Abstract
Purpose of Review
Stillbirth is a devastating event for the pregnant woman, families, and care providers alike. No preventable stillbirths should be tolerated, no matter how low the incidence is. The rate of reducing stillbirth rate is less than satisfactory and warrants continued efforts. Indeed, massive researches from all specialties bloomed in recent years. Some interventions are with good evidence and feasible to be practiced, while others are preliminary but exciting to be investigated further. The purpose of this review is a comprehensive overview of the recent studies on stillbirth prevention. An emphasis is placed on novel ideas or areas to be improved on that might interest prospective readers.
Recent Findings
For pregnant women, optimized healthy lifestyle including body weight, blood sugar, and blood pressure control is warranted. Vigilance on fetal movement is important for detecting fetal distress. Sudden vigorous movement means no less than reduced movement and should prompt timely evaluations. Sleep in supine position compromises maternal vena cava and poses increased stillbirth risks; thus, mothers are advised to sleep on their left side. For health professionals, biomarkers are studied to detect early placental insufficiency. Doppler velocimetry, fetal cardiotocography, and biophysical profile are helpful in evaluating fetal well-being but require adequate training and careful interpretation. Timely iatrogenic delivery is effective in lowering perinatal deaths but should be balanced against newborn prematurity. Precision medicine, utilizing genetic studies, microarrays to analyze causes of death or fetal hypoxia severity in utero is promising in filling the knowledge gaps about stillbirth. Special effort should be allocated to bereavement services, follow-up clinics, and social support to minimize the psychological impact on stillbirths. Moreover, care bundles that set specific goals, algorithms, including stillbirth investigations and cause classifications should be implemented, followed by auditing and data analysis. In the long run, health promotion in women by empowerment through gender equality and access to medical resources should be strived for.
Summary
Stillbirth prevention is a work undone but has received ongoing attention and massive research efforts. Individuals, healthcare providers, and policy makers alike should stay interested and up to date.
Similar content being viewed by others
References
Froen JF, Friberg IK, Lawn JE, Bhutta ZA, Pattinson RC, Allanson ER, et al. Stillbirth: progress and unfinished business. Lancet. 2016;387(10018):574–86.
Flenady V, Wojcieszek AM, Middleton P, Ellwood D, Erwich JJ, Coory M, et al. Stillbirth: recall to action in high-income countries. Lancet. 2016;387(10019):691–702.
Lawn JE, Blencowe H, Waiswa P, Amouzou A, Mathers C, Hogan D. Stillbirths: rates, risk factors and acceleration towards 2030. Lancet. 2016;387(10018):587–603.
Norris T, Manktelow BN, Smith LK, Draper ES. Causes and temporal changes in nationally collected stillbirth audit data in high-resource settings. Semin Fetal Neonatal Med. 2017 Jun;22(3):118–28.
Lean SC, Derricott H, Jones RL, Heazell AEP. Advanced maternal age and adverse pregnancy outcomes: a systematic review and meta-analysis. PLoS One. 2017;12(10):e0186287.
Liu LC, Wang YC, Yu MH, Su HY. Major risk factors for stillbirth in different trimesters of pregnancy—a systematic review. Taiwan J Obstet Gynecol. 2014;53(2):141–5.
Marufu TC, Ahankari A, Coleman T, Lewis S. Maternal smoking and the risk of still birth: systematic review and meta-analysis. BMC Public Health. 2015;15:239.
Pineles BL, Hsu S, Park E, Samet JM. Systematic review and meta-analyses of perinatal death and maternal exposure to tobacco smoke during pregnancy. Am J pidemiol. 2016;184(2):87–97.
Aune D, Saugstad OD, Henriksen T, Tonstad S. Maternal body mass index and the risk of fetal death, stillbirth, and infant death: a systematic review and meta-analysis. JAMA. 2014;311(15):1536–46.
Woolner AM, Bhattacharya S. Obesity and stillbirth. Best Pract Res Clin Obstet Gynaecol. 2015;29(3):415–26.
