-
BJOG : An International Journal of... May 2008To determine if a previous caesarean section increases the risk of unexplained antepartum stillbirth in second pregnancies.
OBJECTIVE
To determine if a previous caesarean section increases the risk of unexplained antepartum stillbirth in second pregnancies.
STUDY DESIGN
Retrospective cohort study.
SETTING
Large Canadian perinatal database.
POPULATION
158 502 second births.
METHODS
Data were obtained from a large perinatal database, which supplied data on demographics, pregnancy complications, maternal medical conditions, previous caesarean section and pregnancy outcomes.
MAIN OUTCOME MEASURES
Total and unexplained stillbirth.
RESULTS
The antepartum stillbirth rate was 3.0/1000 in the previous caesarean section group compared with 2.7/1000 in the previous vaginal delivery group (P= 0.46). Multivariate logistic regression modelling, including terms for maternal age (polynomial), weight >91 kg, smoking during pregnancy, pre-pregnancy hypertension and diabetes, did not document an association between previous caesarean section and unexplained antepartum stillbirth (OR 1.27, 95% CI 0.92-1.77).
CONCLUSION
Caesarean section in the first birth does not increase the risk of unexplained antepartum stillbirth in second pregnancies.
Topics: Adult; Alberta; Cesarean Section; Epidemiologic Methods; Female; Humans; Maternal Age; Parity; Pregnancy; Pregnancy Complications; Premature Birth; Stillbirth
PubMed: 18410656
DOI: 10.1111/j.1471-0528.2008.01705.x -
American Journal of Obstetrics and... Feb 2001This study investigated whether the risk of antepartum stillbirth increases with body mass index during early pregnancy and also investigated the association between...
OBJECTIVE
This study investigated whether the risk of antepartum stillbirth increases with body mass index during early pregnancy and also investigated the association between weight gain during pregnancy and the risk of antepartum stillbirth.
STUDY DESIGN
This population-based case-control study included 649 women with antepartum stillbirths and 690 control subjects among Swedish nulliparous women.
RESULTS
Compared with lean mothers (body mass index < or = 19.9 kg/m2), the odds ratios for risk of antepartum deaths were as follows: normal weight (body mass index, 20.0-24.9 kg/m2) odds ratio, 1.2 (95% confidence interval, 0.8-1.7); overweight (body mass index 25.0-29.9 kg/m2), odds ratio, 1.9 (95% confidence interval, 1.2-2.9); and obese (body mass index > or = 30.0 kg/m2) odds ratio, 2.1 (95% confidence interval, 1.2-3.6). For term antepartum death corresponding risks were even higher, with odds ratios of 1.6 (95% confidence interval, 0.9-2.6) for normal weight, 2.7 (95% confidence interval, 1.5-5.0) for overweight, and 2.8 (95% confidence interval, 1.3-6.0) for obese women, respectively. Maternal weight gain during pregnancy was not associated with risk of antepartum stillbirth.
CONCLUSION
Maternal overweight condition increased the risk of antepartum stillbirth, especially term antepartum stillbirth, whereas weight gain during pregnancy was not associated with risk.
Topics: Adolescent; Adult; Body Mass Index; Case-Control Studies; Employment; Female; Fetal Death; Humans; Linear Models; Obesity; Pregnancy; Prospective Studies; Regression Analysis; Risk Factors; Sweden; Weight Gain
PubMed: 11228504
DOI: 10.1067/mob.2001.109591 -
Early Human Development Dec 2013This study aims to assess the frequency of fetal bacterial infections in stillbirth (SB) and to evaluate the best samples for the diagnosis of infection-related SB.
OBJECTIVES
This study aims to assess the frequency of fetal bacterial infections in stillbirth (SB) and to evaluate the best samples for the diagnosis of infection-related SB.
STUDY DESIGN
Consecutive cases of antepartum SB were enrolled. Vaginal and placental swabs, as well as heart blood cultures and surface swabs from the neonate, were collected. Histological examinations were performed by the same examiner. Immunohistochemistry for leukocyte common antigen was performed in the placenta and fetus. Each case was discussed in a multidisciplinary audit.
RESULTS
One hundred and nine cases were enrolled. Fetal blood cultures were positive in 20/95 cases (21%). Significant histological findings in the placenta/cord and in at least one fetal organ were observed in 8 cases of them (4 Group B Streptococcus GBS, 2 Listeria monocytogenes, 1 Coagulase negative Staphylococcus, 1 Pseudomonas aeruginosa). Neither tissue damage nor inflammatory infiltrate was found in the 12 remnant cases. Funisitis while not histological chorioamnionitis was associated with microbiological findings. Positive findings in maternal/placental/fetal swabs occurred in 18-32% of cases with both negative fetal blood cultures and histopathological findings. With the exception of GBS, no other bacteria agent could be detected by any of the swabs.
