The risk factors and maternal adverse outcomes of stillbirth

Abstract

Background/Aim: Stillbirth is a devastating complication of the pregnancy. Contemporary studies have exposed several reasons; however, most of the cases are still unexplained. Stillbirth delivery could cause various maternal complications. We aimed to evaluate the maternal complications and reveal the risk factors for stillbirth. Methods: A case-control study was performed at a high-volume university-affiliated research and training hospital between June 2016 and June 2020. The study population was divided into two groups as women who delivered stillbirth (study group) and live birth (control group). Patients’ characteristics, birth weight and gender of the newborn, hospital stay, delivery type, concomitant diseases in pregnancy such as preeclampsia, gestational diabetes mellitus, fetal anomaly, preterm premature rupture of the membranes and complications such as uterine atony, abruptio placenta, postpartum hemorrhage, disseminated intravascular coagulation, and uterine rupture were evaluated from the medical records and compared between groups. Results: A total of 46019 births occurred during the study period. The number of women who delivered stillbirth was 520 with a rate of 11.2 per 1000 births. The control group included 6521 patients. Comparison of the groups revealed that women delivering stillbirth were older (P<0.001), had longer hospital stay (P<0.001), lower newborn birth weight (P<0.001), and more babies with congenital anomalies (P<0.001) than the control group. The women in stillbirth group experienced more preterm premature rupture of the membranes (P<0.001), preeclampsia (P<0.001), gestational diabetes mellitus (P<0.001), abruptio placenta (P<0.001), postpartum hemorrhage (P<0.001), and disseminated intravascular coagulation (P<0.001). The rates of severe obstetric and postpartum complications were 14.2% and 12.1%, respectively. Multivariate logistic regression analysis revealed that fetal anomaly (OR 3.170; 95% CI 1.592-6.315, P<0.001), gestational diabetes mellitus (OR 15.203; 95% CI 8.368-27.621, P<0.001) and abruptio placenta (OR 18.221; 95% CI 9.121-36.402, P<0.001) increased the risk of stillbirth. Conclusion: Stillbirth delivery could lead to severe maternal complications that can threaten maternal vitality. Close delivery follow-up is essential, especially during the early postpartum period. Care should be taken for postpartum complications such as disseminated intravascular coagulation and postpartum hemorrhage. Furthermore, patients should be examined carefully for abruptio placenta. Stillbirth deliveries should be carried out in fully equipped hospitals.

Keywords

• Abruptio placenta
• Gestational Diabetes Mellitus
• Maternal Complication
• Stillbirth

References

1. 1. Lawn JE, Blencowe H, Pattinson R, Cousens S, Kumar R, Ibiebele I, et al. Stillbirths: Where? When? Why? How to make the data count? The Lancet. 2011;377(9775):1448-63.
2. 2. Aminu M, Unkels R, Mdegela M, Utz B, Adaji S, Van Den Broek N. Causes of and factors associated with stillbirth in low‐and middle‐income countries: a systematic literature review. BJOG.2014;121(4):141-53.
3. 3. Cnattingius S, Stephansson O. The epidemiology of stillbirth. Semin Perinatol. 2002;26(1):25-30.
4. 4. Organization WH. Neonatal and perinatal mortality: Country, Regional and Global Estimates. World Health Organization; 2006.
5. 5. MacDorman MF, Gregory EC. Fetal and perinatal mortality: United States. Natl Vital Stat Rep. 2015;64(8):1-24.
6. 6. Dudley DJ. Diabetic-associated stillbirth: incidence, pathophysiology, and prevention. Clinics in perinatology. 2007;34(4):611-26.
7. 7. Deniz A. The effects of age, parity and body mass index on 50 g oral glucose tolerance test results and its predictive value in gestational diabetes mellitus. Journal of Surgery and Medicine. 2020;4(9):750-3.
8. 8. Maslow AD, Breen TW, Sarna MC, Soni AK, Watkins J, Oriol NE. Prevalence of coagulation abnormalities associated with intrauterine fetal death. Canadian journal of anaesthesia. 1996;43(12):1237-43.

