-
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 -
BMC Pregnancy and Childbirth Mar 2017Despite impressive improvements in maternal survival throughout the world, rates of antepartum complications remain high. These conditions also contribute to high rates...
BACKGROUND
Despite impressive improvements in maternal survival throughout the world, rates of antepartum complications remain high. These conditions also contribute to high rates of perinatal deaths, which include stillbirths and early neonatal deaths, but the extent is not well studied. This study examines patterns of antepartum complications and the risk of perinatal deaths associated with such complications in rural Bangladesh.
METHODS
We used data on self-reported antepartum complications during the last pregnancy and corresponding pregnancy outcomes from a household survey (N = 6,285 women) conducted in Sylhet district, Bangladesh in 2006. We created three binary outcome variables (stillbirths, early neonatal deaths, and perinatal deaths) and three binary exposure variables indicating antepartum complications, which were antepartum hemorrhage (APH), probable infection (PI), and probable pregnancy-induced hypertension (PIH). We then examined patterns of antepartum complications and calculated incidence rate ratios (IRR) to estimate the associated risks of perinatal mortality using Poisson regression analyses. We calculated population attributable fraction (PAF) for the three antepartum complications to estimate potential risk reductions of perinatal mortality associated them.
RESULTS
We identified 356 perinatal deaths (195 stillbirths and 161 early neonatal deaths). The highest risk of perinatal death was associated with APH (IRR = 3.5, 95% CI: 2.4-4.9 for perinatal deaths; IRR = 3.7, 95% CI 2.3-5.9 for stillbirths; IRR = 3.5, 95% CI 2.0-6.1 for early neonatal deaths). Pregnancy-induced hypertension was a significant risk factor for stillbirths (IRR = 1.8, 95% CI 1.3-2.5), while PI was a significant risk factor for early neonatal deaths (IRR = 1.5, 95% CI 1.1-2.2). Population attributable fraction of APH and PIH were 6.8% and 10.4% for perinatal mortality and 7.5% and 14.7% for stillbirths respectively. Population attributable fraction of early neonatal mortality due to APH was 6.2% and for PI was 7.8%.
CONCLUSIONS
Identifying antepartum complications and ensuring access to adequate care for those complications are one of the key strategies in reducing perinatal mortality in settings where most deliveries occur at home.
Topics: Adult; Bangladesh; Female; Humans; Hypertension, Pregnancy-Induced; Infant, Newborn; Obstetric Labor Complications; Perinatal Mortality; Postpartum Hemorrhage; Pregnancy; Rural Population; Stillbirth; Young Adult
PubMed: 28270117
DOI: 10.1186/s12884-017-1264-1 -
Seminars in Perinatology Aug 2008Antepartum fetal testing in pregnant patients with hypertensive disorders may be beneficial in preventing stillbirth and hypoxic sequelae in the fetus. The highest risk... (Review)
Review
Antepartum fetal testing in pregnant patients with hypertensive disorders may be beneficial in preventing stillbirth and hypoxic sequelae in the fetus. The highest risk patients in this category are those with intrauterine growth restriction, superimposed preeclampsia, associated medical complications such as diabetes, systemic lupus erythematosis, chronic renal disease, or history of a prior stillbirth. The current recommended method of primary testing is a twice weekly modified biophysical profile with either a full BPP or a contraction stress test for backup evaluation of those patients with lack of reactivity or decreased amniotic fluid volume on a modified biophysical profile. Even uncomplicated patients with chronic hypertension or pregnancy-induced hypertension carry an increased risk of perinatal mortality and for these patients testing should begin at 33 to 34 weeks gestation. Patients with complications of intrauterine growth restriction, preeclampsia, diabetes, systemic lupus erythematosis, or chronic renal disease should have antepartum testing begin when intervention for fetal indications is judged to be appropriate, usually beginning at about 26 weeks gestation. Doppler velocimetry may be helpful in further evaluation of those patients in the early third trimester with abnormal primary testing.
Topics: Female; Fetal Diseases; Fetal Growth Retardation; Heart Rate, Fetal; Humans; Hypertension; Pregnancy; Pregnancy Complications, Cardiovascular; Prenatal Diagnosis
PubMed: 18652927
DOI: 10.1053/j.semperi.2008.04.009 -
BMC Pregnancy and Childbirth Jan 2013Maternal age is a known risk factor for stillbirth and delayed childbearing is a societal norm in developed country settings. The timing and reasons for age being a risk...
