Abstract
ObjectivesTo assess the delivery outcome in a pregnancy with a previous unexplained intra-uterine death by elective induction of labour at term.MethodsAn audit of the pregnancy outcome of all women within the catchment area with a current singleton pregnancy; and a previous unexplained or unexplored singleton fetal demise ≥24 weeks (or 500 grams birth weight if gestation unknown) after planned routine induction of labour at full term (39-40 weeks).ResultsDuring the audit period, 306 patients with a previous intra-uterine fetal death were referred for further management. Of these, 161 had a clear indication for earlier intervention and were excluded from the protocol. Of the remaining 145 patients, 9 met further exclusion criteria and there were 2 patients who defaulted. Forty-two of the remaining study patients (with no known previous medical problems) developed complications during their antenatal course that necessitated a change in clinical management and earlier (<39 weeks) delivery. Of the remaining 92 patients in the audit, 47 (51%) went into spontaneous labour before their induction date; all 92 women delivered without major complications. There were no intra-uterine deaths prior to induction.ConclusionsCareful follow up at a high risk clinic identifies new or concealed maternal or fetal complications in 29% of patients with a previous intra-uterine death and no obvious maternal or fetal disease in the index pregnancy. When all risks are excluded and the pregnancy allowed to progress to full term (39-40 weeks) before an induction is offered, 50% will go into spontaneous labour.
Highlights
The stillbirth rate for babies 500g is still unacceptably high in South Africa, at 42.87/1000 in the general population.[1]
Of the remaining 92 patients in the audit, 47 (51%) went into spontaneous labour before their induction date; all 92 women delivered without major complications
Progress to full term (39-40 weeks) before an induction is offered, 50% will go into spontaneous labour
Summary
The stillbirth rate for babies 500g is still unacceptably high in South Africa, at 42.87/1000 in the general population (for all levels of care).[1]. In low-risk mothers with a prior stillbirth, there can be an up to 12-fold increased risk for adverse outcome in the subsequent pregnancy.[3] The biggest risk (hazard ratio 10.3, 95% confidence interval (CI) 6.1–17.2) for repeat stillbirth is before 28 weeks. In a large population based study, the adjusted odds ratio for a subsequent death was 7.1 (95% CI 3.2–15.7).[4] The risk for adverse outcome extends into the first year of life- the infant mortality rate of women with a prior stillbirth was 2.5 times higher (AHR = 2.51, 95% CI: 1.73–3.65) in a large, retrospective population-based study.[5]
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