A quarter of stillbirths are preventable by increased obstetric surveillance

Placental insufficiency was identified as the lead cause of potentially preventable stillbirths, followed by medical complications of pregnancy and hypertensive disorders of pregnancy, reported the result of a small study conducted by Jessica M. Page, MD, of the University of Utah School of Medicine, and her colleagues. 

The stillbirth rate in the US was 5.96 per 1,000 births in 2013 and has remained stable since the last decade. Although it is much lower than the global rate of 18.4/1,000 births, it is higher than rates in other developed countries.

Currently, Finland has the lowest stillbirth rate of 2 per 1,000 births, while Pakistan has the highest rate of 43.1 per 1,000 births. Other countries with relatively low stillbirth rates included Norway, Denmark, and Singapore. 

The researchers conducted a secondary analysis of 512 stillbirths from the Stillbirth Collaborative Research Network with post-mortem data and placental histopathology. They identified 114 (22.3%) that were potentially preventable; 27 of those were included in more than one category, of which 23 fit into two categories and 4 fits into three categories.

In fact, one-third of stillbirths due to placental insufficiency had another cause identified as well. When the stillbirths due to placental insufficiency were analyzed further, it was seen that they increased with increasing gestational age, the most common window being after 37 weeks of gestation. The stillbirths due to other causes (potentially preventable and nonpreventable) did not increase with increasing gestational age.

But, the researchers did notice a significant increase in the proportion of potentially preventable stillbirths with increasing gestational age (P=.023). Notably, 39 out of 114 preventable stillbirths occurred after 37 weeks of gestation, when the risk of prematurity was at its minimal, had they been detected at risk of intrauterine death (IUD) and delivered.

When the researchers looked at the role played by race and ethnicity, they did not find any significant difference between various cohorts.

The majority of stillbirths in low resource setting can be preventable, while there is no clue regarding how to bring down the stillbirth rate in developed countries. There are few risk factors that increase the risk of stillbirths like smoking, obesity, advanced maternal age, and multiple gestations but it is not known that how far the risk can be lowered by modification of these factors.

Researchers are optimistic to get some clue regarding prediction of third-trimester stillbirths from data obtained from the Eunice Kennedy Shriver National Institute of Child Health and Human Development–sponsored Human Placenta Project.

The study has many limitations, but it also did include a large number of well-characterized stillbirths from racially, ethnic and geographically diverse population.

This study underscores the importance of close obstetric surveillance with nearly 25% of stillbirths deemed potentially preventable.

The study was published in February 2018 issue of Journal of Obstetrics and Gynecology and also presented as a poster at the Society for Maternal-Fetal Medicine’s 36th Annual Pregnancy Meeting, February 1–6, 2016, Atlanta, Georgia.

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