title: Reduction in stillbirths at term after new birth induction paradigm: results of a national intervention.
abstract: OBJECTIVE
  The risk of fetal death increases steeply after 42 gestational weeks. Since 2009, Denmark has had a more proactive policy including prevention of prolonged pregnancy, and early intervention in women with diabetes, preeclampsia, high body mass index and of a higher age group. The aim of this study was to describe the development in fetal deaths with this more proactive birth induction practice, and to identify and quantify contributing factors for this development.
  
  
  METHODS
  National cohort study.
  
  
  METHODS
  Denmark.
  
  
  METHODS
  Delivering women in Denmark, 1 January 2000 to 31 December 2012.
  
  
  METHODS
  Stillbirths per 1000 women at risk (prospective risk of stillbirth) and per 1000 newborn from 37 and 40 gestational weeks, respectively, through the study period.
  
  
  RESULTS
  During the study period, 829,165 children were live born and 3770 (0.45%) stillborn. Induction of labour increased from 12.4% in year 2000 to 25.1% in 2012 (p<0.001), and the percentage of children born at or after 42 weeks decreased from 8.0% to 1.5% (p<0.001). Through the same period, the prospective risk of stillbirth after 37 weeks fell from 0.70 to 0.41/1000 ongoing pregnancies (p<0.001), and from 2.4 to 1.4/1000 newborn (p<0.001). The regression analysis confirmed the inverse association between year of birth and risk of stillbirth. The lowest risk was observed in the years 2011-2012 as compared with years 2000-2002 with a fully adjusted HR of 0.69 (95% CI 0.57 to 0.83). The general earlier induction, the focused earlier induction of women with body mass index >30, twins, and of women above 40 years and a halving of smoking pregnant women were all independent contributing factors for the decrease.
  
  
  CONCLUSIONS
  A gradually more proactive and differential earlier labour induction practice is likely to have mainly been responsible for the substantial reduction in stillbirths in Denmark.
authors.affiliation: Department of Gynecology, Faculty of Health Science, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Mette
authors.initials: M
authors.lastname: Hedegaard
authors.affiliation: Department of Gynecology, Faculty of Health Science, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Øjvind
authors.initials: Ø
authors.lastname: Lidegaard
authors.affiliation: Department of Gynecology, Faculty of Health Science, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Charlotte Wessel
authors.initials: CW
authors.lastname: Skovlund
authors.affiliation: Department of Gynecology, Faculty of Health Science, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Lina Steinrud
authors.initials: LS
authors.lastname: Mørch
authors.affiliation: Department of Obstetrics, Faculty of Health Science, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Hedegaard
mesh_terms: D000328:Adult; D000367:Age Factors; D015992:Body Mass Index; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005313:Fetal Death / Q000517:prevention & control*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007751:Labor, Induced; D050498:Live Birth / Q000453:epidemiology; D011247:Pregnancy; D011273:Pregnancy, Prolonged / Q000517:prevention & control*; D011446:Prospective Studies; D012306:Risk; D012307:Risk Factors; D012907:Smoking; D050497:Stillbirth / Q000453:epidemiology; D047929:Term Birth; D014427:Twins
keywords: EPIDEMIOLOGY; OBSTETRICS