Information regarding the cause of stillbirth has a limited ability to predict the outcome of a subsequent pregnancy

Information regarding the cause of stillbirth has a limited ability to predict the outcome of a subsequent pregnancy

Dr Nicole Graham (1,2), Dr Gauri Batra (1,3), Professor Alexander EP Heazell (1,2)

(1) Maternal and Fetal Health Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, UK; (2) Division of Obstetrics, St Mary’s Hospital, Manchester Academic Health Sciences Centre, UK; (3) St Mary’s Hospital, Manchester University NHS Foundation Trust, Oxford Rd, Manchester, UK.

Background
Women who experience a stillbirth are 5 times more likely to experience a recurrent stillbirth, as well as having increased risk of other adverse outcome. Origins of this increased risk are not well understood as few studies have examined cause of death in recurrent pregnancy loss. This study aimed to explore the relationship between the cause of index stillbirth and subsequent pregnancy outcome.

Methods
Retrospective cohort study; cases included if stillbirth was investigated, subsequent pregnancy care provided, and birth was in the same tertiary UK maternity unit. Stillbirth classified using the ReCoDe system. Data on maternal characteristics, findings of investigations at the time of death and the cause of death were extracted and logistic regression performed to determine whether these factors were independently associated with adverse outcome in subsequent pregnancy.

Results
In this cohort (n=213), there were 43 adverse outcomes (20.2%) including: one stillbirth, one neonatal death. Most common were preterm delivery (11.3%) and birthweight <10th centile (10.3%). Half of preterm deliveries were iatrogenic, where delivery expedited for abnormalities in fetal growth (42%) and antepartum haemorrhage (25%).
There was no significant association between maternal characteristics and adverse outcome in subsequent pregnancy. Cause of stillbirth(p=0.96), gestation of stillbirth(p=0.18) and stillbirth placental weight <10th centile(p=0.13) were not associated with subsequent pregnancy outcome. Maternal vascular malperfusion evident on placental histology had increased risk of adverse outcome in subsequent pregnancy p<0.01 (OR 5.31 (95% CI 1.16, 24.35).

Conclusion
Women who have a history of stillbirth have increased risk of adverse outcome in subsequent pregnancies. However, maternal characteristics and classification of cause of stillbirth do not affect risk of adverse outcome. Therefore, increased surveillance is recommended in all pregnancies after stillbirth.

Ethics Statement
This study was approved by South East Coast- Surrey research ethics committee (Ref 16/LO/1666)


International Stillbirth Alliance, Annual Conference on Perinatal Mortality and Bereavement Care, Madrid, Spain. October 5-6th, 2019.

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