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. 2018 Feb;131(2):336-343.
doi: 10.1097/AOG.0000000000002421.

Potentially Preventable Stillbirth in a Diverse U.S. Cohort

Jessica M Page  1 , Vanessa Thorsten, Uma M Reddy, Donald J Dudley, Carol J Rowland Hogue, George R 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
Affiliations

Potentially Preventable Stillbirth in a Diverse U.S. Cohort

Jessica M Page et al. Obstet Gynecol. 2018 Feb.

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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Conflict of interest statement

Financial Disclosure

The authors did not report any potential conflicts of interest.

Each author has indicated that he or she has met the journal’s requirements for authorship.

Figures

Figure 1
Figure 1
Flowchart of study design and analysis.
Figure 2
Figure 2
Potentially preventable stillbirth stratified by gestational age.
See this image and copyright information in PMC

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