Stillbirths

It occurs in approximately 6 per 1000 pregnancies in the United States.

Effective interventions could save the lives of 1.1 million babies annually.

Approximately 26,000 stillbirths per year, a number equivalent to the number of infant deaths.

Fetal mortality is almost as common as infant mortality. affecting 1 in every 160 pregnancies.

Approximately 3.3 million stillbirths worldwide, annually.

Account for a large part of all perinatal deaths.

Many are unexplained, even after standard postmortem evaluation.

Karyotype and chromosomal microarray can identify diagnosis in 8-13% of miscarried fetuses, although monogenic disorders generally are elusive because these approaches are insensitive to small genetic changes.

98% of stillbirths are in low income and middle income countries.

Stillbirth rate is an indicator in women’s health and quality care in pregnancy child birth.

Stillbirth rates are relatively low in high income countries compared with low income and middle income countries.

Stillbirth rates doubled neonatal mortality and often equal to all deaths of infants younger than one year..

Stillbirth rates are steady while neonatal mortality continues to reduce.

Associated with maternal diabetes, obesity, smoking, multi-fetal pregnancy, black race, women pregnant for the first time while living alone.

Stillborn rate in the US is higher than that of many other developed countries, and has slowly declined by an average of 1.4% per year from 1990-2003.

Since 2003 the stillborn birth rate has remained steady at 6.2 stillbirths per 1000 births.

Stillbirth rate for non-Hispanic black women is 2.3 fold higher than that of Caucasians.

Stillbirth rate for Hispanic women is 14% higher than that for Caucasian women.

Risk factors evident at the beginning of pregnancy has low positive predictive value limiting opportunities for intervention.

Frequency of apparent stillbirth ranges from 0.4-0.8 per 1000 births.

Born with Apgar score of 0 at 1 minute.

Accounts for more than a third of all fetal and infant deaths and for >50% of perinatal deaths in North America.

Maternal overweight condition increased the risk of antepartum stillbirth, whereas weight gain during pregnancy is not associated with risk.

Incremental increase in the risk of stillbirth occurs with BMI gain between first and second pregnancies

Cigarette smoking and older maternal age are risk factors.

Survival without neurologic disabilities range from 27% to 40%.

Increased risk with preterm birth, male gender, preeclampsia and abruptio placentae.

Refers to the death of a fetus at 20 or more weeks of gestation.

Advancing maternal age significantly increases the risk.

Placental dysfunction during the first trimester associated with stillbirth.

4 per 1000 pregnancies in maternal age group 20-29 and greater than 10 per 1000 after 40 years of age.

Possible causes: fetal anamolies, maternal illness (diabetes, hypertension, hemoglobinopathy), fetal infection and unexplained cases.

Infection causes about 20% of cases of stillbirth.

Group B streptococci infections cause 4-10% of stillbirths.

In a study involving unexplained stillbirth, the use of e-commerce sequencing to search for disease causing variants in the coding regions of the genome, identified a genetic diagnosis in 8.5% of the cases.

Stillbirth Collaborative Research Network (SCRN) found four categories of stillbirth based on gestational age, maternal race/ethnicity, and causes of death.

Fetal deaths before 28 weeks gestation included deaths between 20 and 24 weeks, occurring during labor and were more common among black women, while a second group of field deaths arose from placental problems and other complications of obstetric that preceded labor/

Fetal deaths after 28 weeks gestation were related to maternal hypertension, between 24 and 31 weeks, whereas on the local cord abnormalities with the most common cause in the last weeks of pregnancy.

Fetal deaths during labor before 24 weeks gestation is a consequence of prematurity, and is comprised by a majority of black mothers.

Fetal deaths before 28 weeks gestation include a group of fetal deaths between 20 and 24 weeks that occur during labor and are more common among black women, and the second group in which fetal death from placental problems and of the obstetrical complications proceed labor.

After 28 weeks gestation fetal deaths related to maternal hypertension predominate. Between 24 and 31 weeks, and umbilical cord abnormalities of the most common cause in the last weeks of pregnancy.

Stillborn and preterm births are closely linked.

A history of a prior stillbirth is associated with an increased risk.

Almost all patients report negative psychological symptoms after a stillbirth.

Increased risk found in nulliparous women who had experienced a pregnancy loss before 20 weeks.

A systematic evaluation of the causes of death among stillbirths found a probable cause in 60.9% and a possible or probable cause and 76.2% of cases: the most common causes were obstetric conditions 29.3%, placental abnormalities 23.6%, fetal genetic/structural abnormalities 13.7%, infection 12.9%, umbilical cord abnormalities 10.4%, hypertensive disorders 9.2%, and of the maternal medical conditions 7.8% (The Stillbirth Collaborative Research Network Writing Group).

In the above study, a higher proportion of stillbirths in non-Hispanic black women compared with non-Hispanic white and Hispanic women was associated with obstetric complications and infections.

In the above study intrapartum and early in gestation stillbirths were more common in non-Hispanic black women.