Maternal and fetal risk factors for stillbirth: population based study

Gardosi, Jason; Madurasinghe, Vichithranie; Williams, Mandy; Malik, Asad Khizar; Francis, André

doi:10.1136/bmj.f108

Cited by 761 publications

(814 citation statements)

References 29 publications

(27 reference statements)

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“…Our data demonstrate that poor fetal growth and SGA at birth, particularly when not suspected during pregnancy, are asociated with antepartum stillbirth 9. However, this association was less evident in the subset of women with longitudinal ultrasound data, selected as they were, for low risk of growth problems.…”

Section: Discussionmentioning

confidence: 58%

The antepartum stillbirth syndrome: risk factors and pregnancy conditions identified from the INTERGROWTH‐21^st Project

Hirst

Villar

Víctora

et al. 2016

BJOG

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ObjectivesTo identify risk factors for antepartum stillbirth, including fetal growth restriction, among women with well‐dated pregnancies and access to antenatal care.DesignPopulation‐based, prospective, observational study.SettingEight international urban populations.PopulationPregnant women and their babies enrolled in the Newborn Cross‐Sectional Study of the INTERGROWTH‐21st Project.MethodsCox proportional hazard models were used to compare risks among antepartum stillborn and liveborn babies.Main outcome measuresAntepartum stillbirth was defined as any fetal death after 16 weeks’ gestation before the onset of labour.ResultsOf 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%.ConclusionsAntepartum 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 abstractInternational stillbirth study finds individual risks poor predictors of death but combinations promising.

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Section: Discussionmentioning

confidence: 58%

The antepartum stillbirth syndrome: risk factors and pregnancy conditions identified from the INTERGROWTH‐21^st Project

Hirst

Villar

Víctora

et al. 2016

BJOG

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“…We adjusted the risk of all outcomes of interest for maternal age, socioeconomic deprivation (Carstairs quintile), 15 parity, previous cesarean section, previous emergency admission, comorbidities (Charlson score), 16 multiple gestation, operations on amniotic cavity (including amniocentesis, sampling of chorionic villus), obstetric surgery, and for the presence of cardiac disease, hypertension/preeclampsia, and gestational diabetes [17][18][19][20][21][22][23][24] (Supplement Table 1, http://links.lww.com/SLA/B89).…”

Section: Methodsmentioning

confidence: 99%

The Risk of Adverse Pregnancy Outcomes Following Nonobstetric Surgery During Pregnancy

et al. 2017

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Objective: The aim of this study was to estimate the risk of adverse birth outcomes for women who underwent nonobstetric surgery during pregnancy compared with those who did not. Background: Previous research suggests that nonobstetric surgery occurs during 1% to 2% of pregnancies. However, there is limited evidence quantifying risks to the mother or pregnancy of such surgery. Methods: We examined maternity admissions using hospital administrative data collected between April 1, 2002, and March 31, 2012, and identified pregnancies wherein nonobstetric surgery occurred. We used logistic regression models to determine the adjusted relative risk, attributable risk, and number needed to harm of nonobstetric surgical procedures for adverse birth outcomes. Results: We identified 6,486,280 pregnancies. In 47,628 of these pregnancies, nonobstetric surgery had occurred. We found that nonobstetric surgery during pregnancy was associated with a higher risk of adverse birth outcomes, although the attributable risk was generally low. We estimated that every 287 surgical operations were associated with 1 additional stillbirth, every 31 operations associated with 1 additional preterm delivery, every 39 operations associated with 1 additional low birth weight baby, every 25 operations associated with 1 additional caesarean section, and every 50 operations associated with 1 additional long inpatient stay. Conclusions: Although we have no means of disentangling the effect of the surgery from the effect of the underlying condition, we found that the risk associated with nonobstetric surgery was relatively low, confirming that surgical procedures during pregnancy are generally safe. We believe that our findings improve upon previous research, and are useful reference points for any discussion of risk with prospective patients.Keywords: complications, obstetric, pregnancy, safety, surgery (Ann Surg 2017;266:260-266) T raditional teaching states that there is an increased risk of miscarriage, stillbirth, and preterm labor when a pregnant woman undergoes surgery under general anesthesia during pregnancy.1 This risk has however never been quantified and such risks may have decreased with the use of modern anesthetic agents and techniques. At present, when counseling a pregnant woman on this risk, the information provided is not robustly evidence-based.Previous research suggests that 1% to 2 % of women undergo nonobstetric surgery during pregnancy, 2 common operations being appendicectomy, cancer surgery, and orthopedic procedures. Research has also suggested that nonobstetric surgery during pregnancy is associated with adverse birth outcomes: a Canadian study of 2565 pregnant women reported an increased risk of spontaneous abortion after a general anesthetic [relative risk (RR) ¼ 1.58, 95% confidence interval (95% CI) 1.19-2.09];3 and a Swedish registry study showed associations between nonobstetric operations during pregnancy and low birth weight. 4 A systematic review brought these and many smaller studies together.5 In this analy...