BACKGROUND
Maternal age is a known risk factor for stillbirth and delayed childbearing is a societal norm in developed country settings. The timing and reasons for age being a risk factor are less clear. This study aimed to document the gestational specific risk of maternal age throughout pregnancy and whether the underlying causes of stillbirth differ for older women.
METHODS
Using linkage of state maternity and perinatal death data collections the authors assessed risk factors for antepartum stillbirth in New South Wales Australia for births between 2002 - 2006 (n = 327,690) using a Cox proportional hazards model. Gestational age specific risk was calculated for different maternal age groups. Deaths were classified according to the Perinatal Mortality Classifications of the Perinatal Society of Australia and New Zealand.
RESULTS
Maternal age was a significant independent risk factor for antepartum stillbirth (35 - 39 years HR 1.4 95% CI 1.12 - 1.75; ≥ 40 years HR 2.41 95% CI 1.8 - 3.23). Other significant risk factors were smoking HR 1.82 (95% CI 1.56 -2.12) nulliparity HR 1.23 (95% CI 1.08 - 1.40), pre-existing hypertension HR 2.77 (95% CI 1.94 - 3.97) and pre-existing diabetes HR 2.65 (95% CI 1.63 - 4.32). For women aged 40 or over the risk of antepartum stillbirth beyond 40 weeks was 1 in 455 ongoing pregnancies compared with 1 in 1177 ongoing pregnancies for those under 40. This risk was increased in nulliparous women to 1 in 247 ongoing pregnancies. Unexplained stillbirths were the most common classification for all women, stillbirths classified as perinatal infection were more common in the women aged 40 or above.
CONCLUSIONS
Women aged 35 or older in a first pregnancy should be counselled regarding stillbirth risk at the end of pregnancy to assist with informed decision making regarding delivery. For women aged 40 or older in their first pregnancy it would be reasonable to offer induction of labour by 40 weeks gestation.
Topics: Adult; Cause of Death; Cohort Studies; Female; Gestational Age; Humans; Maternal Age; Middle Aged; New South Wales; Parity; Perinatal Mortality; Pregnancy; Pregnancy Complications; Proportional Hazards Models; Risk Factors; Stillbirth
PubMed: 23324309
DOI: 10.1186/1471-2393-13-12 -
The Journal of Obstetrics and... Oct 2008We sought to assess the risk of antepartum and intrapartum stillbirth subtypes among women of advanced age.
AIM
We sought to assess the risk of antepartum and intrapartum stillbirth subtypes among women of advanced age.
METHODS
This is a retrospective cohort study using the Missouri maternally linked data containing births from 1978 to 1997. We examined the impact of maternal age on total, antepartum and intrapartum stillbirth across five maternal age group quintiles (20-24, 25-29, 30-34, 35-39 and >or=40) using mothers aged 20-24 years as the referent category. By means of the Cox proportional hazards regression models we obtained adjusted hazards ratios that quantified the magnitude of association between maternal age and the stillbirth subtypes.
RESULTS
The rates of antepartum and intrapartum stillbirth were greatest for older mothers (9.3/1000 and 1.2/1000 respectively) and lowest for gravidas aged 25-29 years (3.6/1000 and 0.8/1000 respectively). After adjusting for potentially confounding characteristics, older mothers still remained at greatest risk for antepartum and intrapartum stillbirth (adjusted hazards ratio = 3.6, 95% confidence interval = 2.9-4.4; and adjusted hazards ratio = 2.7, 95% confidence interval = 2.0-3.6 for antepartum and intrapartum stillbirth respectively). The risks for the two subtypes of stillbirth also increased with ascending maternal age in a dose-dependent pattern.
CONCLUSIONS
As the demographic distribution of pregnant women persistently shifts to the right, care-providers will be increasingly confronted with elevated risks for adverse fetal outcomes among older mothers. Our results confirm this phenomenon and add new findings in relation to the elevated risk for intrapartum stillbirth among mothers advanced for age.
Topics: Adult; Cohort Studies; Female; Humans; Maternal Age; Pregnancy; Retrospective Studies; Stillbirth; Young Adult
PubMed: 18834344
DOI: 10.1111/j.1447-0756.2008.00855.x -
International Journal of Gynaecology... Nov 2019To classify cause-of-death (COD) for stillbirths occurring in a major referral hospital in Kumasi, Ghana.
OBJECTIVE
To classify cause-of-death (COD) for stillbirths occurring in a major referral hospital in Kumasi, Ghana.