WHO. The prevention and elimination of disrespect and abuse during facility-based childbirth. Geneva: World Health Organization; 2014.
Kangatharan C, Labram S, Bhattacharya S. Interpreanancy interval following miscarriage and adverse pregnancy otcomes: systematic review and meta-analysis. Hum Repord Update. 2017;23(2):221–31.
Nybo Andersen AM, Urhoj SK. Is advanced paternal age a health risk for the offspring? Fertil Steril. 2017 Feb;107(2):312–8.
Moraitis AA, Oliver-Williams C, Wood AM, Fleming M, Pell JP, Smith G. Previous caesarean delivery and the risk of unexplained stillbirth: retrospective cohort study and meta-analysis. BJOG. 2015;122(11):1467–74.
Zhang Y, Yu C, Wang L. Temperature exposure during pregnancy and birth outcomes: an updated systematic review of epidemiological evidence. Environ Pollut. 2017;225:700–12.
Siddika N, Blougun HA, Amegah AK, Jaakola JJ. Prenatal ambient air pollution exposure and the risk of stillbirth: systematic review and meta-analysis of the empirical evidence. Occup Environ Med. 2016;73(9):573–81.
Warland J, Mitchell EA, O’Brien LM. Novel strategies to prevent stillbirth. Semin Fetal Neonatal Med. 2017;22(3):146–52.
Page JM, Silver RM. Interventions to prevent stillbirth. Semin Fetal Neonatal Med. 2017;22(3):135–45.
Stacey T, Thompson JM, Mitchell EA, Ekeroma AJ, Zuccollo JM, McCowan LM, et al. Association between maternal sleep practices and risk of late stillbirth: a case-control study. BMJ. 2011;342:d3403.
Platts J, Mitchell EA, Stacey T, Martin BL, Roberts D, McCowan L et al. The midland and north of England stillbirth study (MiNESS). BMJ Pregn Childbirth 2014; 21 (14).
Lamont K, Scott NW, Jones GT, Bhattacharya S. Risk of recurrent stillbirth: systematic review and meta-analysis. BMJ. 2015;350:h3080.
Mondal D, Galloway TS, Bailey TC, Mathews F. Elevated risk of stillbirth in males: systematic review and meta-analysis of more than 30 million births. BMC Med. 2014;12:220.
Newman L, Kamb M, Hawkes S, Gomez G, Say L, Seuc A, et al. Global estiates of syphilis in pregnancy and associated adverse outcomes: analysi of multinational antenatal surveillance data. PLoS Med. 2013;10(2):e1001396.
Arnesen L, Serruya S, Duran P. Gestational syphilis and stillbirth in the Americas: a systematic review and meta-analysis. Rev Panam Salud Publica. 2015;37(6):422–9.
He J, Liu ZW, Lu YP, Li TY, Liang XJ, Arck PC, et al. A systematic review and meta-analysis of influenza a virus infection during pregnancy associated with an increased risk for stillbirth and low birth weight. Kidney Blood Press Res. 2017;42:232–43.
Seale AC, Blencowe H, Bianchi-Jassir F, Embleton N, Bassat Q, Qrdi J, et al. Stillbirth with group B Streptococcus disease worldwide: systematic review and meta-analses. Clin Infect Dis. 2017;65(sup_2):S125–32.
Lai J, Nowlan NC, Vaidyanathan R, Shaw JJ, Lees CC. Fetal movements as a predictor of health. Act Obstet Gyencol Scand. 2016;95(9):968–75.
Collins JH. Umbilical cord accidents and legal implications. Semin Fetal Neonatal Med. 2014;19(5):285–9.
Middleton P, Shepherd E, Crowther CA. Induction of labour for improving birth outcomes for women at or beyong term. Cochrane Database Syst Rev. 2018;5:CD004945.
Little SE. Elective induction of labor: what is the impact? Obstet Gynecol Clin N Am. 2017;44(4):601–14.
Heller DS, Faye-Petersen OM. Pathology of the stillborn infant for the general pathologist: part 1. Adv Anat Pathol. 2015;22(1):1–28.
