Causes of Death Among Stillbirths

Department of Obstetrics and Gynecology, Drexel University, Filadelfia, Pennsylvania, United States
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 12/2011; 306(22):(4):2459-2468. DOI: 10.1097/OGX.0b013e3182502211


com-mon adverse pregnancy out-comes in the United States and affects approximately 1 in 160 pregnancies. 1 These approximately 26 000 still-births per year are equivalent to the number of infant deaths. 2 The still-birth rate in the United States is higher than that of many other developed countries. 3-5 From 1990-2003, the still-birth rate declined slowly but steadily, by an average of 1.4% per year. In con-trast, the infant mortality rate de-clined twice as fast by an average of 2.8% per year. 1 Since 2003 the still-birth rate in the United States has re-mained stagnant at 6.2 stillbirths per 1000 births, 1 59% higher than the Healthy People 2010 target goal of 4.1 fetal deaths per 1000 births. 6 US stillbirth prevalence shows sig-nificant racial disparity. The stillbirth rate for non-Hispanic black women is 2.3-fold higher than that of non-Hispanic white women (11.13 com-pared with 4.79 fetal deaths per 1000 live births and fetal deaths). 1 The rate for Hispanic women is 14% higher than for non-Hispanic white women (5.44 per 1000 live births and fetal deaths). Much of the racial disparity in still-birth remains unexplained. 7-11 The Stillbirth Collaborative Re-search Network (SCRN) was initiated by the Eunice Kennedy Shriver Na-tional Institute of Child Health and Hu-man Development (NICHD) to ad-dress this major public health issue. A workshop of experts convened by NICHD in 2001 concluded that vital records were inadequate to address the Context Stillbirth affects 1 in 160 pregnancies in the United States, equal to the num-ber of infant deaths each year. Rates are higher than those of other developed coun-tries and have stagnated over the past decade. There is significant racial disparity in the rate of stillbirth that is unexplained.

