Stillbirth: are we making more progress than we think? A retrospective cohort study

Selvaratnam, Roshan J; Rolnik, Daniel L.; Ma, Davey; Wallace, Euan M.

doi:10.1111/1471-0528.16665

Cited by 6 publications

(6 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our data confirm that stillbirth occurs more frequently in infertile older mothers, in women with high body mass index and in women with high prevalence of diseases, such as diabetes and hypertension. Other retrospective investigations performed utilizing data that have been collected over 30 years like ours, highlighted the importance of understanding the maternal characteristics associated with stillbirth nowadays, as modern predictors of stillbirth risk [13]. Although many risk factors for stillbirths become apparent late in pregnancy, many maternal conditions can be ascertained and addressed early in pregnancy [14,15], recognizing and potentially preventing their contribution to the adverse fetal outcome.…”

Section: Discussionmentioning

confidence: 85%

Maternal Risk Factors Associated with Antepartum Stillbirth

Raimondi¹,

Massa²,

Ravaldi³

et al. 2022

Clin. Exp. Obstet. Gynecol.

View full text Add to dashboard Cite

Background: Stillbirth is a worldwide devastating adverse pregnancy outcome and specific maternal conditions have been associated with an increased risk of fetal death. However, despite the worldwide increased efforts in prevention of stillbirth, little improvements have been achieved in recent years. Our aim was to explore the role of maternal conditions that can be ascertained at the beginning of pregnancy (i.e., demographic and medical conditions/diseases) and estimate their contribution to antepartum stillbirth. An early identification of risk factors could offer to high-risk pregnancies a tailored antenatal surveillance by trained staff leading to a potential reduction of stillbirth rates. Methods: Retrospective case-control study in singleton pregnancies. The difference between fetal survival rates in women with or without risk factors was evaluated. Results: Antepartum stillbirth occurs more frequently in infertile, older women, with systemic diseases. Maternal conditions may affect fetal outcome in a time-dependent manner. Subdividing cases in early stillbirths (before 28 weeks of gestation) and late stillbirth (≥28 weeks of gestation) we observed that early stillbirths are associated with assisted reproductive technologies (Odds Ratio (OR) 3.10; 95% Confidence Interval (CI) 1.43-6.71), maternal age above 35 years (OR 1.59; 95% CI 1.17-2.17) and pre-gestational hypertension (OR 3.68; 95% CI 1.28-10.56). Autoimmune disease (OR 6.55; 95% CI 2.90-14.80), inherited thrombophilia (OR 2.94; 95% CI 1.40-6.18) and pre-gestational diabetes (OR 7.57; 95% CI 2.17-26.35) are independent risk factors for late stillbirths. Further, the risk of stillbirth rises with the increasing of the number of pathological maternal clinical conditions, reaching an OR of 5.27 (95% CI 2.32-11.98) in cases of mother with three or more conditions/diseases. Conclusions: Early awareness of the maternal conditions/diseases addressable at the beginning of pregnancy is crucial to offer a personalized plan for high quality care during gestation; for the prevention of stillbirth, a cared clinical management should acknowledge that pregnancies can be affected more severely and earlier as the number of abnormal maternal conditions increases.

show abstract

Section: Discussionmentioning

confidence: 85%

Maternal Risk Factors Associated with Antepartum Stillbirth

Raimondi¹,

Massa²,

Ravaldi³

et al. 2022

Clin. Exp. Obstet. Gynecol.

View full text Add to dashboard Cite

show abstract

“…1,2 A large meta-analysis demonstrated a two-fold increased likelihood of stillbirth in black women, 3 and this health disparity is also reflected in other ethnic and socio-economically disadvantaged groups. [4][5][6] Historically, ethnic health disparities were thought to be due to socio-economic factors and poorer access to healthcare services with possible language barriers. 2 However, these disparities persist even after taking account of socioeconomic factors and other demographic variables.…”

Section: Introductionmentioning

confidence: 99%

“…Women of Asian and Black origin are known to have higher rates of adverse pregnancy outcomes 1,2 . A large meta‐analysis demonstrated a two‐fold increased likelihood of stillbirth in black women, 3 and this health disparity is also reflected in other ethnic and socio‐economically disadvantaged groups 4–6 . Historically, ethnic health disparities were thought to be due to socio‐economic factors and poorer access to healthcare services with possible language barriers 2 .…”

Section: Introductionmentioning

confidence: 99%

Reducing health inequality in Black, Asian and other minority ethnic pregnant women: impact of first trimester combined screening for placental dysfunction on perinatal mortality