9. 9. Heazell AE, Siassakos D, Blencowe H, Burden C, Bhutta ZA, Cacciatore J, et al. Stillbirths: economic and psychosocial consequences. The Lancet. 2016;387(10018):604-6.
10. 10. Lawn JE, Blencowe H, Waiswa P, Amouzou A, Mathers C, Hogan D, et al. Stillbirths: Rates, risk factors, and acceleration towards 2030. The Lancet. 2016;387(10018):587-603.
11. 11. Silver RM, Heuser CC. Stillbirth workup and delivery management. Clinical obstetrics and gynecology. 2010;53(3):681-0.
12. 12. Metz TD, Berry RS, Fretts RC, Reddy UM, Turrentine MA. Obstetric Care Consensus# 10: Management of Stillbirth:(Replaces Practice Bulletin Number 102, March 2009). American Journal of Obstetrics and Gynecology. 2020;222(3):B2-B20.
13. 13. Huang L, Sauve R, Birkett N, Fergusson D, van Walraven C. Maternal age and risk of stillbirth: a systematic review. Cmaj. 2008;178(2):165-72.
14. 14. Waldenström U, Cnattingius S, Norman M, Schytt E. Advanced maternal age and stillbirth risk in nulliparous and parous women. Obstetrics & Gynecology. 2015;126(2):355-62.
15. 15. Gregory EC, MacDorman MF, Martin JA. Trends in fetal and perinatal mortality in the United States, 2006-2012. NCHS Data Brief. 2014;169:1-8.
16. 16. Gardosi J, Madurasinghe V, Williams M, Malik A, Francis A. Maternal and fetal risk factors for stillbirth: population based study. Bmj. 2013;24:346:f108.
17. 17. Chakhtoura NA, Reddy UM. Management of stillbirth delivery. Seminars in perinatology. 2015; 39(6):501-4.
18. 18. Hopkins MK, Kuller JA, Dugoff L. Management of Stillbirth. Topics in Obstetrics & Gynecology. 2018;38(13):1-5.
19. 19. Habek D. Delivery course of macerated stillborn fetuses in the third trimester. Fetal diagnosis and therapy. 2008;24(1):42-6.
20. 20. Gold KJ, Mozurkewich EL, Puder KS, Treadwell MC. Maternal complications associated with stillbirth delivery: A cross-sectional analysis. Journal of Obstetrics and Gynaecology. 2016;36(2):208-12.
21. 21. Cham M, Sundby J, Vangen S. Fetal outcome in severe maternal morbidity: too many stillbirths. Acta Obstetricia et Gynecologica Scandinavica. 2009;88(3):343-9.
22. 22. Wall-Wieler E, Carmichael SL, Gibbs RS, Lyell DJ, Girsen AI, El-Sayed YY, et al. Severe maternal morbidity among stillbirth and live birth deliveries in California. Obstetrics and gynecology. 2019;134(2):310.
23. 23. Zanconato G, Cavaliere E, Mariotto O, Zatti N. Perinatal outcome of severe obstetric complications: findings of a 10-year hospital-based surveillance study in Italy. International journal of women's health. 2019;11:463-9
24. 24. Tennant PW, Glinianaia SV, Bilous RW, Rankin J, Bell R. Pre-existing diabetes, maternal glycated haemoglobin, and the risks of fetal and infant death: a population-based study. Diabetologia. 2014;57(2):285-94.
25. 25. Stacey T, Tennant PW, McCowan LM, Mitchell EA, Budd J, Li M, et al. Gestational diabetes and the risk of late stillbirth: A case–control study from England, UK. BJOG: An International Journal of Obstetrics & Gynaecology. 2019;126(8):973-82.
26. 26. Goldenberg RL, Kirby R, Culhane J. Stillbirth: A review. The journal of maternal-fetal & neonatal medicine. 2004;16(2):79-94.
27. 27. Korde-Nayak Vaishali N, Gaikwad Pradeep R. Causes of stillbirth. The Journal of Obstetrics and Gynecology of India. 2008;58(4):314-8.
28. 28. Nkwabong E, Tiomela Goula G. Placenta abruption surface and perinatal outcome. The Journal of Maternal-Fetal & Neonatal Medicine. 2017;30(12):1456-9.
29. 29. Kolettis D, Craigo S. Thromboprophylaxis in pregnancy. Obstetrics and Gynecology Clinics. 2018;45(2):389-402.