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    • "The higher percentage of spontaneous abortions observed in the present study could also be due to relatively higher mean age of the women and is possibly not related to patients having undergone MBV. Stillbirth affects 1 in 160 pregnancies in the United States.20 The overall risk of stillbirth reported in the literature is 4.3 per thousand women in otherwise healthy women and that of ectopic pregnancy is 2.3%.19 "
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    ABSTRACT: Background & Objectives : We report 17 years outcome of subsequent pregnancies of women with severe Mitral Stenosis (MS) who underwent Mitral Balloon Valvuloplasty (MBV) during pregnancy and the follow up of the children born of such pregnancies. Methods: Twenty three pregnant patients suffering from severe MS (NYHA-New York Heart Association class III/IV) who underwent MBV by Inoue balloon catheter technique during second trimester were enrolled. The study was performed between January 1992 and December 2008 at King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia, during which time, details about the obstetric outcome and childhood development were recorded. Mean follow up period was 10± 5.5 years (range 1-17 years). Results: MBV was successful in all patients with improvement in their NYHA class to I/II. All patients were followed until term and had uneventful course after MBV. Twenty two (95.6%) patients delivered 23 babies including a twin birth. These children exhibited normal growth and development according to their age. Nineteen patients had further pregnancies and gave birth to 38 live & healthy babies with one still birth and no unfavorable maternal outcome. Of these, 97.4% were singleton pregnancies while 2.6% were twin pregnancies. Spontaneous abortions were recorded in 21.5% and there was one still birth (2.5%) and one ectopic pregnancy (2.5%). Conclusion : Mitral Balloon Valvuloplasty is a safe and useful procedure during pregnancy, with no short or long term adverse affects on the mothers and their obstetric future. The children born of subsequent pregnancies exhibited normal physical and mental development.
    Full-text · Article · Feb 2014 · Pakistan Journal of Medical Sciences Online
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    • "Epidemiological efforts are under way in the U.S. and internationally to better map where stillbirths occur, to better understand prevalence within and across populations [1,2,10-12]. And there are concerted efforts to increase research both to identify the causes of stillbirth and to find effective interventions to prevent stillbirths [13-16]. In the meantime, many parents in this country suffer this devastating loss, largely in silence, due to persistent stigma and taboo. "
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    ABSTRACT: Background In the United States, an estimated 70 stillbirths occur each day, on average 25,000 each year. Research into the prevalence and causes of stillbirth is ongoing, but meanwhile, many parents suffer this devastating loss, largely in silence, due to persistent stigma and taboo; and many health providers report feeling ill equipped to support grieving parents. Interventions to address bereavement after neonatal death are increasingly common in U.S. hospitals, and there is growing data on the nature of parent bereavement after a stillbirth. However, further research is needed to evaluate supportive interventions and to investigate the parent-clinician encounter during hospitalization following a stillbirth. Qualitative inquiry offers opportunities to better understand the lived experience of parents against the backdrop of clinicians’ beliefs, intentions, and well-meaning efforts to support grieving parents. Methods We present a secondary qualitative analysis of transcript data from 3 semi-structured focus groups conducted with parents who had experienced a stillbirth and delivered in a hospital, and 2 focus groups with obstetrician-gynecologists. Participants were drawn from the greater Seattle region in Washington State. We examine parents’ and physicians’ experiences and beliefs surrounding stillbirth during the clinical encounter using iterative discourse analysis. Results Women reported that the cheery, bustling environment of the labor and delivery setting was a painful place for parents who had had a stillbirth, and that the well-meaning attempts of physicians to offer comfort often had the opposite effect. Parents also reported that their grief is deeply felt but not socially recognized. While physicians recognized patients’ grief, they did not grasp its depth or duration. Physicians viewed stillbirth as an unexpected clinical tragedy, though several considered stillbirth less traumatic than the death of a neonate. In the months and years following a stillbirth, these parents continue to memorialize their children as part of their family. Conclusions Hospitals need to examine the physical environment for deliveries and, wherever possible, offer designated private areas with staff trained in stillbirth care. Training programs in obstetrics need to better address the bereavement needs of parents following a stillbirth, and research is needed to evaluate effective bereavement interventions, accounting for cultural variation. Critical improvements are also needed for mental health support beyond hospitalization. Finally, medical professionals and parents can play an important role in reversing the stigma that surrounds stillbirth.
    Full-text · Article · Nov 2012 · BMC Pregnancy and Childbirth
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    ABSTRACT: T HE NUMBER OF STILLBIRTHS (FE-tal deaths at 20 weeks' ges-tation) is nearly equal to the number of infant deaths in the United States (25 894 vs 28 384 in 2005). 1 Although rates of stillbirth de-creased in the first part of the 20th cen-tury, rates have been relatively stable over the past few decades. 2 Racial/ ethnic disparities have been reported, with stillbirth rates among non-Hispanic blacks being twice those among non-Hispanic whites. 2 Most studies of risk factors for still-birth use vital statistics with limited data. The Stillbirth Collaborative Re-search Network was created to con-duct a detailed, population-based study of stillbirth in selected areas of the United States, with one of the a priori objectives to determine risk factors for stillbirth and reasons for racial dispari-ties. Many of the factors associated with stillbirth need to be addressed early in pregnancy. Although other factors may be important later in pregnancy, clini-cians providing obstetrical care fre-quently spend relatively more time at the initial visits counseling patients re-garding their risk of adverse preg-nancy outcomes. We focused this ini-tial report on factors that could be ascertained at the start of pregnancy to provide the clinician and patient with population-based data applicable to the first prenatal visits. A subsequent re-port will address pregnancy predic-tors of stillbirth risk. METHODS Study Design The overall design and methods of the study have been reported. 3 The study population consisted of residents in 5 geographic catchment areas defined a priori by county lines. Study
    Full-text · Article · Dec 2011 · JAMA The Journal of the American Medical Association
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