Interventions for investigating and identifying the causes of stillbirth

Wojcieszek, Aleena M; Shepherd, Emily; Middleton, Philippa; Gardener, Glenn; Ellwood, David; McClure, Elizabeth M.; Gold, Katherine J.; Khong, T. Yee; Silver, Robert M.; Erwich, Jan Jaap H. M.; Flenady, Vicki

doi:10.1002/14651858.cd012504

Cited by 9 publications

(12 citation statements)

References 34 publications

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“…Considerable research efforts have been focused on seeking causes and modifiable risk factors to reduce the burden of these perinatal losses (Wojcieszek et al . 2018; Cronin et al . 2019).…”

Section: Introductionmentioning

confidence: 99%

“…Considerable research efforts have been focused on seeking causes and modifiable risk factors to reduce the burden of these perinatal losses (Wojcieszek et al 2018;Cronin et al 2019). Epidemiological studies have found that women who went to sleep in a supine position in late gestation had a 2-to 3-fold increased risk of stillbirth, compared to women who went to sleep on their left side (Stacey et al 2011;Gordon et al 2015;Heazell et al 2018;Cronin et al 2019).…”

Section: Introductionmentioning

confidence: 99%

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The effects of maternal position, in late gestation pregnancy, on placental blood flow and oxygenation: an MRI study

Couper

Clark

Thompson

et al. 2021

The Journal of Physiology

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Key points Maternal supine sleep position in late pregnancy is associated with an increased risk of stillbirth. Maternal supine position in late pregnancy reduces maternal cardiac output and uterine blood flow. Using MRI, this study shows that compared to the left lateral position, maternal supine position in late pregnancy is associated with reduced utero‐placental blood flow and oxygen transfer across the placenta with an average 6.2% reduction in oxygen delivery to the fetus and an average 11% reduction in fetal umbilical venous blood flow. Abstract Maternal sleep position in late gestation is associated with an increased risk of stillbirth, though the pathophysiological reasons for this are unclear. Studies using magnetic resonance imaging (MRI) have shown that compared with lateral positions, lying supine causes a reduction in cardiac output, reduced abdominal aortic blood flow and reduced vena caval flow which is only partially compensated for by increased flow in the azygos venous system. Using functional MRI techniques, including an acquisition termed diffusion–relaxation combined imaging of the placenta (DECIDE), which combines diffusion weighted imaging and T2 relaxometry, blood flow and oxygen transfer were estimated in the maternal, fetal and placental compartments when subjects were scanned both supine and in left lateral positions. In late gestation pregnancy, lying supine caused a 23.7% (P < 0.0001) reduction in total internal iliac arterial blood flow to the uterus. In addition, lying in the supine position caused a 6.2% (P = 0.038) reduction in oxygen movement across the placenta. The reductions in oxygen transfer to the fetus, termed delivery flux, of 11.2% (P = 0.0597) and in fetal oxygen saturation of 4.4% (P = 0.0793) did not reach statistical significance. It is concluded that even in healthy late gestation pregnancy, maternal position significantly affects oxygen transfer across the placenta and may in part provide an explanation for late stillbirth in vulnerable fetuses.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The effects of maternal position, in late gestation pregnancy, on placental blood flow and oxygenation: an MRI study

Couper

Clark

Thompson

et al. 2021

The Journal of Physiology

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show abstract

“…Decreasing the global burden of stillbirth mainly focuses on strategic interventions and to enable these strategic interventions to minimize stillbirth rate, identification of risk factors of stillbirth is needed. 9 The risk factors of a large proportion of stillbirths remain unknown despite an improvement in antenatal and intrapartum care and extensive testing. 10 , 11 …”

Section: Introductionmentioning

confidence: 99%

Risk Factors of Stillbirth Among Women Who Gave Birth in Amhara Region Referral Hospitals, Ethiopia, in 2019: A Case-Control Study

