Potentially Preventable Stillbirth in a Diverse US Cohort

• Type of Material: Article
• Authors: Jessica M. Page, University of Utah; Vanessa Thorsten, Research Triangle Park; Uma M. Reddy, National Institutes of Health; Donald J. Dudley, University of Virginia; Carol Hogue, Emory University; George R. Saade, University of Texas Galveston; Halit Pinar, Brown University; Corette B. Parker, Research Triangle Park; Deborah Conway, University of Texas San Antonio; Barbara Stoll, Emory University; Donald Coustan, Brown University; Radek Bukowski, University of Texas Austin; Michael W. Varner, University of Utah; Robert L. Goldenberg, Columbia University; Karen Gibbins, University of Utah; Robert M. Silver, University of Utah
• Language: English
• Date: 2018-02-01
• Publisher: Lippincott, Williams & Wilkins: No Hybrid Open Access
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1097/AOG.0000000000002421
• Title of Journal or Parent Work: Obstetrics and Gynecology
• ISSN: 0029-7844
• Volume: 131
• Issue: 2
• Start Page: 336
• End Page: 343
• Grant/Funding Information: This work, including the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review and approval of the manuscript, was supported by grant funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development: U10-HD045953 Brown University, Rhode Island; U10-HD045925 Emory University, Georgia; U10-HD045952 University of Texas Medical Branch at Galveston, Texas; U10-HDO45955 University of Texas Health Sciences Center at San Antonio, Texas; U10-HD045944 University of Utah Health Sciences Center, Utah; and U01-HD045954 RTI International, RTP.
• Keywords: METAANALYSIS; COLLABORATIVE-RESEARCH-NETWORK; HIGH-INCOME COUNTRIES; Science & Technology; RISK-FACTORS; Obstetrics & Gynecology; DEATHS; PREGNANCY; DELIVERY; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Obstetrics and Gynecology; Health Sciences, Public Health

Abstract

OBJECTIVE: To estimate the proportion of potentially preventable stillbirths in the United States. METHODS: We conducted a secondary analysis of 512 stillbirths with complete evaluation enrolled in the Stillbirth Collaborative Research Network from 2006 to 2008. The Stillbirth Collaborative Research Network was a multisite, geographically, racially, and ethnically diverse, population-based case-control study of stillbirth in the United States. Cases of stillbirth underwent standard evaluation that included maternal interview, medical record abstraction, biospecimen collection, postmortem examination, placental pathology, and clinically recommended evaluation. Each stillbirth was assigned probable and possible causes of death using the Initial Causes of Fetal Death algorithm system. For this analysis, we defined potentially preventable stillbirths as those occurring in nonanomalous fetuses, 24 weeks of gestation or greater, and weighing 500 g or greater that were 1) intrapartum, 2) the result of medical complications, 3) the result of placental insufficiency, 4) multiple gestation (excluding twin-twin transfusion), 5) the result of spontaneous preterm birth, or 6) the result of hypertensive disorders of pregnancy. RESULTS: Of the 512 stillbirths included in our cohort, causes of potentially preventable stillbirth included placental insufficiency (65 [12.7%]), medical complications of pregnancy (31 [6.1%]), hypertensive disorders of pregnancy (20 [3.9%]), preterm labor (16 [3.1%]), intrapartum (nine [1.8%]), and multiple gestations (four [0.8%]). Twenty-seven stillbirths fit two or more categories, leaving 114 (22.3%) potentially preventable stillbirths. CONCLUSION: Based on our definition, almost one fourth of stillbirths are potentially preventable. Given the predominance of placental insufficiency among stillbirths, identification and management of placental insufficiency may have the most immediate effect on stillbirth reduction.