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“…Despite the fact that two thirds of stillbirths were traditionally considered unexplained, it was revealed that 43% of these fetuses were FGR using a different stillbirth post-mortem classification system [5]. Furthermore, a retrospective population study has shown that the antenatal detection of SGA could potentially halve the risk of stillbirth [6]. Therefore, improving the identification of the small for gestational age (SGA) fetuses potentially could prevent stillbirth, likely through appropriate antenatal surveillance and timely delivery [6][7][8][9].…”

Section: Highlightsmentioning

confidence: 99%

“…Furthermore, a retrospective population study has shown that the antenatal detection of SGA could potentially halve the risk of stillbirth [6]. Therefore, improving the identification of the small for gestational age (SGA) fetuses potentially could prevent stillbirth, likely through appropriate antenatal surveillance and timely delivery [6][7][8][9]. At present, the prenatal detection of SGA is achieved in only about 1 in 4 cases [6][7][8][9].…”

Section: Highlightsmentioning

confidence: 99%

Role of uteroplacental and fetal Doppler in identifying fetal growth restriction at term

Khalil

Thilaganathan

2017

Best Practice & Research Clinical Obstetrics & Gynaecol

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Identification of the fetus at risk of adverse outcome at term is a challenge to both clinicians and researchers alike. Despite the fact that fetal growth restriction (FGR) is a known risk factor for stillbirth, at least two thirds of the stillbirth cases at term are not small for gestational age (SGA) -a commonly used proxy for FGR. However, the majority of SGA fetuses are constitutionally small babies and do not suffer from adverse perinatal outcome. Doppler cerebroplacental ratio (CPR) is emerging as a marker of failure to reach growth potential at term. CPR is an independent predictor of intrapartum fetal distress, admission to the neonatal unit at term, stillbirth, perinatal death and neonatal morbidity. Raised uterine artery Doppler resistance in the third trimester is independently associated with significantly lower birthweight and CPR. The combination of the estimated fetal weight, CPR and uterine Doppler in the third trimester can identify the majority of fetuses at risk of stillbirth. HIGHLIGHTS Despite the fact that fetal growth restriction (FGR) is a known risk factor for stillbirth, the majority of fetuses suffering from stillbirth at term are not small for gestational age. Serial measurements to assess growth velocity, combined with fetal Doppler, are preferable than a single point estimate. The cerebroplacental ratio (CPR) is emerging as a marker of failure to reach growth potential at term  The combination of the estimated fetal weight, CPR and uterine Doppler in the third trimester can identify the majority of fetuses at risk of stillbirth Highlights (for review) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 2 ABSTRACT Identification of the fetus at risk of adverse outcome at term is a challenge to both clinicians and researchers alike. Despite the fact that fetal growth restriction (FGR) is a known risk factor for stillbirth, at least two thirds of the stillbirth cases at term are not small for gestational age (SGA) -a commonly used proxy for FGR. However, the majority of SGA fetuses are constitutionally small babies and do not suffer from adverse perinatal outcome. Doppler cerebroplacental ratio (CPR) is emerging as a marker of failure to reach growth potential at term. CPR is an independent predictor of intrapartum fetal distress, admission to the neonatal unit at term, stillbirth, perinatal death and neonatal morbidity. Raised uterine artery Doppler resistance in the third trimester is independently associated with significantly lower birthweight and CPR. The combination of the estimated fetal weight, CPR and uterine Doppler in the t...

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Maternal and fetal risk factors for stillbirth: population based study

Cited by 761 publications

References 29 publications

The antepartum stillbirth syndrome: risk factors and pregnancy conditions identified from the INTERGROWTH‐21^st Project

The antepartum stillbirth syndrome: risk factors and pregnancy conditions identified from the INTERGROWTH‐21^st Project

The Risk of Adverse Pregnancy Outcomes Following Nonobstetric Surgery During Pregnancy

Role of uteroplacental and fetal Doppler in identifying fetal growth restriction at term

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Maternal and fetal risk factors for stillbirth: population based study

Cited by 761 publications

References 29 publications

The antepartum stillbirth syndrome: risk factors and pregnancy conditions identified from the INTERGROWTH‐21st Project

The antepartum stillbirth syndrome: risk factors and pregnancy conditions identified from the INTERGROWTH‐21st Project

The Risk of Adverse Pregnancy Outcomes Following Nonobstetric Surgery During Pregnancy

Role of uteroplacental and fetal Doppler in identifying fetal growth restriction at term

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Product

Resources

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The antepartum stillbirth syndrome: risk factors and pregnancy conditions identified from the INTERGROWTH‐21^st Project

The antepartum stillbirth syndrome: risk factors and pregnancy conditions identified from the INTERGROWTH‐21^st Project