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. 2021 May 25;16(5):e0251965.
doi: 10.1371/journal.pone.0251965. eCollection 2021.

Stillbirth in term and late term gestations in Stockholm during a 20-year period, incidence and causes

Hanna Åmark  1 , Christina Pilo  2 , Ingela Hulthén Varli  3
Affiliations

Stillbirth in term and late term gestations in Stockholm during a 20-year period, incidence and causes

Hanna Åmark et al. PLoS One. .

Abstract

Introduction: The incidence of stillbirth has decreased marginally or remained stable during the past decades in high income countries. A recent report has shown Stockholm to have a lower incidence of stillbirth at term than other parts of Sweden. The risk of antepartum stillbirth increases in late term and postterm pregnancies which is one of the factors contributing to the current discussion regarding the optimal time of induction of labor due to postterm pregnancy.

Material and methods: This is a cohort study based on the Stockholm Stillbirth Database which contains all cases of stillbirth from 1998-2018 in Stockholm County. All cases were reviewed systematically and the cause of death was evaluated according to the Stockholm Stillbirth Classification. Stillbirths diagnosed between gestational week (GW) 37+0 and 40+6 n = 605 were compared to stillbirths diagnosed from GW 41+0 and onwards n = 157, according to the cause of stillbirth and pregnancy and maternal characteristics. The aim was to evaluate the incidence of stillbirth over time and the incidence of stillbirth diagnosed from GW 41+0.

Results: In Stockholm County the overall incidence of stillbirth has decreased from 4.6/1000 births during the period 1998-2004 to 3.4/1000 births during the period 2014-2018, p-value <0.001. When comparing the same time periods, the incidence of stillbirth diagnosed from GW 41+0 and onwards has decreased from 0.5/1000 births to 0.15/1000 births, p-value <0.001. Among women still pregnant at GW 41+0 the incidence of stillbirth has decreased from 1.8/ 1000 to 0.5/ 1000. When comparing stillbirths diagnosed at GW 37+0-40+6 with stillbirths diagnosed from GW 41+0 and onwards infection was a more common cause of stillbirth in the latter group.

Conclusion: In Stockholm County there was a decreasing incidence of stillbirth overall and in stillbirths diagnosed from 41+0 weeks of gestation and onwards during the period 1998-2018. In stillbirths diagnosed from GW 41+0 and onwards infection was a more common cause of death compared to stillbirths diagnosed between GW 37+0 and 40+6.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Total incidence of stillbirth in Stockholm county (violet).
Incidence of stillbirth in Sweden (black). Incidence of stillbirth among women still pregnant at GW 41+0 number/1000 pregnancies (red) and incidence of stillbirth diagnosed from GW 41+0/ 1000 births (blue). The decreased incidences, violet, red and blue were all significant with p-value <0.001. The incidence of stillbirth in Stockholm County has decreased comparing three time periods (1998-2004, 2005-2013 and 2014-2018).
Fig 2
Fig 2. Number of stillbirth cases diagnosed from GW 41+0.
Incidences compared between three time periods (1998-2004, 2005-2013 and 2014-2018). Dark grey indicates cases in GW 41 and light grey indicates cases in GW 42.
See this image and copyright information in PMC

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