Pregnancy Outcome After Previous Stillbirth Resulting from Causes Other Than Maternal Conditions and Fetal Abnormalities

Heinonen, Seppo; Kirkinen, Pertti

doi:10.1046/j.1523-536x.2000.00033.x

Cited by 59 publications

(59 citation statements)

References 20 publications

(19 reference statements)

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“…11 All studies of pregnancy outcome subsequent to unexplained stillbirth are reassuring in terms of perinatal mortality, but report increased rates of intervention and iatrogenic adverse outcomes such as prematurity, emergency cesarean section and post-partum hemorrhage. [7][8][9][10] There is likely to be a strong Hawthorne effect in such studies as the history of a previous stillbirth increases levels of surveillance in the next pregnancy and lowers the threshold to intervene. Optimizing fetal surveillance while minimizing the risk of false-positive results that might prompt unnecessary intervention presents the major challenge in this setting.…”

Section: Early Pregnancymentioning

confidence: 99%

“…Although the odds ratio for recurrence of stillbirths from all causes is almost five, 6 studies of pregnancy outcomes subsequent to unexplained stillbirth have not reported any increase in the risk of perinatal death. [7][8][9][10] However, those studies found that pregnancy after stillbirth is characterized by increased rates of induced labor, elective and emergency cesarean section, preterm birth and low birth weight. These adverse outcomes might be at least partly the result of obstetricians having a low threshold for intervention.…”

Section: Introductionmentioning

confidence: 99%

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Management of subsequent pregnancy after an unexplained stillbirth

Robson

Leader

2009

J Perinatol

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Purpose: To review the management of pregnancy after an unexplained stillbirth.Epidemiology: Approximately 1 in 200 pregnancies will end in stillbirth, of which about one-third will remain unexplained. Unexplained stillbirth is the largest single contributor to perinatal mortality. Subsequent pregnancies do not appear to have an increased risk of stillbirth, but are characterized by increased rates of intervention (induction of labor, elective cesarean section) and iatrogenic adverse outcomes (low birth weight, prematurity, emergency cesarean section and post-partum hemorrhage). Conclusions:There is no level-one evidence to guide management in this situation. Pre-pregnancy counseling is very important to detect and correct potential risk factors such as obesity, smoking and maternal disease. As timely delivery is the mainstay of management, early accurate determination of gestational age is vital. There is controversy regarding the pattern of surveillance, but evidence exists only for ultrasound and not for regular non-stress testing, nor formal fetal movement charting. There is an urgent need for more studies in this important area.

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Section: Early Pregnancymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Management of subsequent pregnancy after an unexplained stillbirth

Robson

Leader

2009

J Perinatol

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“…This relationship is true for stillbirths as well, although because of the relative rarity of recurrence, large populations are needed to demonstrate this relationship. A typical study showed that women with a stillbirth in the first pregnancy were more likely to have low-birth-weight (odds ratio (OR) 2.7) and preterm infants (OR 2.3) in the next pregnancy as well as an eight-fold increase in placental abruptions 18 . Freeman and associates found that women with a previous stillbirth, especially if Figure 1 Rate of stillbirth by gestational age, per 1000 live fetuses at that gestational age.…”

Section: Risk Factors For Stillbirthmentioning

confidence: 99%

Stillbirth: a review

Goldenberg

Kirby

Culhane

2004

Journal of Maternal-Fetal and Neonatal Medicine

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Stillbirth occurs in nearly 1% of all births in the USA, and is one of the most common but least studied adverse pregnancy outcomes. The many risk factors for and causes of stillbirth are presented. Over the past several decades, the rate of stillbirth has been substantially reduced, with the reduction most apparent in those stillbirths previously occurring at term and/or in labor. Reductions have occurred because of reductions in risk factors (i.e. prevention of Rh disease and better control of diabetes), better antepartum monitoring of those with risk factors followed by early delivery for those fetuses found to be at risk (i.e. growth restriction, maternal pre-eclampsia), better intrapartum fetal monitoring, increases in Cesarean section for those at risk, and early detection of congenital anomalies followed by termination prior to the time that these early fetal deaths are classified as stillbirths. Finally, the value of using fetal autopsy and placental examination to determine the cause of death accurately, both for research purposes and for patient counseling in future pregnancies, is explored.