CONCLUSIONS
Eight cases (8.4%) fulfilled both microbiological and histology criteria allowing the diagnosis of SB-related fetal infection demonstrating that search for infections is essential in SB evaluation. Fetal blood culture, placenta swab for GBS and search for histological funisitis are mandatory actions within the SB work-up in order to guide pathology examination and reach clinical conclusions.
Topics: Bacterial Infections; Chorioamnionitis; Female; Fetal Blood; Fetal Death; Humans; Immunohistochemistry; Italy; Leukocyte Common Antigens; Pregnancy; Prevalence; Sensitivity and Specificity
PubMed: 24041816
DOI: 10.1016/j.earlhumdev.2013.08.010 -
Seminars in Perinatology Feb 2002Although certain maternal medical conditions increase the risk of antepartum fetal death, improvements in medical and obstetric care have decreased the likelihood of... (Review)
Review
Although certain maternal medical conditions increase the risk of antepartum fetal death, improvements in medical and obstetric care have decreased the likelihood of stillbirth. This article examines the current stillbirth rates reported in pregnancies complicated by common medical diseases. The reported stillbirth rates are expressed as the number of stillbirths occurring at > or = 20 weeks of gestation per 1,000 births in patients with the condition. Overall, about 10% of all fetal deaths are related to maternal medical illnesses such as hypertension, diabetes, obesity, systemic lupus erythematosus, chronic renal disease, thyroid disorders, and cholestasis of pregnancy. The early recognition of maternal medical diseases provides an opportunity for increased surveillance and interventions that may lead to more favorable pregnancy outcomes.
Topics: Cholestasis; Chronic Disease; Diabetes Complications; Female; Fetal Death; Humans; Hypertension; Kidney Diseases; Lupus Erythematosus, Systemic; Obesity; Pregnancy; Pregnancy Complications; Risk Factors; Thyroid Diseases
PubMed: 11876567
DOI: 10.1053/sper.2002.29838 -
Obstetrics and Gynecology Clinics of... Jun 2014During early gestation, drugs have teratogenic effects and can be associated with structural anomalies in the fetus. Substance abuse can also have physiologic effects on... (Review)
Review
During early gestation, drugs have teratogenic effects and can be associated with structural anomalies in the fetus. Substance abuse can also have physiologic effects on the mother and fetus, including decreased uterine blood flow, increased vascular resistance, and an increase in fetal blood pressure. Women at increased risk for stillbirth should undergo antepartum fetal surveillance initiated at 32 weeks of gestation. Because of the high incidence of low birth weight, fetal anomalies, preterm delivery, and growth restriction in these patients, ultrasonography for appropriate pregnancy dating, a detailed anatomic survey, and cervical length should be performed at 20 weeks' gestation.
Topics: Female; Fetal Monitoring; Humans; Infant, Newborn; Labor, Obstetric; Mothers; Practice Guidelines as Topic; Pregnancy; Risk Factors; Substance Abuse Detection; Substance-Related Disorders
PubMed: 24845492
DOI: 10.1016/j.ogc.2014.02.009 -
The Medical Journal of Australia Sep 2012To determine if maternal country of birth is associated with the risk of antepartum stillbirth in late pregnancy.
OBJECTIVE
To determine if maternal country of birth is associated with the risk of antepartum stillbirth in late pregnancy.
DESIGN, SETTING AND PARTICIPANTS
Retrospective cross-sectional study of all singleton births at 37-42 weeks' gestation, excluding those with congenital abnormalities and intrapartum stillbirths, between 1 June 2001 and 31 May 2011 at Southern Health, a large metropolitan maternity service in Melbourne, Australia.
MAIN OUTCOME MEASURE
Rate of late-pregnancy antepartum stillbirth, analysed by maternal country of birth.
RESULTS
Among 44 326 births, there was a significant difference in the stillbirth rate by maternal country of birth (P < 0.001). The rate of stillbirth per 1000 births was 1.48 among Australian-born women, 3.55 among South Asian-born women and 1.06 among South-East-East Asian-born women. Women born in South Asia were 2.4 (95% CI, 1.4-4.0) times more likely to have a late-pregnancy stillbirth than women born in Australia (P < 0.001). There was no significant difference between women born in Australia and women born in South-East-East Asia (P = 0.34). Adjusting for potential confounding factors, South Asian maternal birth remained an independent risk factor for stillbirth (adjusted odds ratio, 2.5; 95% CI, 1.3-5.1; P = 0.009).
