Pregnancy after stillbirth: maternal and neonatal outcomes and health service utilisation

Pregnancy after stillbirth: maternal and neonatal outcomes and health service utilisation

Dr. Ruth Roseingrave (1), Dr. Margaret Murphy (2), Dr. Keelin O’Donoghue (3)

(1) Senior House Officer in Obstetrics and Gynaecology, Cork University Maternity Hospital; MSc. Student, Department of Obstetrics and Gynaecology, University College Cork, Ireland; (2) Lecturer in Midwifery, School of Nursing and Midwifery, University College Cork, Ireland; (3) Consultant Obstetrician and Gynaecologist, Cork University Maternity Hospital; Senior Lecturer University College Cork; PI, Pregnancy Loss Research Group, INFANT Centre, University College Cork, Ireland.

Background:
Pregnancy after stillbirth attracts increased antenatal surveillance and interventions. Maternal and neonatal outcomes, and health service utilisation in pregnancy after stillbirth within an Irish context was lacking. Objectives: The study’s purpose was to investigate the needs of women in pregnancy after loss, and to investigate maternal and neonatal outcomes.

Methods:
A retrospective cohort study of all pregnancies after stillbirth from 2011-2017 was conducted. Data were collected from a single tertiary-referral university maternity teaching hospital with 8,000 births annually and a dedicated fetal medicine team.

Results:
There were 222 stillbirths reported. 65.3% of women (145/222) had a pregnancy after loss, the majority of whom (131/145) had a livebirth. 19.3% of pregnancies (28/145) ended in miscarriage, but 57.1% (16/28) had a livebirth after miscarriage. Average inter-pregnancy interval was 1.3 years, with 20% (29/145) conceiving within the same year. The average number of antenatal hospital visits was twice that expected (9.2; range 0-27), and the average number of ultrasound scans was five times higher than expected (5; range 0-29). 63.4% of women had screening for gestational diabetes (83/131). 59.5% of births (78/131) were vaginal. 40.5% (53/131) were caesarean sections, 9.6% more than the national average. 48.1% of women (61/131) had an induction of labour, 21.7% more than national rates. Past obstetric history was the indication for induction of labour in 63.5% (40/61). There was a statistically significant increase in the rate of preterm deliveries in pregnancy after loss compared to the general obstetric population (22.9%; 30/131). 23.4% of babies (32/137) required admission to the neonatal unit, more than twice the national average.

Conclusions:
Pregnancy after stillbirth requires increased surveillance and intervention compared to the general obstetric population. Increased health service utilisation places greater demands on hospital resources. We should be cognisant of additional supports required for women and their families in pregnancy after loss.

Ethics Statement:
Full ethical approval for this study was obtained from the Local Hospitals Ethics Committee and the Local Information Governance Group (LIGG). This was a retrospective cohort review of patient notes. Data access was approved by the LIGG and limited to the named authors. All data were anonymised and securely stored.

Conflicts of interest:
The authors of this study have no conflicts of interest to declare


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

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