Previous Perinatal Loss Research Articles

Dynamic prediction of pregnancy outcome after previous stillbirth or perinatal death: pilot study to establish proof-of-concept and explore method feasibility.

To establish proof-of-concept for the dynamic prediction of adverse pregnancy outcome in women with a history of stillbirth or perinatal death, repeatedly throughout the pregnancy. A retrospective cohort study of women in a subsequent pregnancy following previous perinatal loss, who received antenatal care at a tertiary hospital between January 2014 and December 2017, was used as the basis for exploratory prognostic model development. Models were developed to repeatedly predict a composite adverse outcome (stillbirth or neonatal death, 5-min Apgar score < 7, umbilical artery pH ≤ 7.05, admission to the neonatal intensive care unit for longer than 24 h, preterm birth (< 37 completed weeks) or birth weight < 10th centile) using the findings of sequential ultrasound scans for fetal biometry and umbilical and uterine artery Doppler. In total, 506 participants were eligible, of whom 504 were included in the analysis. An adverse pregnancy outcome was experienced by 110 (22%) participants. The ability to predict the composite outcome using repeated head circumference and estimated fetal weight measurements improved as the pregnancy progressed (e.g. area under the receiver-operating-characteristics curve improved from 0.59 at 24 weeks' gestation to 0.74 at 36 weeks' gestation), supporting proof-of-concept. Predictors to include in dynamic prediction models were identified, including ultrasound measurements of fetal biometry, umbilical and uterine artery Doppler and placental size and shape. The present study supports proof-of-concept for dynamic prediction of adverse outcome in pregnancy following prior stillbirth or perinatal death, which could be used to identify risks earlier in pregnancy, while highlighting methodological challenges and requirements for subsequent large-scale model development studies. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Women pregnant after previous perinatal loss: relationships between adult attachment, shame, and prenatal psychological outcomes

ABSTRACT Background Insecure adult attachment, shame, self-blame, and isolation following perinatal loss place bereaved women at risk of adverse psychological outcomes, which can impact child and family outcomes. To date, no research has considered how these variables continue to influence women’s psychological health in pregnancy subsequent to loss. Objective This study explored associations between prenatal psychological adjustment (less grief and distress) and adult attachment, shame, and social connectedness, in women pregnant after loss. Method Twenty-nine pregnant Australian women accessing a Pregnancy After Loss Clinic (PALC) completed measures of attachment styles, shame, self-blame, social connectedness, perinatal grief, and psychological distress. Results Four 2-step hierarchical multiple regression analyses revealed adult attachment (secure/avoidant/anxious; Step 1), shame, self-blame, and social connectedness (Step 2) explained 74% difficulty coping, 74% total grief, 65% despair, and 57% active grief. Avoidant attachment predicted more difficulty coping and higher levels of despair. Self-blame predicted more active grief, difficulty coping, and despair. Social connectedness predicted lower active grief, and significantly mediated relationships between perinatal grief and all three attachment patterns (secure/avoidant/anxious). Conclusions Although avoidant attachment and self-blame can heighten grief in pregnancy after loss, focusing on social connectedness may be a helpful way for prenatal clinicians to support pregnant women during their subsequent pregnancy – and in grief.

Short interpregnancy interval and adverse pregnancy outcomes among women in a Middle Eastern country

Background/Aims A short interpregnancy interval is associated with several maternal and neonatal complications. In Oman, the incidence of short interpregnancy interval is well documented in the annual health report, but evidence is lacking on its impact on adverse pregnancy outcomes. This study examined short interpregnancy interval, its risk factors and its association with the prevalence of adverse pregnancy outcomes among Omani pregnant women. Methods A retrospective matched case–control design was adopted. Data were collected from medical records between January and December 2020. A total of 597 pregnant women from two tertiary care hospitals in Oman were included. Results There was a significant relationship between interpregnancy interval and the prevalence of adverse maternal and perinatal outcomes, including postpartum haemorrhage, iron deficiency anemia, preterm birth and low birth weight. Significant risk factors for a short interpregnancy interval were advanced maternal age, young age at first birth, low parity and previous perinatal loss. Conclusions Encouraging acceptance of birth spacing through the use of contraception would signify a notable change in cultural values that can act as a barrier to birth spacing. This would therefore improve pregnancy outcomes.