CONCLUSION
Women born in South Asia have an increased risk of antepartum stillbirth in late pregnancy, compared with other women. This observation may have implications for the delivery of pregnancy care in Australia.
Topics: Adult; Asia; Asia, Southeastern; Australia; Chi-Square Distribution; Congenital Abnormalities; Cross-Sectional Studies; Female; Humans; Pregnancy; Pregnancy Trimester, Third; Retrospective Studies; Risk Factors; Stillbirth
PubMed: 22938125
DOI: 10.5694/mja12.10125 -
Journal of Perinatal Medicine Jul 2022The identification of causes of stillbirth (SB) can be a challenge due to several different classification systems of SB causes. In the scientific literature there is a...
OBJECTIVES
The identification of causes of stillbirth (SB) can be a challenge due to several different classification systems of SB causes. In the scientific literature there is a continuous emergence of SB classification systems, not allowing uniform data collection and comparisons between populations from different geographical areas. For these reasons, this study compared two of the most used SB classifications, aiming to identify which of them should be preferable.
METHODS
A total of 191 SBs were retrospectively classified by a panel composed by three experienced-physicians throughout the ReCoDe and ICD-PM systems to evaluate which classification minimizes unclassified/unspecified cases. In addition, intra and inter-rater agreements were calculated.
RESULTS
ReCoDe defined: the 23.6% of cases as unexplained, placental insufficiency in the 14.1%, lethal congenital anomalies in the 12%, infection in the 9.4%, abruptio in the 7.3%, and chorioamnionitis in the 7.3%. ICD-PM defined: the 20.9% of cases as unspecified, antepartum hypoxia in the 44%, congenital malformations, deformations, and chromosomal abnormalities in the 11.5%, and infection in the 11.5%. For ReCoDe, inter-rater was agreement of 0.58; intra-rater agreements were 0.78 and 0.79. For ICD-PM, inter-rater agreement was 0.54; intra-rater agreements were of 0.76 and 0.71.
CONCLUSIONS
There is no significant difference between ReCoDe and ICD-PM classifications in minimizing unexplained/unspecified cases. Inter and intra-rater agreements were largely suboptimal for both ReCoDe and ICD-PM due to their lack of specific guidelines which can facilitate the interpretation. Thus, the authors suggest correctives strategies: the implementation of specific guidelines and illustrative case reports to easily solve interpretation issues.
Topics: Cause of Death; Chromosome Aberrations; Female; Humans; Placenta; Pregnancy; Retrospective Studies; Stillbirth
PubMed: 35607751
DOI: 10.1515/jpm-2022-0014 -
JAMA Nov 2004Preterm birth and low birth weight are determined, at least in part, during the first trimester of pregnancy. However, it is unknown whether the risk of stillbirth is...
CONTEXT
Preterm birth and low birth weight are determined, at least in part, during the first trimester of pregnancy. However, it is unknown whether the risk of stillbirth is also determined during the first trimester.
OBJECTIVE
To determine whether the risk of antepartum stillbirth varies in relation to circulating markers of placental function measured during the first trimester of pregnancy.
DESIGN, SETTING, AND PARTICIPANTS
Multicenter, prospective cohort study (conducted in Scotland from 1998 through 2000) of 7934 women who had singleton births at or after 24 weeks' gestation, who had blood taken during the first 10 weeks after conception, and who were entered into national registries of births and perinatal deaths.
MAIN OUTCOME MEASURES
Antepartum stillbirths and stillbirths due to specific causes.
RESULTS
There were 8 stillbirths among the 400 women with levels of pregnancy-associated plasma protein A (PAPP-A) in the lowest fifth percentile compared with 17 among the remaining 7534 women (incidence rate per 10,000 women per week of gestation: 13.4 vs 1.4, respectively; hazard ratio [HR], 9.2 [95% confidence interval [CI], 4.0-21.4]; P<.001). When analyzed by cause of stillbirth, low level of PAPP-A was strongly associated with stillbirth due to placental dysfunction, defined as abruption or unexplained stillbirth associated with growth restriction (incidence rate: 11.7 vs 0.3, respectively; HR, 46.0 [95% CI, 11.9-178.0]; P<.001), but was not associated with other causes of stillbirth (incidence rate: 1.7 vs 1.1, respectively; HR, 1.4 [95% CI, 0.2-10.6]; P = .75). There was no relationship between having a low level of PAPP-A and maternal age, ethnicity, parity, height, body mass index, race, or marital status. Adjustment for maternal factors did not attenuate the strength of associations observed. There was no association between maternal circulating levels of the free beta subunit of human chorionic gonadotropin and stillbirth risk.
