Risk of Unexplained Stillbirth at Different Gestational Ages

Yudkin, Pat; Wood, L.; Redman, C. W. G.

doi:10.1016/s0140-6736(87)92154-4

Cited by 257 publications

(237 citation statements)

References 9 publications

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“…Similar estimates were presented in reports from New Zealand (1983 -1986) 9 and England (1978 -1985) 10 . The stillbirth rate in the expectant arm of the Canadian study was similar at two fetal deaths in 1700 women (1.18 per 1000) 2 .…”

Section: What Are the True Fetal And Neonatal Risks Of Reaching 41 Wesupporting

confidence: 87%

Routine induction of labour at 41 weeks gestation: nonsensus consensus

Menticoglou¹

2002

BJOG: An International Journal of Obstetrics and Gynaecology

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Section: What Are the True Fetal And Neonatal Risks Of Reaching 41 Wesupporting

confidence: 87%

Routine induction of labour at 41 weeks gestation: nonsensus consensus

Menticoglou¹

2002

BJOG: An International Journal of Obstetrics and Gynaecology

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“…The risk of stillbirth was compared between groups using time-to-event analyses in which week of gestation was used as the timescale, antepartum stillbirth due to the specified cause was defined as the event, and all other births were treated as censored. In this method, ongoing pregnancies are the denominator, 18 but censoring due to birth is accounted for and multivariate analysis can be done. 19 This approach allows assessment of the relative risk accounting for variation in the duration of pregnancy, and is appropriate for situations in which not all individuals would ultimately experience the event.…”

Section: Statistical Analysesmentioning

confidence: 99%

“…For unexplained stillbirths at or after 34 weeks' gestation, the median birthweight in women with a previous caesarean delivery was smaller than in women whose first birth was vaginal (2820 g [IQR 2240-3062] vs 3110 [2540-3480], respectively, p=0·04), and more were at or below the fifth percentile for gestational age (12 18 [26%] of 69, respectively, p=0·04). The overall autopsy rate in the 206 unexplained stillbirths in the whole study group was 77·2%.…”

Section: Gestationmentioning

confidence: 99%

Caesarean section and risk of unexplained stillbirth in subsequent pregnancy

2003

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Glasgow ePrints Servicehttp://eprints.gla.ac.uk SummaryBackground Caesarean section is associated with an increased risk of disorders of placentation in subsequent pregnancies, but effects on the rate of antepartum stillbirth are unknown. We aimed to establish whether previous caesarean delivery is associated with an increased risk of antepartum stillbirth.Methods We linked pregnancy discharge data from the Scottish Morbidity Record (1980-98) and the Scottish Stillbirth and Infant Death Enquiry . We estimated the relative risk of antepartum stillbirth in second pregnancies using timeto-event analyses.Findings For 120 633 singleton second births, there were 68 antepartum stillbirths in 17 754 women previously delivered by caesarean section (2·39 per 10 000 women per week) and 244 in 102 879 women previously delivered vaginally (1·44; p<0·001). Risk of unexplained stillbirth associated with previous caesarean delivery differed significantly with gestational age (p=0·04); the excess risk was apparent from 34 weeks (hazard ratio 2·23 [95% CI 1·48-3·36]). Risk was not attenuated by adjustment for maternal characteristics or outcome of the first pregnancy (2·74 [1·74-4·30]). The absolute risk of unexplained stillbirth at or after 39 weeks' gestation was 1·1 per 1000 women who had had a previous caesarean section and 0·5 per 1000 in those who had not. The difference was due mostly to an excess of unexplained stillbirths among women previously delivered by caesarean section.Interpretation Delivery by caesarean section in the first pregnancy could increase the risk of unexplained stillbirth in the second. In women with one previous caesarean delivery, the risk of unexplained antepartum stillbirth at or after 39 weeks' gestation is about double the risk of stillbirth or neonatal death from intrapartum uterine rupture.

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“…For example, diabetic and hypertensive disorders have long been associated with higher rates of term stillbirth, cesarean delivery and neonatal intensive care unit admission, [1][2][3][4][5] and these associations have been influential in the development of high-risk obstetric management protocols. 6 Other investigations have identified an association between post-term pregnancy (>42 weeks gestation) and perinatal mortality, 7,8 and these associations have promoted the development of antenatal testing protocols and the determination of the timing for post-dates induction. 9,10 More recently, associations have been identified between delivery at increasing gestational age during the term period of pregnancy (37 to 42 weeks) and increasing risk of adverse birth outcomes.…”

Section: Introductionmentioning

confidence: 99%

The impact of the interaction between increasing gestational age and obstetrical risk on birth outcomes: evidence of a varying optimal time of delivery

Nicholson

Kellar

2006

J Perinatol

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Objective: To estimate the gestational age ranges that result in optimal birth outcomes for each of four risk-defined groups.Study Design: Retrospective cohort study of singleton late thirdtrimester deliveries at a large urban teaching hospital between July 1995 and September 2003. Low-risk, advanced maternal age, hypertensive and diabetic patients were identified and grouped. Rates, by day of gestation at delivery, of cesarean delivery, major maternal perineal trauma, low 5-min APGAR score and NICU admission were determined for each study group.Results: Each study group had meaningful changes in rates of obstetric outcomes as a function of gestational age at delivery and these patterns differed from group to group. A unique optimal time of delivery (OTD) was estimated for each group. The low-risk group OTD was calculated to be 37 weeks 1 day to 41 weeks 0 day; the advanced maternal age group OTD was 38 weeks 5 days to 39 weeks 6 days; the hypertension group OTD was 39 weeks 2 days to 40 weeks 1 day; and the diabetes mellitus group OTD was 40 weeks 3 days to 41 weeks 1 day. Conclusions:The OTD varied based on obstetrical risk. Strategies to increase the proportion of deliveries that occur within the OTD for specific risk-defined groups could theoretically improve birth outcomes.

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Risk of Unexplained Stillbirth at Different Gestational Ages

Cited by 257 publications

References 9 publications

Routine induction of labour at 41 weeks gestation: nonsensus consensus

Routine induction of labour at 41 weeks gestation: nonsensus consensus

Caesarean section and risk of unexplained stillbirth in subsequent pregnancy

The impact of the interaction between increasing gestational age and obstetrical risk on birth outcomes: evidence of a varying optimal time of delivery

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