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“…5 To our knowledge, this is the first study that has exlusively assessed healthcare utilisation in the pregnancy following stillbirth compared with other pregnant women. So far, there have been few large-scale studies on mode of delivery in pregnancies following stillbirth, 17,18 particularly stillbirths of all causes. 19 Hence, this study adds to a limited body of evidence.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…17 Studies from Finland and Scotland reported similar findings. 18,19 Whether anxiety, fear or dread of childbirth partially accounts for more frequent use of interventions in pregnancies subsequent to stillbirth, however, remains unknown.…”

Section: Introductionmentioning

confidence: 99%

Healthcare utilisation, induced labour and caesarean section in the pregnancy after stillbirth: a prospective study

Gravensteen

Jacobsen

Sandset

et al. 2017

BJOG

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Objective To investigate healthcare utilisation, induced labour and caesarean section (CS) in the pregnancy after stillbirth and assess anxiety and dread of childbirth as mediators for these outcomes.Design Population-based pregnancy cohort study. Setting The Norwegian Mother and Child Cohort Study.Sample A total of 901 pregnant women; 174 pregnant after stillbirth, 362 pregnant after live birth and 365 previously nulliparous.Methods Data from questionnaires answered in the second and third trimesters of pregnancy and information from the Medical Birth Registry of Norway.Main outcome measures Self-reported assessment of antenatal care, register-based assessment of onset and mode of delivery.Results Women with a previous stillbirth had more frequent antenatal visits (mean 10.0; 95% CI 9.4-10.7) compared with women with a previous live birth (mean 6.0; 95% CI 5.8-6.2) and previously nulliparous women (mean 6.3; 95% CI 6.1-6.6). Induced labour and CS, elective and emergency, were also more prevalent in the stillbirth group. The adjusted odds ratio for elective CS was 2.5 (95% CI 1.3-5.0) compared with women with previous live birth and 3.7 (1.8-7.6) compared with previously nulliparous women. Anxiety was a minor mediator for the association between stillbirth and frequency of antenatal visits, whereas dread of childbirth was not a significant mediator for elective CS.Conclusions Women pregnant after stillbirth were more ample users of healthcare services and more often had induced labour and CS. The higher frequency of antenatal visits and elective CS could not be accounted for by anxiety or dread of childbirth.Keywords Anxiety, caesarean section, induced labour, MoBa, prenatal care, stillbirth, The Norwegian Mother and Child Cohort study. Please cite this paper as: Gravensteen IK, Jacobsen E-M, Sandset PM, Helgadottir LB, R adestad I, Sandvik L, Ekeberg Ø. Healthcare utilisation, induced labour and caesarean section in the pregnancy after stillbirth: a prospective study . BJOG 2018;125:202-210. IntroductionMost couples embark on another pregnancy after a stillbirth, as many as 50% within a year.1 In pregnancies subsequent to a miscarriage or stillbirth, many women sense a threat of an additional loss 2 and have increased generalised and pregnancy-specific anxiety. [2][3][4][5][6][7] Attempts to cope may involve asking more questions, requesting additional tests and telephoning healthcare professionals between visits. It remains uncertain whether anxiety accounts for higher healthcare utilisation in women pregnant after stillbirth and if the type of support given is helpful. In a recent international survey on care for parents in pregnancies subsequent to stillbirth, most were provided with additional visits and ultrasound scans.9 Care addressing psychosocial needs was less frequently reported. In another study including 36 women pregnant after pregnancy loss, increased healthcare utilisation was associated with maternal intrusion symptoms and state anxiety. The rate of caesarean section (CS) in Norway has increase...

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Pregnancy Outcome After Previous Stillbirth Resulting from Causes Other Than Maternal Conditions and Fetal Abnormalities

Cited by 59 publications

References 20 publications

Management of subsequent pregnancy after an unexplained stillbirth

Management of subsequent pregnancy after an unexplained stillbirth

Stillbirth: a review

Healthcare utilisation, induced labour and caesarean section in the pregnancy after stillbirth: a prospective study

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