METHODS
In a retrospective review conducted between June 8, 2011, and June 12, 2012, detailed information was collected on all stillbirths delivered at Komfo Anokye Teaching Hospital in Kumasi, Ghana. Patient records were independently reviewed by investigators using the Perinatal Society of Australia and New Zealand's Perinatal Death Classification system to determine COD for each case.
RESULTS
COD was analyzed in 465 stillbirth cases. The leading causes of death were hypoxic interpartum death (105, 22.6%), antepartum hemorrhage (67, 14.4%), hypertension (52, 11.2%), and perinatal infection (32, 6.9%). One hundred and fifty seven (33.8%) stillbirths were classified as unexplained antepartum deaths.
CONCLUSIONS
This evaluation of stillbirth in a busy, tertiary care hospital in Kumasi, Ghana provides crucial insight into the high volume of stillbirth in Ghana as well as its medical causes. The study demonstrated the high rate of stillbirth attributed to hypoxic intrapartum events, placental abruption, pre-eclampsia, and unspecified bacterial infections. Yet, our rate of unexplained stillbirths underscores the need for a stillbirth classification system that thoughtfully integrates the needs and limitations of low-resource settings as unexplained stillbirth rates are a common indicator of the effectiveness of a classification system.
Topics: Adult; Cause of Death; Female; Ghana; Humans; Infant, Newborn; Obstetric Labor Complications; Pregnancy; Retrospective Studies; Stillbirth
PubMed: 31353461
DOI: 10.1002/ijgo.12930 -
Clinical Obstetrics and Gynecology Sep 2010World-wide, there are between 3 and 4 million stillbirths delivered each year, 98% of these deaths occur in the developing world. Although there are very significant... (Review)
Review
World-wide, there are between 3 and 4 million stillbirths delivered each year, 98% of these deaths occur in the developing world. Although there are very significant differences in the rate and causes of stillbirth in these settings, the study of stillbirth globally gives insight into the interaction between the fetal and maternal conditions in the setting of varying access to healthy food, access to medical care, treatment of infections, screening of congenital anomalies, education, and access to antepartum and intrapartum care.
Topics: Female; Fetal Death; Fetal Growth Retardation; Fetal Movement; Humans; Maternal Age; Obesity; Parity; Preconception Care; Pregnancy; Pregnancy Trimesters; Pregnancy, High-Risk; Pregnancy, Multiple; Prenatal Care; Racial Groups; Risk Factors; Smoking; Stillbirth; Substance-Related Disorders
PubMed: 20661043
DOI: 10.1097/GRF.0b013e3181eb63fc -
European Journal of Obstetrics,... Oct 2013To estimate the effectiveness of antepartum surveillance and delivery at 41 weeks in reducing the risk of stillbirth in advanced maternal age (AMA) patients.
OBJECTIVE
To estimate the effectiveness of antepartum surveillance and delivery at 41 weeks in reducing the risk of stillbirth in advanced maternal age (AMA) patients.
STUDY DESIGN
Retrospective cohort study of all patients managed in one maternal-fetal medicine practice from June 2005 to May 2012. We included all singleton pregnancies delivered at ≥ 20 weeks of gestation. All AMA patients (age ≥ 35 years at their estimated delivery date) underwent weekly biophysical profile testing beginning at 36 weeks, as well as planned delivery at 41 weeks, or sooner if indicated. We compared the rate of fetal death at ≥ 20 weeks and fetal death at ≥ 36 weeks in AMA vs. non-AMA patients. Fetal deaths due to lethal and chromosomal abnormalities were excluded.
RESULTS
4469 patients met the inclusion criteria: 1541 (34.5%) were AMA and 2928 (65.5%) were non-AMA. Using our AMA protocol for surveillance and timing of delivery, the incidence of stillbirth was similar to the non-AMA population (stillbirth ≥ 20 weeks: 3.9 per 1000 vs. 3.4 per 1000, p=0.799; stillbirth ≥ 36 weeks: 1.4 per 1000 vs. 1.1 per 1000, p=0.773). When looking at women age <35, age 35-39, and age ≥ 40, the incidence of stillbirth ≥ 20 weeks and ≥ 36 weeks did not increase across the three groups. Our findings were similar when we excluded all patients with other indications for antepartum surveillance.
CONCLUSIONS
In AMA patients, antepartum surveillance and delivery at 41 weeks appears to reduce the risk of stillbirth to that of the non-AMA population. Routine antepartum surveillance should be considered in all AMA patients.
