Abstract
Objective: To evaluate obstetric outcome after stillbirth according to placental and prothrombotic risk factors.
Methods: Obstetric outcomes of women with prior stillbirth and subsequent pregnancies were reviewed. Data on the immediate subsequent pregnancy included fetal loss, stillbirth, obstetric/medical complications, gestational age and birth weight at delivery, mode of delivery, thrombophilia, and prescribed medication. Placental stillbirth was defined as stillbirth associated with placental abruption, intrauterine growth restriction (IUGR), or histological evidence of placental infarcts. Controls were unselected women who gave birth at our center during a single calendar year. Factors influencing recurrence risks were estimated.
Results: Seventy-three subsequent pregnancies were identified. Five out of 73 (6.8%) women had a repeat stillbirth, significantly higher than controls (relative risk 22.2, 95% confidence interval 8.9–55.4). Four out of five repeat stillbirth cases occurred <37 weeks gestation. Hypertensive complications, diabetes and abruption were higher, while gestational age and birth weight at delivery were significantly lower than controls. Prior placental stillbirth was associated with a 10.5 times higher risk of IUGR in the subsequent pregnancy compared with non-placental stillbirth. All five repeat stillbirth cases occurred in thrombophilic women.
Conclusion: Women with prior stillbirth face an increased risk of pregnancy complications and stillbirth recurrence, especially with concurrent thrombophilia. Most repeat stillbirth cases occur preterm.
References
[1] Alfirevic Z, Roberts D, Martlew V. How strong is the association between maternal thrombophilia and adverse pregnancy outcome? A systematic review. Eur J Obstet Gynecol Reprod Biol. 2002;101:6–14.10.1016/S0301-2115(01)00496-1Search in Google Scholar
[2] Bhattacharya S, Prescott GJ, Black M, Shetty A. Recurrence risk of stillbirth in a second pregnancy. BJOG. 2010;117:1243–7.10.1111/j.1471-0528.2010.02641.xSearch in Google Scholar
[3] Black M, Shetty A, Bhattacharya S. Obstetric outcomes subsequent to intrauterine death in the first pregnancy. BJOG. 2008;115:269–74.10.1111/j.1471-0528.2007.01562.xSearch in Google Scholar
[4] Crowther ME. Communication following a stillbirth or neonatal death: room for improvement. Br J Obstet Gynaecol. 1995;102:952–6.10.1111/j.1471-0528.1995.tb10901.xSearch in Google Scholar
[5] Dollberg S, Haklai Z, Mimouni FB, Gorfein I, Gordon ES. Birth weight standards in the live-born population in Israel. Isr Med Assoc J. 2005;7:311–4.Search in Google Scholar
[6] Freeman RK, Dorchester W, Anderson G, Garite TJ. The significance of a previous stillbirth. Am J Obstet Gynecol. 1985;151:7–13.10.1016/0002-9378(85)90414-4Search in Google Scholar
[7] Fretts RC. Etiology and prevention of stillbirth. Am J Obstet Gynecol 2005;193: 1923–35.10.1016/j.ajog.2005.03.074Search in Google Scholar PubMed
[8] Gardosi J, Mul T, Mongelli M, Fagan D. Analysis of birthweight and gestational age in antepartum stillbirths. Br J Obstet Gynaecol. 1998;105:524–30.10.1111/j.1471-0528.1998.tb10153.xSearch in Google Scholar PubMed
[9] Getahun D, Lawrence JM, Fassett MJ, Strickland D, Koebnick C, Chen W, et al. The association between stillbirth in the first pregnancy and subsequent adverse perinatal outcomes. Am J Obstet Gynecol. 2009;201:378.e1–6.10.1016/j.ajog.2009.06.071Search in Google Scholar PubMed
[10] Gonen R, Lavi N, Attias D, Schliamser L, Borochowitz Z, Toubi E, et al. Absence of association of inherited thrombophilia with unexplained third-trimester intrauterine fetal death. Am J Obstet Gynecol. 2005;192:742–6.10.1016/j.ajog.2004.12.050Search in Google Scholar PubMed
