Etiology and prevention of stillbirth. Am J Obstet Gynecol

Harvard Vanguard Medical Associates, Wellesley, MA 02481, USA.
American journal of obstetrics and gynecology (Impact Factor: 4.7). 01/2006; 193(6):1923-35. DOI: 10.1016/j.ajog.2005.03.074
Source: PubMed


This is a systematic review of the literature on the causes of stillbirth and clinical opinion regarding strategies for its prevention.
We reviewed the causes of stillbirth by performing a Medline search limited to articles in English published in core clinical journals from January 1, 1995, to January 1, 2005. Articles before this date were included if they added historical information relevant to the topic. A total of 1445 articles obtained, 113 were the basis of this review and chosen based on the criterion that stillbirth or fetal death was central to the article.
Fifteen risk factors for stillbirths were identified and the prevalence of these conditions and associated risks are presented The most prevalent risk factors for stillbirth are prepregnancy obesity, socioeconomic factors, and advanced maternal age. Biologic markers associated with increased stillbirth risk are also reviewed, and strategies for its prevention identified.
Identification of risk factors for stillbirth assists the clinician in performing a risk assessment for each patient. Unexplained stillbirths and stillbirths related to growth restriction are the 2 categories of death that contribute the most to late fetal losses. Late pregnancy is associated with an increasing risk of stillbirth, and clinicians should have a low threshold to evaluate fetal growth. The value of antepartum testing is related to the underlying risk of stillbirth and, although the strategy of antepartum testing in patients with increased risk will decrease the risk of late fetal loss, it is of necessity associated with higher intervention rates.

