Substandard care in antepartum term stillbirths: prospective cohort study

Evers, Annemieke C.C.; Nikkels, Peter G. J.; Brouwers, H. A. A.; Boon, Janine; Egmond-Linden, Anneke van; Hart, Claartje; Snuif, Yvette S.; Sterken-Hooisma, Sietske; Bruinse, Hein W.; Kwee, Anneke

doi:10.1111/j.1600-0412.2011.01251.x

Cited by 11 publications

(13 citation statements)

References 30 publications

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“…Similarly, the risk of antepartum stillbirth was also increased for women who had a previous stillbirth, antepartum hemorrhage or hypertensive disorder during pregnancy, or small-for-gestational age babies in a tertiary hospital setting in Nepal. Similar to our results, studies in developed countries have identified several modifiable risk factors for antepartum stillbirth such as lack of antenatal care, antepartum hemorrhage, hypertensive disorder during pregnancy, and small-for-gestational age babies, however, the socio-economic and health service settings were different [ 4 , 7 , 20 ]. A study conducted in India has also identified lack of antenatal care as a modifiable risk factor for stillbirth [ 21 ].…”

Section: Discussionsupporting

confidence: 89%

“…There are several risk factors which have been associated with antepartum stillbirth in studies from high-income countries; maternal age greater than 35 years, parity higher than four, low maternal educational status, lack of antenatal care attendance, chronic maternal medical conditions, pre-eclampsia or placenta abruption during pregnancy, intra-uterine growth restriction, major congenital anomaly of the infant, and poor maternal nutritional status [ 4 – 6 ]. Additionally, a prospective cohort study from the Netherlands found that substandard clinical care during pregnancy was a risk factor for antepartum stillbirth among term infants [ 7 ]. A population-based cohort study in rural Ghana (a lower-middle-income country) found an association of antepartum stillbirth with previous stillbirth, increasing maternal age (>35 years), primiparity, multiple pregnancies and no antenatal care attendance [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Risk factors for antepartum stillbirth: a case-control study in Nepal

Nelin

Wrammert

et al. 2015

BMC Pregnancy Childbirth

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BackgroundGlobally, at least 2.65 million stillbirths occur every year, of which more than half are during the antepartum period. The proportion of intrapartum stillbirths has substantially declined with improved obstetric care; however, the number of antepartum stillbirths has not decreased as greatly. Attempts to lower this number may be hampered by an incomplete understanding of the risk factors leading to the majority of antepartum stillbirths. We conducted this study in a tertiary hospital in Nepal to identify the specific risk factors that are associated with antepartum stillbirth in this setting.MethodsThis case-control study was conducted between July 2012 and September 2013. All women who had antepartum stillbirths during this period were included as cases, while 20 % of all women delivering at the hospital were randomly selected and included as referents. Information on potential risk factors was taken from medical records and interviews with the women. Logistic regression analysis was completed to determine the association between those risk factors and antepartum stillbirth.ResultsDuring the study period, 4567 women who delivered at the hospital were enrolled as referents, of which 62 had antepartum stillbirths and were re-categorized into the case population. In total, there were 307 antepartum stillbirths. An association was found between the following risk factors and antepartum stillbirth: increasing maternal age (aOR 1.0, 95 % CI 1.0–1.1), less than five years of maternal education (aOR 2.4, 95 % CI 1.7–3.2), increasing parity (aOR 1.2, 95 % CI 1.0–1.3), previous stillbirth (aOR 2.6, 95 % CI 1.6–4.4), no antenatal care attendance (aOR 4.2, 95 % CI 3.2–5.4), belonging to the poorest family (aOR 1.3, 95 % CI 1.0–1.8), antepartum hemorrhage (aOR 3.7, 95 % CI 2.4–5.7), maternal hypertensive disorder during pregnancy (aOR 2.1, 95 % CI 1.5–3.1), and small weight-for-gestational age babies (aOR 1.5, 95 % CI 1.2–2.0).ConclusionLack of antenatal care attendance, which had the strongest association with antepartum stillbirth, is a potentially modifiable risk factor, in that increasing the access to and availability of these services can be targeted. Antenatal care attendance provides an opportunity to screen for other potential risk factors for antepartum stillbirth, as well as to provide counseling to women, and thus, helps to ensure a successful pregnancy outcome.Clinical trial registrationISRCTN97846009 (url. www.isrctn.com/ISRCTN97846009)

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Risk factors for antepartum stillbirth: a case-control study in Nepal

Nelin

Wrammert

et al. 2015

BMC Pregnancy Childbirth

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“…It is estimated that suboptimal care accounts for 20%–50% of stillbirths 21 23. Nonetheless, a number of stillbirths and perinatal deaths are not preventable, especially in case of undetected severe congenital malformations 24.…”

Section: Discussionmentioning

confidence: 99%

Routine induction in late-term pregnancies: follow-up of a Danish induction of labour paradigm

et al. 2019

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ObjectivesFor many years, routine elective induction of labour at gestational week (GW) 42+0 has been recommended in Denmark. In 2011, a more proactive protocol was introduced aimed at reducing stillbirths, and practice changed into earlier routine induction, i.e. between 41+3 and 41+5 GW. The present study evaluates a national change in induction of labour regime. The trend of maternal and neonatal consequences are monitored in the preintervention period (2000–2010) compared with the postintervention period (2012–2016).DesignA national retrospective register-based cohort study.SettingDenmark.ParticipantsAll births in Denmark 41+3 to 45+0 GWs between 2000 and 2016 (N = 152 887).Outcome measuresPrimary outcomes: stillbirths, perinatal death, and low Apgar scores. Additional outcomes: birth interventions and maternal outcomes.ResultsFor the primary outcomes, no differences in stillbirths, perinatal death, and low Apgar scores were found comparing the preintervention and postintervention period. Of additional outcomes, the trend changed significantly postintervention concerning use of augmentation of labour, epidural analgesia, induction of labour and uterine rupture (all p<0.05). There was no significant change in the trend for caesarean section and instrumental birth. Most notable for clinical practice was the increase in induction of labour from 41% to 65% (p<0.01) at 41+3 weeks during 2011 as well as the rare occurrence of uterine ruptures (from 2.6 to 4.2 per thousand, p<0.02).ConclusionsEvaluation of a more proactive regimen recommending induction of labour from GW 41+3 compared with 42+0 using national register data found no differences in neonatal outcomes including stillbirth. The number of women with induced labour increased significantly.

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“…Placental abnormalities were noted in 72% of cases in a recent prospective cohort study evaluating intrauterine fetal death. 9 Various placental disorders can be distinguished, including uteroplacental insufficiency, acute and chronic infections, and fetal vascular lesions. 10 Understanding placental pathology and associated clinical factors in relation to the different patterns of brain injury in infants with neonatal encephalopathy secondary to presumed perinatal HI may be of importance for developing new preventive strategies.…”

mentioning

confidence: 99%