Predicting and preventing stillbirth at term

Abstract

Stillbirth at term affects ∼1 per 1000 pregnancies at term in high income countries. A range of maternal characteristics are associated with stillbirth risk. However, given the low a priori risk of stillbirth, the vast majority of women with clinical risk factors would not experience a stillbirth in the absence of intervention. Stillbirth is the end point of multiple pathways, including both fetal growth restriction and fetal overgrowth. In most term stillbirths there is no mechanistic understanding of the cause of death and a sizeable proportion are completely unexplained. Term stillbirth is potentially preventable by early delivery, providing a rationale for screening. “Omic” analyses of blood taken prior to the onset of some of the conditions associated with stillbirth may help identify women at high risk and allow the potentially harmful intervention of early term medically indicated delivery to be targeted to the pregnancies most likely to benefit.