Liyew¹,

Molla

Azene

2021

IJWH

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Background Worldwide, 2.6 million stillbirths occur annually and more than three-quarters of them are recorded in South Asia and Sub-Saharan Africa. Thus, the aim of this study was to identify risk factors of stillbirth among women who gave birth in Amhara region referral hospitals found in northwest and northcentral, Ethiopia in 2019. Methods A multi-center institution-based unmatched case-control study was conducted among 456 mothers who gave birth in Amhara region referral hospitals from October 1 to December 30, 2019. Consecutive and simple random sampling was used to select the cases and controls, respectively. A semi-structured, interviewer-administered questionnaire and patient chart reviews were used to collect the data. Epidemiological (Epi) data version 4.4.2.1 and Statistical Package for the Social Sciences (SPSS) version 25.0 were used for data entry and analysis, respectively. Binary logistic regression was employed. An adjusted odds ratio with a 95% confidence interval was used to declare statistically significant variables on the basis of p -value<0.05 in the multivariable binary logistic regression model. Results Alcohol drinking (adjusted odds ratio (AOR)=3.02, 95% confidence interval (CI)=1.24–7.35), antepartum hemorrhage (AOR=5.74, 95% CI=2.67–12.33), premature rupture of membrane (AOR=2.21, 95% CI=1.09–4.44), meconium-stained amniotic fluid (AOR=8.18, 95% CI=4.29–15.60), non-use of partograph for labor follow-up (AOR=3.89, 95% CI=2.12–7.17), induction of labor (AOR=2.12, 95% CI=1.09–4.11), previous history of stillbirth (AOR=2.15, 95% CI=1.08–4.26), and birthweight less than 2,500 grams (AOR=7.36, 95% CI=3.43–15.81) increase the odds of stillbirth. Conclusion Stillbirth was higher among women who drank alcohol during their pregnancy, experienced antepartum hemorrhage, premature rupture of membrane, meconium-stained amniotic fluid, induction of labor, labor not followed by partograph, previous history of stillbirth, and birthweight less than 2,500 grams. As such, education to stop alcohol drinking during pregnancy, monitoring the progress of labor with partograph, and improving the quality of care for mothers and newborns at the time of pregnancy and childbirth will contribute to preventing stillbirth.

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“…Importantly, for any medical intervention, the index cause of stillbirth will influence the appropriateness of that intervention and its likelihood of effectiveness 18 43. The index cause of stillbirth and its associated recurrence risk may also influence parents’ willingness to participate in clinical trials of certain medical interventions, especially depending on the design of those trials.…”

Section: Discussionmentioning

confidence: 99%

Research priorities and potential methodologies to inform care in subsequent pregnancies following stillbirth: a web-based survey of healthcare professionals, researchers and advocates

et al. 2019

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ObjectivesTo identify research priorities and explore potential methodologies to inform care in subsequent pregnancies following a stillbirth.DesignWeb-based survey by invitation.ParticipantsMultidisciplinary panel of 79 individuals involved in stillbirth research, clinical practice and/or advocacy from the international stillbirth research community (response rate=64%).Outcome measuresImportance of 16 candidate research topics and perceived utility and appropriateness of randomised controlled trial (RCT) methodology for the evaluation of four pertinent interventions: (1) medical therapies for placental dysfunction (eg, antiplatelet agents); (2) additional antepartum fetal surveillance (eg, ultrasound scans); (3) early planned birth from 37 weeks’ gestation and (4) different forms of psychosocial support for parents and families.ResultsCandidate research topics that were rated as ‘important and urgent’ by the greatest proportion of participants were: medical therapies for placental dysfunction (81%); additional antepartum fetal surveillance (80%); the development of a core outcomes dataset for stillbirth research (79%); targeted antenatal interventions for women who have risk factors (79%) and calculating the risk of recurrent stillbirth according to specific causes of index stillbirth (79%). Whether RCT methodologies were considered appropriate for the four selected interventions varied depending on the criterion being assessed. For example, while 72% of respondents felt that RCTs were ‘the best way’ to evaluate medical therapies for placental dysfunction, fewer respondents (63%) deemed RCTs ethical in this context, and approximately only half (52%) felt that such RCTs were feasible. There was considerably less support for RCT methodology for the evaluation of different forms of psychosocial support, which was reinforced by free-text comments.ConclusionsFive priority research topics to inform care in pregnancies after stillbirth were identified. There was support for RCTs in this area, but the panel remained divided on the ethics and feasibility of such trials. Engagement with parents and families is a critical next step.

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Interventions for investigating and identifying the causes of stillbirth

Cited by 9 publications

References 34 publications

The effects of maternal position, in late gestation pregnancy, on placental blood flow and oxygenation: an MRI study

The effects of maternal position, in late gestation pregnancy, on placental blood flow and oxygenation: an MRI study

Risk Factors of Stillbirth Among Women Who Gave Birth in Amhara Region Referral Hospitals, Ethiopia, in 2019: A Case-Control Study

Research priorities and potential methodologies to inform care in subsequent pregnancies following stillbirth: a web-based survey of healthcare professionals, researchers and advocates

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