CONCLUSION
The risk of stillbirth in late pregnancy may be determined by placental function in the first 10 weeks after conception.
Topics: Chorionic Gonadotropin, beta Subunit, Human; Cohort Studies; Female; Fetal Death; Humans; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, First; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Pregnancy-Associated Plasma Protein-A; Proportional Hazards Models; Risk
PubMed: 15536112
DOI: 10.1001/jama.292.18.2249 -
International Journal of Gynaecology... Jun 2011To assess stillbirth rates and antepartum risk factors in rural Nepal.
OBJECTIVE
To assess stillbirth rates and antepartum risk factors in rural Nepal.
METHODS
Data were collected prospectively during a cluster-randomized, community-based trial in Sarlahi, Nepal, from 2002 to 2006. Multivariate regression modeling was performed to calculate adjusted relative risk estimates.
RESULTS
Among 24531 births, the stillbirth rate was 35.4 per 1000 births (term stillbirth rate 21.2 per 1000 births). Most births occurred at home without a skilled birth attendant. The majority (69%) of intrapartum maternal deaths resulted in stillbirth. The adjusted RR (aRR) of stillbirth was 2.74 among nulliparas and 1.47 among mothers with history of a child death. Mothers above the age of 30 years carried a 1.59-fold higher risk for stillbirth than mothers who were 20-24 years old. The stillbirth risk was lower among households where the father had any formal education (aRR 0.70). Land ownership (aRR 0.85) and Pahadi ethnicity (aRR 0.67; reference: Madhesi ethnicity) were associated with significantly lower risks of stillbirth.
CONCLUSION
Stillbirth rates were high in rural Nepal, with the majority of stillbirths occurring at full-term gestation. Nulliparity, history of prior child loss, maternal age above 30 years, Madhesi ethnicity, and socioeconomic disadvantage were significant risk factors for stillbirth. Clinicaltrials.govNCT00 109616.
Topics: Adolescent; Adult; Female; Humans; Logistic Models; Maternal Age; Nepal; Pregnancy; Retrospective Studies; Risk Factors; Rural Health; Socioeconomic Factors; Stillbirth; Young Adult
PubMed: 21458812
DOI: 10.1016/j.ijgo.2010.12.015 -
BJOG : An International Journal of... Jan 2021To estimate a stillbirth rate at 24 or more gestational weeks in 2015-2016 and to explore potentially preventable causes in China.
OBJECTIVE
To estimate a stillbirth rate at 24 or more gestational weeks in 2015-2016 and to explore potentially preventable causes in China.
DESIGN
A multi-centre cross-sectional study.
SETTING
Ninety-six hospitals distributed in 24 (of 34) provinces in China.
POPULATION
A total of 75 132 births at 24 completed weeks of gestation or more.
METHODS
COX Proportional Hazard Models were performed to examine risk factors for antepartum and intrapartum stillbirths. Population attributable risk percentage was calculated for major risk factors. Correspondence analysis was used to explore region-specific risk factors for stillbirths.
MAIN OUTCOME MEASURES
Stillbirth rate and risk factors for stillbirth.
RESULTS
A total of 75 132 births including 949 stillbirths were used for the final analysis, giving a weighted stillbirth rate of 13.2 per 1000 births (95% CI 7.9-18.5). Small for gestational age (SGA) and pre-eclampsia/eclampsia increased antepartum stillbirths by 26.2% and 11.7%, respectively. Fetal anomalies increased antepartum and intrapartum stillbirths by 17.9% and 7.4%, respectively. Overall, 31.4% of all stillbirths were potentially preventable. Advanced maternal age, pre-pregnant obesity, chronic hypertension and diabetes mellitus were important risk factors in East China; low education and SGA were major risk factors in Northwest, Southwest, Northeast and South China; and pre-eclampsia/eclampsia and intrapartum complications were significant risk factors in Central China.
CONCLUSIONS
The prevalence of stillbirth was 13.2 per 1000 births in China in 2015-2016. Nearly one-third of all stillbirths may be preventable. Strategies based on regional characteristics should be considered to reduce further the burden of stillbirths in China.
TWEETABLE ABSTRACT
The stillbirth rate was 13.2 per 1000 births in China in 2015-2016 and nearly one-third of all stillbirths may be preventable.
Topics: China; Cross-Sectional Studies; Female; Gestational Age; Humans; Infant, Newborn; Pregnancy; Prenatal Care; Risk Factors; Socioeconomic Factors; Stillbirth; Surveys and Questionnaires
PubMed: 32770714
DOI: 10.1111/1471-0528.16458