Topics: Adult; Female; Humans; Maternal Age; New York; Population Surveillance; Pregnancy; Prenatal Care; Retrospective Studies; Stillbirth; Young Adult
PubMed: 23932303
DOI: 10.1016/j.ejogrb.2013.07.035 -
PloS One 2013To compare the risk of stillbirth and miscarriage in a subsequent pregnancy in women with a previous caesarean or vaginal delivery. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To compare the risk of stillbirth and miscarriage in a subsequent pregnancy in women with a previous caesarean or vaginal delivery.
DESIGN
Systematic review of the published literature including seven databases: CINAHL; the Cochrane library; Embase; Medline; PubMed; SCOPUS and Web of Knowledge from 1945 until November 11(th) 2011, using a detailed search-strategy and cross-checking of reference lists.
STUDY SELECTION
Cohort, case-control and cross-sectional studies examining the association between previous caesarean section and subsequent stillbirth or miscarriage risk. Two assessors screened titles to identify eligible studies, using a standardised data abstraction form and assessed study quality.
DATA SYNTHESIS
11 articles were included for stillbirth, totalling 1,961,829 pregnancies and 7,308 events. Eight eligible articles were included for miscarriage, totalling 147,017 pregnancies and 12,682 events. Pooled estimates across the stillbirth studies were obtained using random-effect models. Among women with a previous caesarean an increase in odds of 1.23 [95% CI 1.08, 1.40] for stillbirth was yielded. Subgroup analyses including unexplained stillbirths yielded an OR of 1.47 [95% CI 1.20, 1.80], an OR of 2.11 [95% CI 1.16, 3.84] for explained stillbirths and an OR of 1.27 [95% CI 0.95, 1.70] for antepartum stillbirths. Only one study reported adjusted estimates in the miscarriage review, therefore results are presented individually.
CONCLUSIONS
Given the recent revision of the National Institute for Health and Clinical Excellence guidelines (NICE), providing women the right to request a caesarean, it is essential to establish whether mode of delivery has an association with subsequent risk of stillbirth or miscarriage. Overall, compared to vaginal delivery, the pooled estimates suggest that caesarean delivery may increase the risk of stillbirth by 23%. Results for the miscarriage review were inconsistent and lack of adjustment for confounding was a major limitation. Higher methodological quality research is required to reliably assess the risk of miscarriage in subsequent pregnancies.
Topics: Abortion, Spontaneous; Adult; Case-Control Studies; Cesarean Section; Cohort Studies; Cross-Sectional Studies; Databases, Bibliographic; Female; Humans; Likelihood Functions; Middle Aged; Pregnancy; Risk Factors; Stillbirth
PubMed: 23372739
DOI: 10.1371/journal.pone.0054588 -
The Journal of Maternal-fetal &... Jul 2022To identify risk factors for antepartum fetal death (APD) in term pregnancies while considering maternal, pregnancy and fetal characteristics.
OBJECTIVE
To identify risk factors for antepartum fetal death (APD) in term pregnancies while considering maternal, pregnancy and fetal characteristics.
MATERIALS AND METHODS
Our study took place between the years 1988-2013. A total of 272,527 singleton births at term were recorded during this time period, including 524 cases of APD (0.2%). Cases of known chromosomal or other fetal abnormalities and cases with poor prenatal care were excluded. In order to identify independent risk factors contributing to antepartum fetal death in term we conducted a multivariate analysis using logistic regression.
RESULTS
The main risk factors found to be significantly associated with APD in term were suspected intrauterine growth restriction (OR = 2.70, < .001), diabetes (OR = 1.37, = .05), hypertensive disorders (OR = 1.59, = .01), advanced maternal age (OR = 1.03, < .001) and grand-multiparity (OR = 1.79, < .001). Advanced gestational age was not significantly associated with APD (38.95 vs. 39.44, < .001).
CONCLUSIONS
Most of the risk factors for antepartum fetal death in term pregnancies found in this study coincide with known risk factors for APD as described in previous studies. We believe that in the presence of these risk factors, closer surveillance and careful medical management of the pregnancy are required, in order to reduce the incidence of APD, including induction of labor at advanced gestational age.
Topics: Female; Fetal Death; Gestational Age; Humans; Labor, Obstetric; Pregnancy; Prenatal Care; Risk Factors
PubMed: 32715816
DOI: 10.1080/14767058.2020.1797664