Predicting antepartum stillbirth.
OBJECTIVE
Rates of stillbirth in the developed world have been static or rising in recent years. Clinical prediction of stillbirth risk may allow interventional studies.


RESULTS
The most prevalent independent risk factors are nulliparity, advanced age and obesity. These are increasingly prevalent in the developed world. Obesity is particularly associated with stillbirth at term and after term. Pregestational diabetes is a major risk factor for stillbirth and these women are usually offered intensive surveillance during pregnancy. Despite this, a recent national study in the UK demonstrated a fourfold excess of stillbirth, with 80% unrelated to congenital abnormality. Studies of association between previous caesarean section and subsequent stillbirth risk are inconsistent, although in data sources with detailed information, the association has been confirmed. Global analyses of stillbirth risk demonstrate that 98% occur in the developing world and that many are due to potentially preventable causes. A randomized controlled trial of very simple educational interventions was associated with a 30% lower risk of stillbirth.


CONCLUSIONS
Relatively simple interventions may be successful in reducing the global burden of stillbirth. Further biological understanding of the causes of stillbirth is required to reduce the burden of the disease in the developed world.
Smith
Gordon C S
GC
Obstetrics and Gynaecology, Cambridge University, Cambridge, UK. gcss2@cam.ac.uk
D002585:Cesarean Section / Q000009:adverse effects; D016640:Diabetes, Gestational; D005260:Female; D005313:Fetal Death / Q000209:etiology*; D047109:Fetal Development; D006801:Humans; D009765:Obesity / Q000150:complications; D011247:Pregnancy; D011254:Pregnancy in Diabetics; D012307:Risk Factors; D050497:Stillbirth; D014430:Twins, Monozygotic / Q000502:physiology