Anxiety and depression in pregnant women who have experienced a previous perinatal loss: a case-cohort study from Scandinavia

BackgroundPerinatal loss can have long-lasting adverse effects on a woman’s psychosocial health, including during subsequent pregnancies. However, maternal mental health status after perinatal loss during subsequent pregnancy is understudied with very little data available for Scandinavian populations.AimsThe primary aim of the study was to explore the association between previous perinatal loss and anxiety/depression symptoms of expectant mothers during the subsequent pregnancy. The secondary aim of this study was to explore possible determinants of maternal mental health during the subsequent pregnancy, independent of previous perinatal loss.MethodThis case-cohort study is based on primary data from Scandinavian Successive Small-for-Gestational Age Births Study (SGA Study) in Norway and Sweden. The total case-cohort sample in the current study includes 1458 women. Cases include 401 women who had reported a previous perinatal loss (spontaneous abortion, stillbirth, or neonatal death) and who responded to two mental health assessment instruments, the State-Trait Anxiety Inventory (STAI), and the Centre for Epidemiological Studies Depression (CES-D) scale. Multiple linear regression models were used to assess the association between previous perinatal loss and maternal mental health in subsequent pregnancy.ResultsScandinavian pregnant women with previous perinatal loss reported higher symptoms for both anxiety and depression during their subsequent pregnancy compared to mothers in the same cohort reported no previous perinatal loss. Multiple linear regression analyses showed a positive association between previous perinatal loss and per unit increase in both total anxiety score (β: 1.22, 95% CI: 0.49–1.95) and total depression score (β: 0.90, 95% CI: 0.06–1.74). We identified several factors associated with maternal mental health during pregnancy independent of perinatal loss, including unintended pregnancy despite 97% of our population being married/cohabitating.ConclusionWomen who have experienced previous perinatal loss face a significantly higher risk of anxiety and depression symptoms in their subsequent pregnancy.

Nursing Care of Childbearing Families After Previous Perinatal Loss

Nurses who care for childbearing families facilitate the family’s adaptation to the arrival of a newborn through assessment of physical, emotional, and psychological needs. After experiencing a perinatal loss, such as miscarriage, stillbirth, or neonatal death, a woman’s perception of pregnancy and of her sense of control in becoming a mother can include fear and anxiety, and she may have significantly different needs than a pregnant woman who has not experienced perinatal loss. In this article, we provide evidence-based information and recommendations for maternal–child nurses caring for childbearing families who are preparing to welcome a new baby (sometimes called a “rainbow baby”) after a previous perinatal loss.

Infant Developmental Outcomes: Influence of Prenatal Maternal-Fetal Attachment, Adult Attachment, Maternal Well-Being, and Perinatal Loss.

Identification of prenatal characteristics that predict later infant development may afford opportunities for early intervention, potentially optimizing childhood development outcomes. The aim of the present study was to examine the effects of selected prenatal factors (maternal–fetal attachment, maternal adult attachment, maternal well-being, and previous perinatal loss) on later infant development. Pregnant women were recruited from two antenatal clinics at one tertiary hospital and asked to complete self-report questionnaires. The Bayley’s Scales of Infant and Toddler Development were then completed one to two years after their baby’s birth. Independent samples t-tests, correlational analyses, and multivariate linear regression models were conducted. Results from 40 dyads revealed that more favorable maternal–fetal attachment, more secure/less anxious maternal attachment, and higher maternal well-being predicted maternal reports of infant adaptive behavior regardless of previous perinatal loss. Infants of women without perinatal loss scored higher in external observer-rated cognitive development compared to infants of women with previous perinatal loss. While further research is required, findings indicate that a mother’s well-being and her relationship with her baby during pregnancy contributes to positive perceptions of her infant’s daily living skills. Supporting the parenting of women with perinatal loss is required to, in turn, promote optimal cognitive development in infants.

Infant sensory patterns: associations with previous perinatal loss, maternal-foetal attachment and postnatal maternal sensory patterns

PurposeThis paper aims to investigate infant sensory patterns and their associations with previous perinatal loss, maternal-foetal attachment and postnatal maternal sensory patterns.Design/methodology/approachIn a prospective cohort study, women with and without perinatal loss (N= 57) were recruited from an Australian public hospital. Participants were surveyed during pregnancy (maternal-foetal attachment, loss) and again postnatally (maternal/infant sensory patterns). Chi-square tests and logistic regression analyses controlling for previous perinatal loss were conducted with infant sensory patterns as outcome variables.Findings“More than typical” infant low registration was associated with poorer quality of maternal-foetal attachment. “More than typical” infant sensory seeking was associated with previous perinatal loss and higher levels of maternal sensory seeking. “More than typical” infant sensory sensitivity was linked with previous perinatal loss, poorer quality of maternal-foetal attachment and higher maternal low registration. “More than typical” infant sensory avoidance was associated with poorer quality of maternal-foetal attachment and higher levels of maternal sensory sensitivity.Practical implicationsTo support more typical infant sensory patterns, results point to the potential benefit of occupational therapists supporting pregnant women with previous perinatal loss; facilitating favourable maternal-foetal attachment; and educating new mothers on how their sensory patterns impact on interactions with their infant. Sensory modulation strategies that consider the sensory patterns of both mother and infant may be beneficial to promote engagement in co-occupations.Originality/valueThese findings are the first to suggest that previous perinatal loss, poorer quality of maternal-foetal attachment and higher levels of maternal postnatal sensory patterns represent risk factors for infant sensory patterns that are “more than typical.”

Perinatal Grief and Post-Traumatic Stress Disorder in Pregnancy after Perinatal Loss: A Longitudinal Study Protocol.

