Prediction and prevention of recurrent stillbirth

Abstract

Stillbirth is one of the most common adverse pregnancy outcomes worldwide with ≥ 3.2 million occurring each year.(1) There are important psychological and emotional issues when dealing with a pregnancy resulting in a stillbirth. Couples experience feelings of anxiety, failure, personal guilt, and apprehension when contemplating pregnancy after having a stillborn infant. Many women do not receive comprehensive counseling regarding the cause of the stillbirth because an incomplete evaluation was performed. Furthermore, in half of the cases the cause remains unknown. It is difficult for clinicians to counsel, evaluate, and manage subsequent pregnancies optimally as very little is known about pregnancy outcome after a stillbirth. RecuRRence Risk of stillbiRthThe overall recurrence risk for stillbirth increased 2-to 10-fold in the next pregnancy. Goldenberg et al.(2) evaluated the association between fetal loss in the second trimester and subsequent adverse birth outcomes. Out of 95 women who had a pregnancy loss at 13-24 weeks in the index pregnancy, 39% had a preterm delivery in their next pregnancy, 5% had a stillbirth, and 6% had a neonatal death. There was almost a sixfold increase in the risk for stillbirth in the subsequent pregnancy for the group of women with a previous 13-to 24-week pregnancy loss compared to the term control group.Samueloff et al.(3) studied the incidence of recurrent stillbirth at an academic center in the United States over a 13-year period. The overall stillbirth rate was 8.3 per 1,000 births. Of the 403 women who had pregnancies subsequent to experiencing a stillbirth, 34 women had a recurrent stillbirth for a rate of 84.3 per 1,000 births. Therefore, the risk was 10-fold higher than that of women who had no previous history of stillbirth.Surkan et al. (4) evaluated the association between previous adverse outcomes of pregnancy and the risk of stillbirth (

Risk Prediction for Adverse Pregnancy Outcomes in a Medicaid Population

“…history of preterm birth, history of low birthweight delivery, and history of intrauterine fetal demise). [23][24][25] Interpregnancy interval was based on maternal report of interval from last prior live birth to current pregnancy and categorized as either <18 or ‡18 months. 26 Twin gestation and known short cervical length, defined as <25 mm, 27 was also included in the assessment.…”

Management of subsequent pregnancy after an unexplained stillbirth

“…Many authorities now concede that the single most important aspect of management of uncomplicated pregnancies after an unexplained stillbirth may be delivery by 39 weeks. [3][4][5]11 If delivery is delayed beyond this gestation the fetus should be reassessed by ultrasound to measure amniotic fluid volume and abdominal circumference, and to assess umbilical artery flow. Only a small number of women will request elective cesarean delivery in this setting, unless they have had a previous cesarean or were advised at the time of the stillbirth to have a cesarean birth in their next pregnancy.…”

“…Accurate knowledge of the etiology of a stillbirth will then allow the woman and her family to be counseled about risks they face in a subsequent pregnancy, as well as potential management strategies to optimize future pregnancy outcomes. [2][3][4] Unfortunately, as many as one-third of such cases remain 'unexplained' and unexplained stillbirth is now the commonest single contributor to perinatal mortality.…”

“…Principles of the investigation of stillbirth have been reviewed in detail elsewhere. 3,4 It may be useful to describe a previous stillbirth as unexplained but low recurrence risk (that is, sufficient investigation was performed to exclude all the causes of stillbirth known to be associated with a risk of recurrence), or unexplained but potentially recurrent (where a lack of information makes it impossible to tell what the risk of recurrence is).…”

Morphology of fetal losses after antenatal hypoxia

“…У ча-сти женщин можно наблюдать смешанные факторы, к которым относятся короткие интервалы между беремен-ностями, раса, возраст матери, низкий социально-эконо-мический статус [5]. Применение индивидуальных стан-дартов роста может помочь в прогнозировании неблаго-приятных исходов беременности путем дифференциаль-ной диагностики ЗРП от конституционально маленьких здоровых плодов [9].…”