752 Risk factors for severe maternal morbidity among singleton stillbirth pregnancies

Abstract

Data regarding severe maternal morbidity (SMM) in pregnancies complicated by stillbirth are limited. We sought to investigate the rate of SMM and associated risk factors among singleton stillbirth pregnancies. We used the California Linked Birth File database to perform a retrospective analysis of singleton pregnancies delivered at 20 to 42 weeks gestation between 2007-2011. The database contained information from birth certificates/fetal death records linked to maternal hospital discharge records. We defined SMM using the Centers for Disease Control and Prevention composite SMM indicator and compared rate of SMM between stillbirth deliveries and live births. Characteristics of stillbirth deliveries with and without SMM were also compared using univariate and multivariable logistic regression. Of 2,974,658 singleton pregnancies, 9,554 (0.32%) resulted in stillbirth. SMM rate was higher among mothers with stillbirth (6.05%) than those with live birth deliveries (1.08%) (odds ratio=5.92, 95% confidence interval: 5.44, 6.45). The most frequent types of SMM among stillbirth deliveries were: blood transfusion (4.95%), disseminated intravascular coagulation (1.32%), acute renal failure (0.69%), sepsis (0.55%) and shock (0.46%). Among women with a stillbirth, non-Hispanic black race, multiparity, chronic and gestational hypertension and chronic renal disease were significantly associated with a higher risk for SMM (Table 1). SMM occurred in 1 of every 16 women with a singleton stillbirth; an almost 6-fold increase compared to live birth deliveries. Risk of SMM in stillbirth was higher in women with non-Hispanic Black race, multiparity, hypertensive disorder, or renal disease. Obstetric providers should consider this increased risk, particularly hemorrhage with 5% of women with stillbirth requiring blood transfusion.