Archives of Gynecology and Obstetrics

, Volume 279, Issue 3, pp 299–303 | Cite as

Perinatal mortality: a sporadic event or a recurrent catastrophe?

  • Adi Y. Weintraub
  • Amit Rozen
  • Eyal Sheiner
  • Amalia Levy
  • Fernanda Press
  • Arnon Wiznitzer
Original Article



The purpose of this study was to determine whether women who experienced perinatal mortality in their first delivery had, in their subsequent birth, a higher risk for adverse perinatal outcome.


A population-based study was undertaken to compare all second deliveries of women with previous perinatal mortality in their first delivery to those with no such history. Deliveries occurred from 1988 to 2004 in a tertiary medical center. Patients lacking prenatal care, multiple gestations, and congenital malformations were excluded from the analysis. A multivariable logistic regression model and the Mantel–Haenszel procedure were carried out to control for confounders.


During the study period, out of 25,876 singleton second deliveries, 230 (0.9%) cases were of patients with previous perinatal mortality. Multivariable analysis with backward elimination showed a significant association between previous perinatal mortality and the following conditions: hypertensive disorders (OR = 2.6, 95% CI 1.7–3.9, P < 0.001), diabetes mellitus (OR = 2.4, 95% CI 1.5–3.7, P < 0.001), fertility treatment (OR = 2.7, 95% CI 1.6–4.7, P = 0.001), and younger maternal age (OR = 0.9, 95% CI 0.92–0.98, P < 0.001). Controlling for preterm delivery, using the Mantel–Haenszel procedure, the association between previous and subsequent perinatal mortality remained significant (weighted OR = 2.2, 95% CI 1.2–3.9, P = 0.010).


Previous perinatal loss poses an independent risk for subsequent perinatal mortality. Prospective studies are warranted in order to establish the appropriate means of surveillance and/or interventions needed to decrease future adverse perinatal outcomes.


Perinatal mortality Stillbirth Ante-partum death Intra-partum death Post-partum death Hypertensive disorders Diabetes mellitus 


