Can We Prevent Stillbirth?

Abstract

Objective This study aimed to identify the frequency of potentially preventable causes of stillbirth in a large heterogeneous population.

Study Design This is a retrospective study of all stillbirth cases between January 2011 and December 2016 at a single tertiary medical center. Deliveries resulting from a nonviable fetus prior to 24 weeks of gestation, intrapartum fetal death, and incomplete stillbirth workup were excluded. Potentially preventable stillbirth was defined as that of a nonanomalous fetus that most likely resulted from one or more of the following: (1) placental-mediated complications, (2) postterm pregnancy, (3) monochorionicity-associated complications, (4) cholestasis of pregnancy, (5) preventable or treatable infections, and (6) isoimmunization.

Results During the study period, 312 stillbirths were identified, 228 of which met the inclusion criteria. Of the 110 cases with a recognized cause, 47 (20.6%) were potentially preventable. The most common causes were placental-mediated complications and preventable or treatable infections, accounting for 75 and 9% of all potentially preventable causes, respectively. There were no recognizable maternal risk factors for potentially preventable stillbirth.

Conclusion One-fifth of all causes of stillbirth are potentially preventable. Due to the significant contribution of placental-mediated complications to preventable stillbirth, close sonographic surveillance and timely delivery may decrease risk substantially.

Keywords

stillbirth - intrauterine - fetal death - stillbirth prevention - fetal pathology

• References

• 1 Lawn JE, Lee AC, Kinney M. , et al. Two million intrapartum-related stillbirths and neonatal deaths: where, why, and what can be done?. Int J Gynaecol Obstet 2009; 107 (Suppl. 01) S5-S18
• 2 Lawn JE, Blencowe H, Waiswa P. , et al; Lancet Ending Preventable Stillbirths Series study group; Lancet Stillbirth Epidemiology investigator group. Stillbirths: rates, risk factors, and acceleration towards 2030. Lancet 2016; 387 (10018): 587-603
• 3 ACOG practice bulletin no. 102: management of stillbirth. Obstet Gynecol 2009; 113 (03) 748-761
• 4 Muldoon KA, Galway LP, Nakajima M. , et al. Health system determinants of infant, child and maternal mortality: a cross-sectional study of UN member countries. Global Health 2011; 7: 42
• 5 Frøen JF, Arnestad M, Frey K, Vege A, Saugstad OD, Stray-Pedersen B. Risk factors for sudden intrauterine unexplained death: epidemiologic characteristics of singleton cases in Oslo, Norway, 1986-1995. Am J Obstet Gynecol 2001; 184 (04) 694-702
• 6 Huang DY, Usher RH, Kramer MS, Yang H, Morin L, Fretts RC. Determinants of unexplained antepartum fetal deaths. Obstet Gynecol 2000; 95 (02) 215-221
• 7 Page JM, Thorsten V, Reddy UM. , et al. Potentially preventable stillbirth in a diverse U.S. cohort. Obstet Gynecol 2018; 131 (02) 336-343
• 8 Goldenberg RL, Farrow V, McClure EM, Reddy UM, Fretts RC, Schulkin J. Stillbirth: knowledge and practice among U.S. obstetrician-gynecologists. Am J Perinatol 2013; 30 (10) 813-820
• 9 Flenady V, Middleton P, Smith GC. , et al; Lancet's Stillbirths Series steering committee. Stillbirths: the way forward in high-income countries. Lancet 2011; 377 (9778): 1703-1717
• 10 Langston C, Kaplan C, Macpherson T. , et al. Practice guideline for examination of the placenta: developed by the Placental Pathology Practice Guideline Development Task Force of the College of American Pathologists. Arch Pathol Lab Med 1997; 121 (05) 449-476
• 11 Khong TY, Mooney EE, Ariel I. , et al. Sampling and definitions of placental lesions: Amsterdam Placental Workshop Group consensus statement. Arch Pathol Lab Med 2016; 140 (07) 698-713
• 12 Dudley DJ, Goldenberg R, Conway D. , et al; Stillbirth Research Collaborative Network. A new system for determining the causes of stillbirth. Obstet Gynecol 2010; 116 (2 Pt 1): 254-260
• 13 Yudkin PL, Wood L, Redman CW. Risk of unexplained stillbirth at different gestational ages. Lancet 1987; 1 (8543): 1192-1194
• 14 Caughey AB, Musci TJ. Complications of term pregnancies beyond 37 weeks of gestation. Obstet Gynecol 2004; 103 (01) 57-62
• 15 Roberts D, Neilson JP, Kilby MD, Gates S. Interventions for the treatment of twin-twin transfusion syndrome. Cochrane Database Syst Rev 2014; (01) CD002073
• 16 Papageorghiou AT, Avgidou K, Bakoulas V, Sebire NJ, Nicolaides KH. Risks of miscarriage and early preterm birth in trichorionic triplet pregnancies with embryo reduction versus expectant management: new data and systematic review. Hum Reprod 2006; 21 (07) 1912-1917
• 17 Harnden A, Mayon-White R, Mant D, Kelly D, Pearson G. Child deaths: confidential enquiry into the role and quality of UK primary care. Br J Gen Pract 2009; 59 (568) 819-824
• 18 Glantz A, Marschall HU, Mattsson LA. Intrahepatic cholestasis of pregnancy: Relationships between bile acid levels and fetal complication rates. Hepatology 2004; 40 (02) 467-474
• 19 Reddy UM, Goldenberg R, Silver R. , et al. Stillbirth classification--developing an international consensus for research: executive summary of a National Institute of Child Health and Human Development workshop. Obstet Gynecol 2009; 114 (04) 901-914
• 20 Akolekar R. Re: Risk of fetal loss associated with invasive testing following combined first-trimester screening for Down syndrome: a national cohort of 147 987 singleton pregnancies. C. B. Wulff, T. A. Gerds, L. Rode, C. K. Ekelund, O. B. Petersen, A. Tabor and the Danish Fetal Medicine Study Group. Ultrasound Obstet Gynecol 2016; 47: 38-44. Ultrasound Obstet Gynecol 2016; 47 (01) 14
• 21 Dollberg S, Haklai Z, Mimouni FB, Gorfein I, Gordon ES. Birth weight standards in the live-born population in Israel. Isr Med Assoc J 2005; 7 (05) 311-314
• 22 MacDorman MF, Kirmeyer S. Fetal and perinatal mortality, United States, 2005. Natl Vital Stat Rep 2009; 57 (08) 1-19
• 23 Frøen JF, Cacciatore J, McClure EM. , et al; Lancet's Stillbirths Series steering committee. Stillbirths: why they matter. Lancet 2011; 377 (9774): 1353-1366
• 24 Moscovis SM, Gordon AE, Al Madani OM. , et al. Virus infections and sudden death in infancy: the role of interferon-γ. Front Immunol 2015; 6: 107
• 25 Group SCRNW; Stillbirth Collaborative Research Network Writing Group. Causes of death among stillbirths. JAMA 2011; 306 (22) 2459-2468