Faye-Petersen OM, Heller DS. Pathology of the stillborn infant for the general pathologist: part 2. Adv Anat Pathol. 2015;22(2):71–93.
NijKamp JW, Sebire NJ, Bouman K, Korteweg FJ, Erwich JJHM, Gordijn SJ. Perinatal eath investigations: what is current practice? Semin Fetal Neonatal Med. 2017;22(3):167–75.
Fockler ME, Ladhani NNN, Watson J, Barerett JFR. Pregnancy subsequent to stillbirth: medical and psychological aspects of care. Semin Fetal Neonatal Med. 2017;22(3):186–92.
DiMiceli-Zsigmond M, Williams AK, Richardson MG. Expecting the unexpected: perspectives on stillbirth and late termination of pregnancy for fetal anomalies. Anesth Analg. 2015;121(2):457–64.
Bakhbakhi D, Burden C, Storey C, Siassakos D. Care following stillbirth in high-resource settings: latest evidence, guidelines and best practice points. Semin Fetal Neonatal Med. 2017;22(3):161–6.
D’Silva A, Fyfe R, Hyett J. Frist trimester prediction and prevention of adverse pregnancy outcomes related to poor placentation. Curr Opin Obstet Gynecol. 2017;29(6):367–74.
Conde-Agudelo A, Bird S, Kennedy SH, Villar J, Papageorghiou AT. First- and second-trimester tests to predict stillbirth in unselected pregnant women: a systematic review and meta-analysis. BJOG. 2015;122(1):41–55.
Whitehead CL, Tong S. Measuring hypoxia-induced RNA in maternal blood: a new way to identify critically hypoxic fetuses in utero? Expert Rev Mol Diagn. 2014;14(5):509–11.
Scheimberg I. The genetic autopsy. Curr Opin Pediatr. 2013;25(5):659–65.
Andrews WW. What is new in stillbirth?: important recent articles. Obstet Gynecol. 2015;125(10):160–1.
Burden C, Bradley S, Storey C, Ellis A, Heazell AE, Downe S, et al. From grief, guilt pain and stigma to hope and pride—a systematic review and meta-analysis of mixed-method research of the psychosocial impact of stillbirth. BMC Pregnancy Childbirth. 2016;16:9.
International Stillbirth Alliance Collaborative for Improving Classification of Perinatal Deaths. Classification of causes and associated conditions for stillbirth and neonatal deaths. Semin Fetal Neonatal Med. 2017;22(3):176–85.
Leisher SH, Teoh Z, Reinebrant H, Allason E, Blencowe H, Erwich JJ, et al. Seeking order amidst chaos: a systematic review of classification systems for causes of stillbirth and neonatal death, 2009-2014. BMC Pregnancy Childbirth. 2016;16(1):295.
Amimu M, Bar-Zeev S, van den Broek N. Cause of and factors associated with stillbirth: a systematic review of classification systems. Acta Obstet Gynecol Scand. 2017;96(5):519–28.
Robertson L, Knight H, Prosser Snelling E, Petch E, Knight M, Cameron A, et al. Each baby counts: national quality improvement programme to reduce intrapartum-related deaths and brain injuries in term babies. Semin Fetal Neonatal Med. 2017;22(3):193–8.
Misry H, Heazell AE, Vincent O, Roberts T. A structured review and exploration of the healthcare costs associated with stillbirth and a subsequent pregnancy in England and Wales. BMC Pregnancy Childbrith. 2013;13:236.
Chou D, Daelmans B, Jolivet RR, Kinney M, Say L. Ending preventable maternal and newborn mortality and stillbirths. BMJ. 2015;351:h4255.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The author declares no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by the author.
Additional information
This article is part of the Topical Collection on High-risk Gestation and Prenatal Medicine
Rights and permissions
About this article
Cite this article
Ker, CR. A Comprehensive Update on Stillbirth Prevention: from Preconception to Postpartum, Individuals to Public Health Administrations. Curr Obstet Gynecol Rep 7, 172–178 (2018). https://doi.org/10.1007/s13669-018-0251-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13669-018-0251-5