Top

Archives of Gynecology and Obstetrics

Published in:

01-03-2009 | Original Article

Perinatal mortality: a sporadic event or a recurrent catastrophe?

Authors: Adi Y. Weintraub, Amit Rozen, Eyal Sheiner, Amalia Levy, Fernanda Press, Arnon Wiznitzer

Published in: Archives of Gynecology and Obstetrics | Issue 3/2009

Abstract

Objective

The purpose of this study was to determine whether women who experienced perinatal mortality in their first delivery had, in their subsequent birth, a higher risk for adverse perinatal outcome.

Methods

A population-based study was undertaken to compare all second deliveries of women with previous perinatal mortality in their first delivery to those with no such history. Deliveries occurred from 1988 to 2004 in a tertiary medical center. Patients lacking prenatal care, multiple gestations, and congenital malformations were excluded from the analysis. A multivariable logistic regression model and the Mantel–Haenszel procedure were carried out to control for confounders.

Results

During the study period, out of 25,876 singleton second deliveries, 230 (0.9%) cases were of patients with previous perinatal mortality. Multivariable analysis with backward elimination showed a significant association between previous perinatal mortality and the following conditions: hypertensive disorders (OR = 2.6, 95% CI 1.7–3.9, P < 0.001), diabetes mellitus (OR = 2.4, 95% CI 1.5–3.7, P < 0.001), fertility treatment (OR = 2.7, 95% CI 1.6–4.7, P = 0.001), and younger maternal age (OR = 0.9, 95% CI 0.92–0.98, P < 0.001). Controlling for preterm delivery, using the Mantel–Haenszel procedure, the association between previous and subsequent perinatal mortality remained significant (weighted OR = 2.2, 95% CI 1.2–3.9, P = 0.010).

Conclusion

Previous perinatal loss poses an independent risk for subsequent perinatal mortality. Prospective studies are warranted in order to establish the appropriate means of surveillance and/or interventions needed to decrease future adverse perinatal outcomes.

Silver RM (2007) Fetal death. Obstet Gynecol 109:153–167PubMed

Fretts RC (2005) Etiology and prevention of stillbirth. Am J Obstet Gynecol 193:1923–1935. doi:10.1016/j.ajog.2005.03.074 PubMedCrossRef

Froen JF, Arnestad M, Frey K, Vege A, Saugstad OD, Stray-Pedersen B (2001) Risk factors for sudden intrauterine unexplained death: epidemiologic characteristics of singleton cases in Oslo, Norway, 1986–1995. Am J Obstet Gynecol 184:694–702. doi:10.1067/mob.2001.110697 PubMedCrossRef

Vintzileos AM, Ananth CV, Smulian JC, Scorza WE, Knuppel RA (2002) Prenatal care and black–white fetal death disparity in the United States: heterogeneity by high-risk conditions. Obstet Gynecol 99:483–489. doi:10.1016/S0029-7844(01)01758-6 PubMedCrossRef

Fretts RC, Schmittdiel J, McLean FH, Usher RH, Goldman MB (1995) Increased maternal age and the risk of fetal death. N Engl J Med 333:953–957. doi:10.1056/NEJM199510123331501 PubMedCrossRef

Kristensen J, Vestergaard M, Wisborg K, Kesmodel U, Secher NJ (2005) Pre-pregnancy weight and the risk of stillbirth and neonatal death. BJOG 112:403–408. doi:10.1111/j.1471-0528.2005.00437.x PubMedCrossRef

Simpson LL (2002) Maternal medical disease: risk of antepartum fetal death. Semin Perinatol 26:42–50. doi:10.1053/sper.2002.29838 PubMedCrossRef

Weintraub AY, Press F, Wiztitzer A, Sheiner E (2007) Maternal thrombophilia and adverse pregnancy Outcomes. Expert Rev Obstet Gynecol 2:203–216. doi:10.1586/17474108.2.2.203 CrossRef

Goldenberg RL, Thompson C (2003) The infectious origins of stillbirth. Am J Obstet Gynecol 189:861–873. doi:10.1067/S0002-9378(03)00470-8 PubMedCrossRef

10.

Wapner RJ, Lewis D (2002) Genetics and metabolic causes of stillbirth. Semin Perinatol 26:70–74. doi:10.1053/sper.2002.29853 PubMedCrossRef

11.

Froen JF, Gardosi JO, Thurmann A, Francis A, Stray-Pedersen B (2004) Restricted fetal growth in sudden intrauterine unexplained death. Acta Obstet Gynecol Scand 83:801–807. doi:10.1111/j.0001-6349.2004.00602.x PubMedCrossRef

12.

Laube DW, Schauberger CW (1982) Fetomaternal bleeding as a cause for “unexplained” fetal death. Obstet Gynecol 60:649–651PubMed

13.

