Potentially preventable stillbirth in a diverse U.S. Cohort

Jessica M. Page, Vanessa Thorsten, Uma M. Reddy, Donald J. Dudley, Carol J.Rowland Hogue, George Saade, Halit Pinar, Corette B. Parker, Deborah Conway, Barbara J. Stoll, Donald Coustan, Radek Bukowski, Michael W. Varner, Robert L. Goldenberg, Karen Gibbins, Robert M. Silver

Research output: Contribution to journalArticle

2 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)336-343
Number of pages8
JournalObstetrics and Gynecology
Volume131
Issue number2
DOIs
StatePublished - Feb 1 2018

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Stillbirth
Placental Insufficiency
Pregnancy
Cause of Death
Fetofetal Transfusion
Fetal Death
Pregnancy Complications
Premature Obstetric Labor
Premature Birth
Research
Medical Records

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Page, J. M., Thorsten, V., Reddy, U. M., Dudley, D. J., Hogue, C. J. R., Saade, G., ... Silver, R. M. (2018). Potentially preventable stillbirth in a diverse U.S. Cohort. Obstetrics and Gynecology, 131(2), 336-343. https://doi.org/10.1097/AOG.0000000000002421

Potentially preventable stillbirth in a diverse U.S. Cohort. / Page, Jessica M.; Thorsten, Vanessa; Reddy, Uma M.; Dudley, Donald J.; Hogue, Carol J.Rowland; Saade, George; Pinar, Halit; Parker, Corette B.; Conway, Deborah; Stoll, Barbara J.; Coustan, Donald; Bukowski, Radek; Varner, Michael W.; Goldenberg, Robert L.; Gibbins, Karen; Silver, Robert M.

In: Obstetrics and Gynecology, Vol. 131, No. 2, 01.02.2018, p. 336-343.

Research output: Contribution to journalArticle

Page, JM, Thorsten, V, Reddy, UM, Dudley, DJ, Hogue, CJR, Saade, G, Pinar, H, Parker, CB, Conway, D, Stoll, BJ, Coustan, D, Bukowski, R, Varner, MW, Goldenberg, RL, Gibbins, K & Silver, RM 2018, 'Potentially preventable stillbirth in a diverse U.S. Cohort', Obstetrics and Gynecology, vol. 131, no. 2, pp. 336-343. https://doi.org/10.1097/AOG.0000000000002421
Page, Jessica M. ; Thorsten, Vanessa ; Reddy, Uma M. ; Dudley, Donald J. ; Hogue, Carol J.Rowland ; Saade, George ; Pinar, Halit ; Parker, Corette B. ; Conway, Deborah ; Stoll, Barbara J. ; Coustan, Donald ; Bukowski, Radek ; Varner, Michael W. ; Goldenberg, Robert L. ; Gibbins, Karen ; Silver, Robert M. / Potentially preventable stillbirth in a diverse U.S. Cohort. In: Obstetrics and Gynecology. 2018 ; Vol. 131, No. 2. pp. 336-343.
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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.",
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AU - Saade, George

AU - Pinar, Halit

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AU - Conway, Deborah

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AU - Coustan, Donald

AU - Bukowski, Radek

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