Causes of Death Among Stillbirths

Abstract

Context Stillbirth affects 1 in 160 pregnancies in the United States, equal to the number of infant deaths each year. Rates are higher than those of other developed countries and have stagnated over the past decade. There is significant racial disparity in the rate of stillbirth that is unexplained. Objective To ascertain the causes of stillbirth in a population that is diverse by race/ethnicity and geography. Design, Setting, and Participants A population-based study from March 2006 to September 2008 with surveillance for all stillbirths at 20 weeks or later in 59 tertiary care and community hospitals in 5 catchment areas defined by state and county boundaries to ensure access to at least 90% of all deliveries. Termination of a live fetus was excluded. Standardized evaluations were performed at delivery. Main Outcome Measures Medical history, fetal postmortem and placental pathology, karyotype, other laboratory tests, systematic assignment of causes of death. Results Of 663 women with stillbirth enrolled, 500 women consented to complete postmortem examinations of 512 neonates. A probable cause of death was found in 312 stillbirths (60.9%; 95% CI, 56.5%–65.2%) and possible or probable cause in 390 (76.2%; 95% CI, 72.2%–79.8%). The most common causes were obstetric conditions (150 [29.3%; 95% CI, 25.4%–33.5%]), placental abnormalities (121 [23.6%; 95% CI, 20.1%–27.6%]), fetal genetic/structural abnormalities (70 [13.7%; 95% CI, 10.9%–17.0%]), infection (66 [12.9%; 95% CI, 10.2%–16.2%]), umbilical cord abnormalities (53 [10.4%; 95% CI, 7.9%–13.4%]), hypertensive disorders (47 [9.2%; 95% CI, 6.9%–12.1%]), and other maternal medical conditions (40 [7.8%; 95% CI, 5.7%–10.6%]). A higher proportion of stillbirths in non-Hispanic black women compared with non-Hispanic white and Hispanic ones was associated with obstetric complications (43.5% [50] vs 23.7% [85]; difference, 19.8%; 95% CI, 9.7%–29.9%; P<.001) and infections (25.2% [29] vs 7.8% [28]; difference, 17.4%; 95% CI, 9.0%–25.8%; P<.001). Stillbirths occurring intrapartum and early in gestation were more common in non-Hispanic black women. Sources most likely to provide positive information regarding cause of death were placental histology (268 [52.3%; 95% CI, 47.9%–56.7%]), perinatal postmortem examination (161 [31.4%; 95% CI, 27.5%–35.7%]), and karyotype (32 of 357 with definitive results [9%; 95% CI, 6.3%–12.5%]). Conclusions A systematic evaluation led to a probable or possible cause in the majority of stillbirths. Obstetric conditions and placental abnormalities were the most common causes of stillbirth, although the distribution differed by race/ethnicity.

Karyotype versus Microarray Testing for Genetic Abnormalities after Stillbirth

“…5 All the stillbirths that were included in the analysis were carefully phenotyped because the women provided consent for a complete evaluation, including fetal postmortem examination, placental pathological analysis, karyotyping, and maternal–fetal testing. 31 Microarray analysis was performed at an institution that was not part of the study, and the researchers who performed the analysis were unaware of the karyotyping results and the clinical history.…”

The impact of changes in preterm birth among twins on stillbirth and infant mortality in the United States

“…This finding suggests that induction of labor and cesarean delivery may have played a significant role in preventing fetal demise during the observed time period, 26,27 at a cost of increasing the rate of premature births. Obstetric complications, placental abnormalities, fetal genetic/structural abnormalities, umbilical cord abnormalities, hypertensive disorders and other maternal medical conditions are the most common cause of stillbirth 28 that calls for immediate action such as induction of labor or cesarean. Using data in Tables 1, 2 and 5, we estimated that the increase in cesarean rates over the study period resulted in 50 603 additional cesarean sections (32 235 done preterm) and 19 438 additional preterm births, but was associated with 1166 fewer stillbirths and 797 fewer neonatal deaths than would have occurred in the 2005–06 had 1995–96 rates persisted.…”

Pregnancy Loss and Carotid Intima–Media Thickness in Mexican Women

“…Miscarriages result mainly from embryonic anomalies, whereas stillbirths are attributed to obstetric conditions and placental abnormalities 27, 28. However, both conditions appear to have similar risk for posttraumatic stress disorder (25% for miscarriage and 21% for stillbirth) 6, 7.…”