Liu

Nadeem

Frick

et al. 2022

BJOG

View full text Add to dashboard Cite

Objective To assess the impact of the Fetal Medicine Foundation (FMF) first trimester screening algorithm for pre‐eclampsia on health disparities in perinatal death among minority ethnic groups. Design A retrospective cohort study from July 2016 to December 2020. Setting A large London teaching hospital. Patients and methods All women who underwent first trimester pre‐eclampsia risk assessment using either the NICE screening checklist or the FMF multimodal approach. Women considered at high‐risk in the FMF cohort were offered 150 mg aspirin before 16 weeks' gestation, serial growth scans and elective birth at 40 weeks. Main outcome measures Stillbirth, neonatal death and perinatal death rates stratified by screening method and maternal ethnicity. Results In the NICE cohort, the perinatal death rate was significantly higher in non‐white than white women (7.95 versus 2.63/1000 births, OR 3.035, 95% CI 1.551–5.941). Following the introduction of FMF screening, the perinatal death rate in non‐white women fell from 7.95 to 3.22/1000 births (OR 0.403, 95% CI 0.206–0.789), such that it was no longer significantly different from the perinatal mortality rate in white women (3.22 versus 2.55/1000 births, OR 1.261, 95% CI 0.641–2.483). Conclusions First trimester combined screening for placental dysfunction is associated with a significant reduction in perinatal death in minority ethnic women. Health disparities in perinatal death among ethnic minority women demand urgent attention from both clinicians and health policy makers. The data of this study suggest that this ethnic health inequality may be avoidable. Tweetable abstract Multimodal early pregnancy placental dysfunction screening can lead to a significant reduction in perinatal deaths in non‐white women.

show abstract

“…8 Over the past decade, clinical care, frequency of perinatal autopsy 9,10 and the obstetric risk profile of women giving birth in Australia have changed. 11,12 It is unknown, however, whether the causes of preterm perinatal death between gestations have changed over time in relation to these changing factors.…”

Section: Introductionmentioning

confidence: 99%

“…National data sets also do not delineate terminations of pregnancy (TOP) >20 weeks’ gestation, which clouds our understanding of the key causes of perinatal death 8 . Over the past decade, clinical care, frequency of perinatal autopsy 9,10 and the obstetric risk profile of women giving birth in Australia have changed 11,12 . It is unknown, however, whether the causes of preterm perinatal death between gestations have changed over time in relation to these changing factors.…”

Section: Introductionmentioning

confidence: 99%

Causes of perinatal deaths in Australia: Slow progress in the preterm period

Tindal

Bimal

Flenady

et al. 2022

Aust NZ J Obst Gynaeco

View full text Add to dashboard Cite

Aim The majority of perinatal deaths occur in the preterm period; however, current approaches predominantly focus on prevention in the term period. Reducing perinatal deaths in the preterm period is, therefore, key to reducing the rates of perinatal death overall in Australia. The aim was to understand the classifications of causes of preterm stillbirth and neonatal death in Victoria over time and by gestation. Materials and methods Retrospective study using state‐wide, publicly available data. All births in Victoria between 2010 and 2018 included in the Victorian Perinatal Data Collection, excluding terminations of pregnancy for maternal psychosocial indications, were studied. Differences in causes of preterm perinatal mortality gestation group and over time were determined. Results Out of 7977 perinatal deaths reported, 85.9% (n = 6849) were in the preterm period. The most common cause of preterm stillbirths was congenital anomalies (n = 1574, 29.8%), followed by unexplained antepartum deaths (n = 557, 14.2%). The most common cause of preterm neonatal death was spontaneous preterm birth (sPTB; n = 599, 38.2%), followed by congenital anomalies (n = 493, 31.4%). The rate of preterm stillbirths due to hypertension (−14.9% (95% CI −27.1% to −2.7%; P = 0.02)), maternal conditions (−24.1% (95% CI −44.2% to −4.0%; P = 0.03)) and those that were unexplained (−5.4% (95% CI −9.8% to −1.2%; P = 0.02)) decreased per annum between 2010 and 2018. All other classifications did not change significantly over time. Conclusion Prevention of congenital anomalies and sPTB is critical to reducing preterm perinatal mortality. Greater emphasis on understanding causes of preterm deaths through mortality investigations may reduce the proportion of those considered ‘unexplained’.

show abstract

Stillbirth: are we making more progress than we think? A retrospective cohort study

Cited by 6 publications

References 31 publications

Maternal Risk Factors Associated with Antepartum Stillbirth

Maternal Risk Factors Associated with Antepartum Stillbirth

Reducing health inequality in Black, Asian and other minority ethnic pregnant women: impact of first trimester combined screening for placental dysfunction on perinatal mortality

Causes of perinatal deaths in Australia: Slow progress in the preterm period

Contact Info

Product

Resources

About