: 10.1055/s-0040-1714421 -
The Journal of Maternal-fetal &... Sep 2020To examine the potential value of fetal ultrasound and maternal characteristics in the prediction of antepartum stillbirth after 32 weeks' gestation. This was a...
To examine the potential value of fetal ultrasound and maternal characteristics in the prediction of antepartum stillbirth after 32 weeks' gestation. This was a retrospective multicenter study in Spain. In 29 pregnancies, umbilical artery pulsatility index (UA PI), middle cerebral artery pulsatility index (MCA PI), cerebroplacental ratio (CPR), estimated fetal weight (EFW), and maternal characteristics were recorded within 15 days prior to a stillbirth. The values of UA PI, MCA PI, and CPR were converted into multiples of the normal median (MoM) for gestational age and the EFW was expressed as percentile according to a Spanish reference range for gestational age. Data from the 29 pregnancies with stillbirths and 2298 control pregnancies resulting in livebirths were compared and multivariate logistic regression analysis was used to determine significant predictors of stillbirth. The only significant predictor of stillbirth was CPR (OR = 0.161, 95% confidence interval [CI] 0.035, 0.654; = .014); the area under the receiver operating characteristics curve was 0.663 (95% CI 0.545, 0.782) and the detection rate (DR) was 32.14% at a 10% false-positive rate (FPR). In addition, when we included MCA and UA PI MoM instead of CPR, only MCA PI MoM was significant (OR = 0.104, 95% confidence interval [CI] 0.013, 0.735; = .029), with similar prediction abilities (area under the curve (AUC) 0.645, DR 28.6%, FPR 10%). The CPR and MCA PI are predictors of late stillbirth but the performance of prediction is poor.
Topics: Female; Gestational Age; Humans; Middle Cerebral Artery; Pregnancy; Pulsatile Flow; Retrospective Studies; Spain; Stillbirth; Ultrasonography, Prenatal; Umbilical Arteries
PubMed: 30672365
DOI: 10.1080/14767058.2019.1566900