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Available from: Ruth C Fretts
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    • "It is well known that AMA women are at increased risk of various pregnancy complications, including stillbirth [2] [3] [4] [5] [6] [7]. The risk of stillbirth, defined as fetal death at 20 weeks or more, has been quoted as 11–14 per 1000 in women age 35–39 and 11–29 per 1000 in women age 40 and over, compared to 6.4 per 1000 in the general population and 4.0–5.5 per 1000 in lowrisk pregnancies [8] [9]. Recent data from the United States show an overall decrease in stillbirth compared to prior data, but a continued increased prevalence among older women, with rates of 6.9 per 1000 in women age 35–39, 9.8 per 1000 in women age 40–44, and 13 per 1000 in women age 45 and older [10]. "
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    ABSTRACT: To estimate the effectiveness of antepartum surveillance and delivery at 41 weeks in reducing the risk of stillbirth in advanced maternal age (AMA) patients. Retrospective cohort study of all patients managed in one maternal-fetal medicine practice from June 2005 to May 2012. We included all singleton pregnancies delivered at ≥20 weeks of gestation. All AMA patients (age ≥35 years at their estimated delivery date) underwent weekly biophysical profile testing beginning at 36 weeks, as well as planned delivery at 41 weeks, or sooner if indicated. We compared the rate of fetal death at ≥20 weeks and fetal death at ≥36 weeks in AMA vs. non-AMA patients. Fetal deaths due to lethal and chromosomal abnormalities were excluded. 4469 patients met the inclusion criteria: 1541 (34.5%) were AMA and 2928 (65.5%) were non-AMA. Using our AMA protocol for surveillance and timing of delivery, the incidence of stillbirth was similar to the non-AMA population (stillbirth ≥20 weeks: 3.9 per 1000 vs. 3.4 per 1000, p=0.799; stillbirth ≥36 weeks: 1.4 per 1000 vs. 1.1 per 1000, p=0.773). When looking at women age <35, age 35-39, and age ≥40, the incidence of stillbirth ≥20 weeks and ≥36 weeks did not increase across the three groups. Our findings were similar when we excluded all patients with other indications for antepartum surveillance. In AMA patients, antepartum surveillance and delivery at 41 weeks appears to reduce the risk of stillbirth to that of the non-AMA population. Routine antepartum surveillance should be considered in all AMA patients.
    Full-text · Article · Aug 2013 · European journal of obstetrics, gynecology, and reproductive biology
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    • "In this study, the highest perinatal mortality was observed among illiterate mothers, and the finding is similar to those of other studies in developing countries [19,20]. Evidences from other developing countries also indicated that increased levels of mother’s education were observed to be associated with improved chances of infant survival [26]. Our findings emphasize the need for encouraging female literacy which by itself is expected to provide multiple benefits and better chances for alleviating poverty and poverty-related health problems [26]. "
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    ABSTRACT: Background Perinatal mortality is one of the serious challenges in meeting maternal and child Millennium Development Goals in developing countries. Identifying its predictors is an important step to develop focused and appropriate health interventions for reducing perinatal deaths. This study therefore aims at identifying predictors of perinatal mortality in a rural setting in northwest Ethiopia. Methods A prospective longitudinal study was conducted at Dabat Health and Demographic Surveillance site, northwest Ethiopia, from November 2009 to August 2011. Data were collected by interviewing the mothers or guardians of eligible children. Multiple logistic regressions were employed to identify potential predictors. Results A total of 1752 eligible children were included in the study. Perinatal mortality rate in the study population was 50.22 per 1000 (95% CI: 39.99, 60.46) total births. In multiple logistic analysis, previous still birth [(AOR = 8.38, 95% CI: 3.94, 17.83)], twin birth [(AOR = 7.09, 95% CI: (3.22, 15.61)], not receiving tetanus toxoid vaccine during the index pregnancy [(AOR = 3.62, 95% CI: 1.57, 8.34)], short birth interval of less than 24 months [(AOR = 2.58, 95% CI: (1.61, 4.13)], maternal illiteracy [(AOR = 4.83, 95% CI: (1.45, 16.05)] and mothers’ running own business [(AOR = 5.40, 95% CI: 1.40, 27.96)] were the main predictors associated with increased risk of perinatal death. Conclusions Predictors of perinatal death in the study area are easily recognizable and potentially preventable with the existing maternal health programs. Efforts need to be intensified in expanding maternal and newborn health services to significantly reduce perinatal mortality in rural settings.
    Full-text · Article · Feb 2013 · BMC Public Health
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    • "The exact mechanism underlying the pathogenesis of adverse pregnancy outcome in older mothers is unclear. It has been suggested that pre-pregnancy obesity and lower socio-economic factors contribute to increase rates of adverse outcomes for women over 35 years of age [26], [27]. In the present study, social deprivation appeared to have a confounding effect on the association between maternal age and several pregnancy outcomes but the confounding effect was limited and did not change the conclusions. "
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    ABSTRACT: Background Recent decades have witnessed an increase in mean maternal age at childbirth in most high-resourced countries. Advanced maternal age has been associated with several adverse maternal and perinatal outcomes. Although there are many studies on this topic, data from large contemporary population-based cohorts that controls for demographic variables known to influence perinatal outcomes is limited. Methods We performed a population-based cohort study using data on all singleton births in 2004–2008 from the North Western Perinatal Survey based at The University of Manchester, UK. We compared pregnancy outcomes in women aged 30–34, 35–39 and ≥40 years with women aged 20–29 years using log-linear binomial regression. Models were adjusted for parity, ethnicity, social deprivation score and body mass index. Results The final study cohort consisted of 215,344 births; 122,307 mothers (54.19%) were aged 20–29 years, 62,371(27.63%) were aged 30–34 years, 33,966(15.05%) were aged 35–39 years and 7,066(3.13%) were aged ≥40 years. Women aged 40+ at delivery were at increased risk of stillbirth (RR = 1.83, [95% CI 1.37–2.43]), pre-term (RR = 1.25, [95% CI: 1.14–1.36]) and very pre-term birth (RR = 1.29, [95% CI:1.08–1.55]), Macrosomia (RR = 1.31, [95% CI: 1.12–1.54]), extremely large for gestational age (RR = 1.40, [95% CI: 1.25–1.58]) and Caesarean delivery (RR = 1.83, [95% CI: 1.77–1.90]). Conclusions Advanced maternal age is associated with a range of adverse pregnancy outcomes. These risks are independent of parity and remain after adjusting for the ameliorating effects of higher socioeconomic status. The data from this large contemporary cohort will be of interest to healthcare providers and women and will facilitate evidence based counselling of older expectant mothers.
    Full-text · Article · Feb 2013 · PLoS ONE
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