  1. 1.
    Silver RM (2007) Fetal death. Obstet Gynecol 109:153–167PubMedGoogle Scholar
  2. 2.
    Fretts RC (2005) Etiology and prevention of stillbirth. Am J Obstet Gynecol 193:1923–1935. doi:10.1016/j.ajog.2005.03.074 PubMedCrossRefGoogle Scholar
  3. 3.
    Froen JF, Arnestad M, Frey K, Vege A, Saugstad OD, Stray-Pedersen B (2001) Risk factors for sudden intrauterine unexplained death: epidemiologic characteristics of singleton cases in Oslo, Norway, 1986–1995. Am J Obstet Gynecol 184:694–702. doi:10.1067/mob.2001.110697 PubMedCrossRefGoogle Scholar
  4. 4.
    Vintzileos AM, Ananth CV, Smulian JC, Scorza WE, Knuppel RA (2002) Prenatal care and black–white fetal death disparity in the United States: heterogeneity by high-risk conditions. Obstet Gynecol 99:483–489. doi:10.1016/S0029-7844(01)01758-6 PubMedCrossRefGoogle Scholar
  5. 5.
    Fretts RC, Schmittdiel J, McLean FH, Usher RH, Goldman MB (1995) Increased maternal age and the risk of fetal death. N Engl J Med 333:953–957. doi:10.1056/NEJM199510123331501 PubMedCrossRefGoogle Scholar
  6. 6.
    Kristensen J, Vestergaard M, Wisborg K, Kesmodel U, Secher NJ (2005) Pre-pregnancy weight and the risk of stillbirth and neonatal death. BJOG 112:403–408. doi:10.1111/j.1471-0528.2005.00437.x PubMedCrossRefGoogle Scholar
  7. 7.
    Simpson LL (2002) Maternal medical disease: risk of antepartum fetal death. Semin Perinatol 26:42–50. doi:10.1053/sper.2002.29838 PubMedCrossRefGoogle Scholar
  8. 8.
    Weintraub AY, Press F, Wiztitzer A, Sheiner E (2007) Maternal thrombophilia and adverse pregnancy Outcomes. Expert Rev Obstet Gynecol 2:203–216. doi:10.1586/17474108.2.2.203 CrossRefGoogle Scholar
  9. 9.
    Goldenberg RL, Thompson C (2003) The infectious origins of stillbirth. Am J Obstet Gynecol 189:861–873. doi:10.1067/S0002-9378(03)00470-8 PubMedCrossRefGoogle Scholar
  10. 10.
    Wapner RJ, Lewis D (2002) Genetics and metabolic causes of stillbirth. Semin Perinatol 26:70–74. doi:10.1053/sper.2002.29853 PubMedCrossRefGoogle Scholar
  11. 11.
    Froen JF, Gardosi JO, Thurmann A, Francis A, Stray-Pedersen B (2004) Restricted fetal growth in sudden intrauterine unexplained death. Acta Obstet Gynecol Scand 83:801–807. doi:10.1111/j.0001-6349.2004.00602.x PubMedCrossRefGoogle Scholar
  12. 12.
    Laube DW, Schauberger CW (1982) Fetomaternal bleeding as a cause for “unexplained” fetal death. Obstet Gynecol 60:649–651PubMedGoogle Scholar
  13. 13.
    Joseph KS, Marcoux S, Ohlsson A, Kramer MS, Allen AC, Liu S, Infant Fetal Health Study Group of the Canadian Perinatal Surveillance System et al (2002) Preterm birth, stillbirth and infant mortality among triplet births in Canada, 1985–1996. Paediatr Perinat Epidemiol 16:141–148. doi:10.1046/j.1365-3016.2002.00413.x PubMedCrossRefGoogle Scholar
  14. 14.
    Hershkovitz R, Silberstein T, Sheiner E, Shoham-Vardi I, Holcberg G, Katz M et al (2001) Risk factors associated with true knots of the umbilical cord. Eur J Obstet Gynecol Reprod Biol 98:36–39. doi:10.1016/S0301-2115(01)00312-8 PubMedCrossRefGoogle Scholar
  15. 15.
    Sheiner E, Abramowicz JS, Levy A, Silberstein T, Mazor M, Hershkovitz R (2006) Nuchal cord is not associated with adverse perinatal outcome. Arch Gynecol Obstet 274:81–83. doi:10.1007/s00404-005-0110-2 PubMedCrossRefGoogle Scholar
  16. 16.
    McGovern PG, Llorens AJ, Skurnick JH, Weiss G, Goldsmith LT (2004) Increased risk of preterm birth in singleton pregnancies resulting from in vitro fertilization–embryo transfer or gamete intrafallopian transfer: a meta-analysis. Fertil Steril 82:1514–1520. doi:10.1016/j.fertnstert.2004.06.038 PubMedCrossRefGoogle Scholar
  17. 17.
    Oron T, Sheiner E, Shoham-Vardi I, Mazor M, Katz M, Hallak M (2001) Risk factors for antepartum fetal death. J Reprod Med 46:825–830PubMedGoogle Scholar
  18. 18.
    Sheiner E, Hallak M, Shoham-Vardi I, Goldstein D, Mazor M, Katz M (2000) Determining risk factors for intrapartum fetal death. J Reprod Med 45:419–424PubMedGoogle Scholar
  19. 19.
    Mesogitis S, Daskalakis G, Pilalis A, Papantoniou N, Antsaklis A (2005) Fetal intravascular transfusion for hydropic disease due to rhesus isoimmunization. Fetal Diagn Ther 20:431–436. doi:10.1159/000086826 PubMedCrossRefGoogle Scholar
  20. 20.
    Weintraub AY, Leron E, Mazor M (2006) The pathophysiology of trauma in pregnancy: a review. J Matern Fetal Neonatal Med 19:601–605. doi:10.1080/14767050600900996 PubMedCrossRefGoogle Scholar
  21. 21.
    Frias AE Jr, Luikenaar RA, Sullivan AE, Lee RM, Porter TF, Branch DW et al (2004) Poor obstetric outcome in subsequent pregnancies in women with prior fetal death. Obstet Gynecol 104:521–526PubMedGoogle Scholar
  22. 22.
    Sharma PP, Salihu HM, Oyelese Y, Ananth CV, Kirby RS (2006) Is race a determinant of stillbirth recurrence? Obstet Gynecol 107:391–397PubMedGoogle Scholar
  23. 23.
    Robson S, Chan A, Keane RJ, Luke CG (2001) Subsequent birth outcomes after an unexplained stillbirth: preliminary population-based retrospective cohort study. Aust N Z J Obstet Gynaecol 41:29–35. doi:10.1111/j.1479-828X.2001.tb01290.x PubMedCrossRefGoogle Scholar
  24. 24.
    Fretts RC, Elkin EB, Myers ER, Heffner LJ (2004) Should older women have antepartum testing to prevent unexplained stillbirth? Obstet Gynecol 104:56–64PubMedCrossRefGoogle Scholar
  25. 25.
    Robson S, Thompson J, Ellwood D (2006) Obstetric management of the next pregnancy after an unexplained stillbirth: an anonymous postal survey of Australian obstetricians. Aust N Z J Obstet Gynaecol 46:278–281. doi:10.1111/j.1479-828X.2006.00591.x PubMedCrossRefGoogle Scholar
  26. 26.
    Silver RM, Varner MW, Reddy U, Goldenberg R, Pinar H, Conway D et al (2007) Work-up of stillbirth: a review of the evidence. Am J Obstet Gynecol 196:433–444. doi:10.1016/j.ajog.2006.11.041 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Adi Y. Weintraub
    • 1
  • Amit Rozen
    • 1
  • Eyal Sheiner
    • 1
  • Amalia Levy
    • 2
  • Fernanda Press
    • 1
  • Arnon Wiznitzer
    • 1
  1. 1.Department of Obstetrics and Gynecology, Faculty of Health SciencesSoroka University Medical Center, Ben-Gurion University of the NegevBeer-ShevaIsrael
  2. 2.Department of Epidemiology and Health Services Evaluation, Faculty of Health SciencesBen-Gurion University of the NegevBeer-ShevaIsrael

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