Stillbirth at term: Does size really matter?

Abstract

Placental dysfunction has a deleterious influence on fetal size and is associated with higher rates of perinatal morbidity and mortality. This association underpins the strategy of fetal size evaluation as a mechanism to identify placental dysfunction and prevent stillbirth. The optimal method of routine detection of small for gestational age (SGA) remains to be clarified with choices between estimation of symphyseal-fundal height versus routine third-trimester ultrasound, various formulae for fetal weight estimation by ultrasound, and the variable use of national, customized, or international fetal growth references. In addition to these controversies, the strategy for detecting SGA is further undermined by data demonstrating that the relationship between fetal size and adverse outcome weakens significantly with advancing gestation such that near term, the majority of stillbirths and adverse perinatal outcomes occur in normally sized fetuses. The use of maternal serum biochemical and Doppler parameters near term appears to be superior to fetal size in the identification of fetuses compromised by placental dysfunction and at increased risk of damage or demise. Multiparameter models and predictive algorithms using maternal risk factors, and biochemical and Doppler parameters have been developed, but need to be prospectively validated to demonstrate their effectiveness.

Effect of routine first‐trimester combined screening for pre‐eclampsia on small‐for‐gestational‐age birth: secondary interrupted time series analysis

“…In addition, induction of labor was offered from 40 weeks, given that aspirin prophylaxis delays the onset of pre-eclampsia but has not been shown to prevent the development of FGR or small-for-gestational-age (SGA) babies at birth 6 . Placental dysfunction, which often leads to SGA at birth, is associated with stillbirth, significant shortand long-term morbidity and reduced quality of life 7,8 . It is therefore important to understand the impact of the FMF first-trimester combined pre-eclampsia screening program on the prevalence of SGA and FGR.…”

Growth Abnormalities as a Risk Factor of Adverse Neonatal Outcome in Hypertensive Pregnancies—A Single-Center Retrospective Cohort Study

“…Interestingly, before adjusting for gestational age, the Polish reference growth chart was the only independent risk factor of stillbirth [ 6 ]. These comparisons perfectly illustrate how the methodology used to create growth charts can affect the obtained results [ 8 , 32 , 33 ]. Researchers should have extreme caution when interpreting the results generated on different types of growth charts.…”

Molecular Pathways of Cellular Senescence and Placental Aging in Late Fetal Growth Restriction and Stillbirth

“…WHO recommends reporting data only for fetuses stillborn above 1000 g or 28 weeks of gestation [76]. Classifications have been developed to differentiate the causes of stillbirth [6,13,77] Once all known causes such as clinically symptomatic placental insufficiency presenting as FGR, congenital defects, chromosomal abnormalities, infection, placental abruption, or infarction are excluded, the clinicians are left with "unexplained" stillbirth. It is believed that between 25-60% of stillbirths are classified as unexplained [78][79][80].…”

“…Late or even term stillbirths rarely present Doppler or histological signs of placental insufficiency. Yet, the majority of term stillbirths occur in normally grown fetuses [6]. It has been shown that appropriate for gestational age fetuses (AGA) can also present symptoms of FGR.…”

“…It is believed that one differs from the other by the presence of ultrasonographic signs of placental insufficiency [5]. SGA and FGR both carry a certain degree of stillbirth risk, but most term deaths are found in normally grown fetuses [6]. A confounding relationship Int.…”