Obstetric outcomes subsequent to intrauterine death in the first pregnancy

Abstract

Objective: To compare obstetric outcomes in the pregnancy subsequent to intrauterine death with that following live birth in first pregnancy.

Design: Retrospective cohort study.

Setting: Grampian region of Scotland, UK.

Population: All women who had their first and second deliveries in Grampian between 1976 and 2006.

Methods: All women delivering for the first time between 1976 and 2002 had follow up until 2006 to study their next pregnancy. Those women who had an intrauterine death in their first pregnancy formed the exposed cohort, while those who had a live birth formed the unexposed cohort.

Main outcome measures: Maternal and neonatal outcomes in the second pregnancy, including pre-eclampsia, placental abruption, induction of labour, instrumental delivery, caesarean delivery, malpresentation, prematurity, low birthweight and stillbirth.

Results: The exposed cohort (n = 364) was at increased risk of pre-eclampsia (OR 3.1, 95% CI 1.7-5.7); placental abruption (OR 9.4, 95% CI 4.5-19.7); induction of labour (OR 3.2, 95% CI 2.4-4.2); instrumental delivery (OR 2.0, 95% CI 1.4-3.0); elective (OR 3.1, 95% CI 2-4.8) and emergency caesarean deliveries (OR 2.1, 95% CI 1.5-3.0); and prematurity (OR 2.8, 95% CI 1.9-4.2), low birthweight (OR 2.8, 95% CI 1.7-4.5) and malpresentation (OR 2.8, 95% CI 2.0-3.9) of the infant as compared with the unexposed cohort (n = 33,715). The adjusted odds ratio for stillbirth was 1.2 and 95% CI 0.4-3.4.

Conclusion: While the majority of women with a previous stillbirth have a live birth in the subsequent pregnancy, they are a high-risk group with an increased incidence of adverse maternal and neonatal outcomes.