[11] Gris JC, Quéré I, Monpeyroux F, Mercier E, Ripart-Neveu S, Tailland ML, et al. Case-control study of the frequency of thrombophilic disorders in couples with late foetal loss and no thrombotic antecedent. The Nimes Obstetricians and Haematologists Study 5 (NOHA5). Thromb Haemost. 1999;81:891–9.Search in Google Scholar
[12] Heinonen S, Kirkinen P. Pregnancy outcome after previous stillbirth resulting from causes other than maternal conditions and fetal abnormalities. Birth. 2000;27:33–7.10.1046/j.1523-536x.2000.00033.xSearch in Google Scholar PubMed
[13] Lekea-Karanika V, Tzoumaka-Bakoula C. Past obstetric history of the mother and its association with low birthweight of a subsequent child: a population based study. Paediatr Perinat Epidemiol. 1994;8:173–87.10.1111/j.1365-3016.1994.tb00448.xSearch in Google Scholar
[14] Lurie S, Eldar I, Glezerman M, Sadan O. Pregnancy outcome after stillbirth. J Reprod Med. 2007;52:289–92.Search in Google Scholar
[15] Martinelli I, Taioli E, Cetin I, Marinoni A, Gerosa S, Villa MV, et al. Mutations in coagulation factors in women with unexplained late fetal loss. N Eng J Med. 2000;343:1015–8.10.1056/NEJM200010053431405Search in Google Scholar
[16] Robson S, Chan A, Keane RJ, Luke CG. Subsequent birth outcomes after an unexplained stillbirth: preliminary population-based retrospective cohort study. Aust N Z J Obstet Gynaecol. 2001;41:29–35.10.1111/j.1479-828X.2001.tb01290.xSearch in Google Scholar
[17] Robson S, Thompson J, Ellwood D. Obstetric management of the next pregnancy after an unexplained stillbirth: an anonymous postal survey of Australian obstetricians. Aust N Z J Obstet Gynaecol. 2006;46:278–81.10.1111/j.1479-828X.2006.00591.xSearch in Google Scholar
[18] Saade GR, McLintock C. Inherited thrombophilia and stillbirth. Semin Perinatol. 2002;26:51–69.10.1053/sper.2002.29858Search in Google Scholar
[19] Salomon O, Seligsohn U, Steinberg DM, Zalel Y, Lerner A, Rosenberg N, et al. The common prothrombotic factors in nulliparous women do not compromise blood flow in the feto-maternal circulation and are not associated with preeclampsia or intrauterine growth restriction. Am J Obstet Gynecol. 2004;191:2002–9.10.1016/j.ajog.2004.07.053Search in Google Scholar
[20] Samueloff A, Xenakis EM, Berkus MD, Huff RW, Langer O. Recurrent stillbirth. Significance and characteristics. J Reprod Med. 1993;38:883–6.Search in Google Scholar
[21] Sharma PP, Salihu HM, Kirby RS. Stillbirth recurrence in a population of relatively low-risk mothers. Paediatr Perinat Epidemiol. 2007;21(Suppl 1):24–30.10.1111/j.1365-3016.2007.00834.xSearch in Google Scholar
[22] Simchen MJ, Ofir K, Moran O, Kedem A, Sivan E, Schiff E. Thrombophilic risk factors for placental stillbirth. Eur J Obstet Gynecol Reprod Biol. 2010;153:160–4.10.1016/j.ejogrb.2010.07.031Search in Google Scholar
[23] Smith GC, Fretts RC. Stillbirth. Lancet 2007;370:1715–25.10.1016/S0140-6736(07)61723-1Search in Google Scholar
[24] Surkan PJ, Stephansson O, Dickman PW, Cnattingius S. Previous preterm and small-for-gestational-age births and the subsequent risk of stillbirth. N Engl J Med. 2004;350:777–85.10.1056/NEJMoa031587Search in Google Scholar PubMed
[25] Vossen CY, Preston FE, Conrad J, Fontcuberta J, Makris M, van der Meer FJ, et al. Hereditary thrombophilia and fetal loss: a prospective follow-up. J Thromb Haemost. 2004;2:592–6.10.1111/j.1538-7836.2004.00662.xSearch in Google Scholar PubMed
The authors stated that there are no conflicts of interest regarding the publication of this article.
©2013 by Walter de Gruyter Berlin Boston
