Abstract
Objective
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.
Methods
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.
Results
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).
Conclusion
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.
Similar content being viewed by others
References
Silver RM (2007) Fetal death. Obstet Gynecol 109:153–167
Fretts RC (2005) Etiology and prevention of stillbirth. Am J Obstet Gynecol 193:1923–1935. doi:10.1016/j.ajog.2005.03.074
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
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
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
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
Simpson LL (2002) Maternal medical disease: risk of antepartum fetal death. Semin Perinatol 26:42–50. doi:10.1053/sper.2002.29838
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
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
Wapner RJ, Lewis D (2002) Genetics and metabolic causes of stillbirth. Semin Perinatol 26:70–74. doi:10.1053/sper.2002.29853
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
Laube DW, Schauberger CW (1982) Fetomaternal bleeding as a cause for “unexplained” fetal death. Obstet Gynecol 60:649–651
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
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
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
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
Oron T, Sheiner E, Shoham-Vardi I, Mazor M, Katz M, Hallak M (2001) Risk factors for antepartum fetal death. J Reprod Med 46:825–830
Sheiner E, Hallak M, Shoham-Vardi I, Goldstein D, Mazor M, Katz M (2000) Determining risk factors for intrapartum fetal death. J Reprod Med 45:419–424
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
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
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 104:521–526
Sharma PP, Salihu HM, Oyelese Y, Ananth CV, Kirby RS (2006) Is race a determinant of stillbirth recurrence? Obstet Gynecol 107:391–397
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
Fretts RC, Elkin EB, Myers ER, Heffner LJ (2004) Should older women have antepartum testing to prevent unexplained stillbirth? Obstet Gynecol 104:56–64
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
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
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Weintraub, A.Y., Rozen, A., Sheiner, E. et al. Perinatal mortality: a sporadic event or a recurrent catastrophe?. Arch Gynecol Obstet 279, 299–303 (2009). https://doi.org/10.1007/s00404-008-0702-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-008-0702-8