Abstract

One in 200 pregnancies ends in stillbirth. The subsequent pregnancy requires increased surveillance and intervention. We aimed to examine management of this pregnancy with maternal and neonatal outcomes.

A retrospective cohort study of subsequent pregnancies in women who had a stillbirth from 2007 to 2011.

One hundred women were identified in a new pregnancy. Median maternal age was 32 years (range 20–44). Median gestational age at prior stillbirth (infant > 500 g) was 34 weeks (range 22 + 6–41 + 4). 25% of the stillbirths were classified as unexplained and 23% were due to a congenital abnormality. Nineteen women (19/100; 19%) had a first trimester miscarriage. Seven women were diagnosed with gestational diabetes (7/81; 9%) and six developed gestational hypertension (6/81; 7%). Median number of antenatal clinic attendances was ten (range 3–21) and median number of ultrasound examinations was six (range 1–22). One woman experienced a stillbirth at 26 weeks due to recurrent non-immune hydrops, two had a preterm placental abruption, and three developed early-onset fetal growth restriction. Eight women (8/81; 10%) delivered preterm (28–36 weeks). The remainder had a term delivery (37 + 0–40 + 5 weeks). Of these, 11 (11/73; 15%) had an elective caesarean section (CS), and 41 (41/73; 56%) underwent induction of labour, with 81% delivering vaginally. Eleven infants were admitted to the neonatal intensive care unit, but there were no significant morbidities.

Pregnancy after stillbirth results in increased medical intervention and a demand on hospital resources. Both can be justified but are of unproven medical benefit. Here, the majority of women delivered a liveborn infant after an uncomplicated pregnancy.