To Study Perinatal Outcome in Pregnancy with Previous Stillbirth

Abstract

Background: A previous stillbirth is an important predictor of recurrent fetal death and other adverse outcomes in subsequent pregnancies. Identifying associated risk factors may facilitate closer surveillance and timely intervention.
Aim: To study perinatal outcomes among pregnant women with a history of previous stillbirth.
Materials and Methods: This retrospective analytical study included 1,347 pregnant women with one or more previous stillbirths who received care at Department of Obstetrics and Gynaecology, Shree Narayan Medical Institute and Hospital, Saharsa. Sociodemographic characteristics, obstetric history, maternal complications, fetal outcomes and neonatal outcomes were obtained from hospital records. Women with and without recurrent stillbirth were compared using the independent-samples t-test, chi-square test or Fisher’s exact test, as appropriate. Odds ratios with 95% confidence intervals were calculated. A p value <0.05 was considered statistically significant.
Results: Recurrent stillbirth occurred in 179 women, giving an incidence of 13.3% (95% CI: 11.6-15.2%). Of these, 123 (9.1%) were antepartum and 56 (4.2%) were intrapartum stillbirths. Women with recurrence were significantly older than those without recurrence (30.8±5.9 versus 28.4±5.3 years; p<0.001). Unbooked pregnancy (OR=2.65), rural residence (OR=1.74), parity ≥3 (OR=1.80) and a history of two or more stillbirths (OR=3.66) were significantly associated with recurrence. Hypertensive disorders (OR=2.87), maternal anaemia (OR=1.53), fetal growth restriction (OR=2.53), preterm delivery (OR=3.16), placental abruption (OR=3.19) and preterm premature rupture of membranes (OR=1.76) were also significant factors. Women with two or more previous stillbirths had higher risks of low-birth-weight neonates (OR=2.97), NICU admission (OR=3.35) and early neonatal death (OR=3.87; all p<0.001).
Conclusion: Pregnancy following stillbirth was associated with a substantial risk of recurrence and adverse maternal, fetal and neonatal outcomes. Multiple previous stillbirths, inadequate antenatal care, hypertension, fetal growth restriction, prematurity and placental abruption were important risk factors. Early registration, intensive antenatal surveillance and timely intervention are essential for improving outcomes.