A Comprehensive Update on Stillbirth Prevention: from Preconception to Postpartum, Individuals to Public Health Administrations

Abstract

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. 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. 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.