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Monitor women better to cut stillbirth rates

More babies’ lives could be saved by early delivery – but it’s hard to tell which are at risk

Louise Prime

Wednesday, 08 July 2015

Stillbirth rates could be reduced by better monitoring of women during pregnancy and early delivery of babies who are found to be at risk, according to a review published in The Obstetrician & Gynaecologist (TOG). But its author warns that screening could also lead to more harm, through an increase in false-positives.

About 1 in every 200 babies born in the UK are stillborn, and in most cases the exact reasons are unclear. In high-income countries, fewer than 10% of stillbirths occur after the onset of labour. But factors known to be associated with the risk of stillbirth include complications during childbirth, maternal infections during pregnancy, maternal health conditions such as high blood pressure or diabetes, foetal growth restriction (often due to the placenta not functioning correctly), and congenital abnormalities. Half of all stillbirths are small for gestational age (SGA) babies.

The author of the report, Professor Gordon Smith, head of the department of obstetrics and gynaecology at the University of Cambridge, pointed out that although – in theory – identifying babies known to be SGA and delivering them early could halve the rate of stillbirth, this exaggerates the benefits that could be achieved in practice. Currently, only about one in four small babies are detected by routine care; and, he noted, research has shown that even improving screening for SGA would still miss most small babies. He warned: “Screening for stillbirth risk has the potential to do good by preventing deaths. However, if programmes of screening and intervention are developed, many more women may be harmed due to high false positive rates.” He said better ways to screen for SGA babies are urgently needed.

Professor Smith called for a greater awareness of risk factors, and for more to be done to tackle them. He said: “Maternal risk factors for stillbirth include this being their first baby, being over 40 years old, smoking and obesity. While women should be encouraged to address risk factors such as smoking and obesity, the only way to prevent antepartum stillbirth in an otherwise apparently healthy infant is to induce delivery. Of course this requires identifying women at high risk and needs to be balanced against the risks inherent in early delivery and preterm birth ...

“A range of strategies for women have been proposed to prevent stillbirth, such as sleeping on their left side, or low dose aspirin for women with high risk of preeclampsia. However the potential impact of these interventions on overall rates of stillbirth are limited. Research is currently underway to try determine maternal biomarkers which might be a useful addition in screening for stillbirth risk.”

He concluded that, until we are better able to identify those low-risk women who are carrying a high-risk conceptus, “increased awareness of the problem is likely to improve outcomes, for example, through better management of babies with problems, such as SGA, and targeted use of indicated delivery, the primary disease modifying therapy.”

* Gordon CS Smith. Prevention of stillbirth. The Obstetrician & Gynaecologist (TOG) 2015; DOI: 10.1111/tog.12197

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