Joseph KS, Marcoux S, Ohlsson A, Kramer MS, Allen AC, Liu S, Infant Fetal Health Study Group of the Canadian Perinatal Surveillance System et al (2002) Preterm birth, stillbirth and infant mortality among triplet births in Canada, 1985–1996. Paediatr Perinat Epidemiol 16:141–148. doi:10.1046/j.1365-3016.2002.00413.x PubMedCrossRef

14.

Hershkovitz R, Silberstein T, Sheiner E, Shoham-Vardi I, Holcberg G, Katz M et al (2001) Risk factors associated with true knots of the umbilical cord. Eur J Obstet Gynecol Reprod Biol 98:36–39. doi:10.1016/S0301-2115(01)00312-8 PubMedCrossRef

15.

Sheiner E, Abramowicz JS, Levy A, Silberstein T, Mazor M, Hershkovitz R (2006) Nuchal cord is not associated with adverse perinatal outcome. Arch Gynecol Obstet 274:81–83. doi:10.1007/s00404-005-0110-2 PubMedCrossRef

16.

McGovern PG, Llorens AJ, Skurnick JH, Weiss G, Goldsmith LT (2004) Increased risk of preterm birth in singleton pregnancies resulting from in vitro fertilization–embryo transfer or gamete intrafallopian transfer: a meta-analysis. Fertil Steril 82:1514–1520. doi:10.1016/j.fertnstert.2004.06.038 PubMedCrossRef

17.

Oron T, Sheiner E, Shoham-Vardi I, Mazor M, Katz M, Hallak M (2001) Risk factors for antepartum fetal death. J Reprod Med 46:825–830PubMed

18.

Sheiner E, Hallak M, Shoham-Vardi I, Goldstein D, Mazor M, Katz M (2000) Determining risk factors for intrapartum fetal death. J Reprod Med 45:419–424PubMed

19.

Mesogitis S, Daskalakis G, Pilalis A, Papantoniou N, Antsaklis A (2005) Fetal intravascular transfusion for hydropic disease due to rhesus isoimmunization. Fetal Diagn Ther 20:431–436. doi:10.1159/000086826 PubMedCrossRef

20.

Weintraub AY, Leron E, Mazor M (2006) The pathophysiology of trauma in pregnancy: a review. J Matern Fetal Neonatal Med 19:601–605. doi:10.1080/14767050600900996 PubMedCrossRef

21.

Frias AE Jr, Luikenaar RA, Sullivan AE, Lee RM, Porter TF, Branch DW et al (2004) Poor obstetric outcome in subsequent pregnancies in women with prior fetal death. Obstet Gynecol 104:521–526PubMed

22.

Sharma PP, Salihu HM, Oyelese Y, Ananth CV, Kirby RS (2006) Is race a determinant of stillbirth recurrence? Obstet Gynecol 107:391–397PubMed

23.

Robson S, Chan A, Keane RJ, Luke CG (2001) Subsequent birth outcomes after an unexplained stillbirth: preliminary population-based retrospective cohort study. Aust N Z J Obstet Gynaecol 41:29–35. doi:10.1111/j.1479-828X.2001.tb01290.x PubMedCrossRef

24.

Fretts RC, Elkin EB, Myers ER, Heffner LJ (2004) Should older women have antepartum testing to prevent unexplained stillbirth? Obstet Gynecol 104:56–64PubMedCrossRef

25.

Robson S, Thompson J, Ellwood D (2006) Obstetric management of the next pregnancy after an unexplained stillbirth: an anonymous postal survey of Australian obstetricians. Aust N Z J Obstet Gynaecol 46:278–281. doi:10.1111/j.1479-828X.2006.00591.x PubMedCrossRef

26.

Silver RM, Varner MW, Reddy U, Goldenberg R, Pinar H, Conway D et al (2007) Work-up of stillbirth: a review of the evidence. Am J Obstet Gynecol 196:433–444. doi:10.1016/j.ajog.2006.11.041 PubMedCrossRef

Title: Perinatal mortality: a sporadic event or a recurrent catastrophe?
Authors: Adi Y. Weintraub
Amit Rozen
Eyal Sheiner
Amalia Levy
Fernanda Press
Arnon Wiznitzer
Publication date: 01-03-2009
Publisher: Springer-Verlag
Published in: Archives of Gynecology and Obstetrics / Issue 3/2009
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-008-0702-8

At a glance: The STEP trials

Springer Medicine

Perinatal mortality: a sporadic event or a recurrent catastrophe?

Abstract

Objective

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2009

The sexual activity during pregnancy among a group of Iranian women

Vaginal osseous metaplasia

Combined spinal–epidural analgesia for labor pain: best timing of epidural infusion following spinal dose

Peritoneal fluid and serum leptin concentrations in women with primary infertility

Severe metabolic acidosis as a consequence of acute starvation in pregnancy

Partial mole with fetal triploidy as a cause for imminent HELLP-syndrome at 16 weeks of gestation