Risk Factors for Stillbirth in an Inner-City Community Hospital [18C

Abstract

INTRODUCTION: The stillbirth rate at Lincoln Medical and Mental Health Center (LMMHC) in the Bronx is 1/130, which is higher than the national average. Our aim was to compare the reported risk factors for term stillbirth with the identified antenatal risk factors for all cases of fetal demise that occurred after 39 weeks of gestation. METHODS: For this IRB approved quality improvement project, we reviewed data from all of the term fetal demise that occurred at LMMHC from 2013-2017. We categorized women based on the following characteristics which have been reported as risk factors for stillbirth: Hypertension, Diabetes, Obesity (BMI>30), and Advanced Maternal Age (>35). RESULTS: For births at LMMHC from 2013-2015, the relative risk (RR) of having a Stillbirth for a woman with Obesity was 3.2 (CI 95% 1.8-5.3, p<0.0001), RR for Diabetes was 3.5 (CI 95% 1.9-6.2, p<0.0001), RR for Hypertension was 3.1 (CI 95% 1.7-5.5, p<0.0001). For births from 2016-2017, the RR of a woman with Diabetes to have a Stillbirth was 3.8 (CI 95%, 1.8-7.9, p<0.0004), the RR for Hypertension was 3.5 (CI 95% 1.6-7.3, p<0.0010). We did not have the BMI data for this time period. We did not see an increased risk of stillbirth in patients with AMA. CONCLUSION: Considering the known risk factors of stillbirth and the potential benefits of delivery at 39 weeks gestation, induction can be considered to potentially decrease the risk of stillbirth. Physicians should utilize shared decision making with their patients who exhibit these risk factors.