Management of subsequent pregnancy after an unexplained stillbirth

Abstract

Purpose: To review the management of pregnancy after an unexplained stillbirth.Epidemiology: Approximately 1 in 200 pregnancies will end in stillbirth, of which about one-third will remain unexplained. Unexplained stillbirth is the largest single contributor to perinatal mortality. Subsequent pregnancies do not appear to have an increased risk of stillbirth, but are characterized by increased rates of intervention (induction of labor, elective cesarean section) and iatrogenic adverse outcomes (low birth weight, prematurity, emergency cesarean section and post-partum hemorrhage). Conclusions:There is no level-one evidence to guide management in this situation. Pre-pregnancy counseling is very important to detect and correct potential risk factors such as obesity, smoking and maternal disease. As timely delivery is the mainstay of management, early accurate determination of gestational age is vital. There is controversy regarding the pattern of surveillance, but evidence exists only for ultrasound and not for regular non-stress testing, nor formal fetal movement charting. There is an urgent need for more studies in this important area.

Heavy prenatal alcohol exposure and risk of stillbirth and preterm delivery

“…We had one stillbirth of unknown cause; however, one third of stillbirths being of unknown cause is consistent with the literature [10]. Moreover, prenatal alcohol exposure has previously been associated with stillbirth caused by placental abruption, one of the two causes identified here [3].…”

A Population-based Study on Trends in the Mode of Delivery Subsequent to Stillbirth, Infant Mortality and Severe Infant Malformations in the State of Hesse, Germany between 1990 and 2012

“…This confi rms the fi nding of another study proposing pre-pregnancy counseling to identify important potential risk factors (e. g., maternal disease, smoking, obesity) for the lack of evidence with regard to the management in the case of a subsequent pregnancy following a stillbirth. Therefore and with respect to timing an adequate surveillance of the delivery and an early accurate determination of gestational age are essential [ 11 ] . As a result of a single institution short-term study (1997)(1998)(1999)(2000)(2001) with 54 women with stillbirths in the past medical history compared to women without stillbirths there are no diff erences in subsequent pregnancy rates (61.1 % vs. 54.6 %) and the outcome was described as favorable.…”

Care in subsequent pregnancies following stillbirth: an international survey of parents

“…6 There is currently little evidence to guide clinical management of pregnancies subsequent to stillbirth. [7][8][9][10] Women often want increased antepartum surveillance and early birth in these pregnancies, 11 but in many cases the medical benefits of such practices remain uncertain. In addition to recurrent stillbirth, previous stillbirth is associated with various adverse pregnancy outcomes.…”