Background: Pregnancies that follow perinatal loss are often associated with mental health disorders, which are not usually treated or even identified. Objectives: The main study aim is to identify the prevalence of symptoms of post-traumatic stress disorder and complicated perinatal grief at different stages of pregnancy following a prior gestational loss. Methods: This descriptive longitudinal study will be conducted with a twelve-month follow-up. The study variables addressed will include sociodemographic data (age, sex, education, marital status, employment status and obstetric history) together with clinical data on complicated perinatal grief and post-traumatic stress disorder scores. Results: The results obtained are expected to provide a new perspective on the healthcare approach to perinatal loss and subsequent pregnancy. Conclusions: We seek to optimise comprehensive healthcare in cases of pregnancy following previous perinatal loss and to evaluate options to minimise possible risks.

Maternal–Fetal Attachment: Associations with Maternal Sensory Processing, Adult Attachment, Distress and Perinatal Loss

Maternal–fetal attachment (MFA) describes the thoughts, feelings, and behaviors of a pregnant woman toward her unborn baby. With MFA increasingly seen as an important predecessor of future outcomes, understanding the factors associated with MFA may reveal targets for treatment, potentially optimizing outcomes for mothers and infants. The primary aim of this research was to examine associations between MFA and maternal sensory and attachment patterns, when controlling for psychological distress. The secondary aim was to compare MFA and distress for women with and without previous perinatal loss. Pregnant women (N = 108) were recruited from two antenatal clinics at an Australian maternity hospital. During pregnancy, participants completed the Maternal Antenatal Attachment Scale, Adolescent/Adult Sensory Profile, Mental Health Inventory-38, and Attachment Style Questionnaire. Hierarchical linear regression models, controlling for psychological distress as the second step, were performed. Final models revealed that more favorable quality of MFA was associated with lower sensory sensitivity and higher sensory seeking. More time spent in MFA was associated with younger maternal age and higher levels of maternal sensory seeking. Women with previous perinatal loss had more distress but similar levels of MFA compared to women without loss. We provide the first evidence of links between MFA and maternal sensory patterns, and further elucidate links between adult attachment and mental health in women with and without previous perinatal loss. Consideration of maternal sensory patterns, adult attachment, and mental health status antenatally may inform new directions for services seeking to facilitate the relationship between a mother and her unborn baby.

Pregnancy after miscarriage in primiparae and multiparae: implications for women’s psychological well-being

ABSTRACT Introduction: Miscarriage is a stressful life event with negative consequences that can last into the subsequent gestation, increasing women’s risk for psychological symptoms. Less clear in literature is whether having a living child may buffer the psychological impact of miscarriage on subsequent pregnancies. Objective: explore levels of depression, anxiety and fear of delivery in women with and without a previous miscarriage, taking into consideration the presence of a living child. Method: 208 women (M = 34.68) were recruited during the third trimester of gestation. The sample was composed of 159 women without a previous miscarriage (72.3% primiparae and 27.7% multiparae) and 49 women with a history of miscarriage (53.1% primiparae and 46.9% multiparae). Participants filled out a battery of questionnaires aimed at assessing anxiety, depression, and fear of delivery. Results: Primiparae reported higher levels of fear of childbirth than multiparae. Moreover, women without a history of previous perinatal loss showed lower levels of depression and fear of childbirth than women with a previous perinatal loss. Conclusions: Data highlight the importance of developing specific support groups, for primiparae, due to their great emotional vulnerability, and for women with past miscarriage, to help them cope in adaptive ways with a new pregnancy.

\u201cNot just a normal mum\u201d: a qualitative investigation of a support service for women who are pregnant subsequent to perinatal loss

BackgroundFollowing previous perinatal loss, women in a subsequent pregnancy may experience heightened emotions, such as anxiety and fear, with a range of longer-term implications. To support these women, the Mater Mothers’ Bereavement Support Service in Brisbane, Australia, developed a Pregnancy After Loss Clinic (PALC) as a specialised hospital-based service. The present study investigated the experiences of mothers with previous perinatal loss in relation to: (a) their subsequent pregnancy-to-birth journey, and (b) the PALC service. Such research seeks to inform the ongoing development of effective perinatal services.MethodA qualitative interview-based research design was employed with a purposive sample of 10 mothers who had previously experienced perinatal loss and who attended the Mater Mothers’ PALC during their subsequent pregnancy in 2015. All mothers had subsequently delivered a live baby and were in a relationship with the father of the new baby. Women were aged between 22 and 39 years, primiparous or multiparous, and from a range of cultural backgrounds. Semi-structured interviews, conducted either at the hospital or by telephone by an experienced, independent researcher, lasted between 20 min and one hour. All interviews were audio-recorded and transcribed verbatim, with participant names changed. Interviews were analysed using content analysis by two researchers who were not involved in the service delivery or data gathering process.ResultsSeven themes were identified from the interview material: The overall experience, The unique experience of first pregnancy after loss, Support from PALC, Experiences of other services, Recommendations for PALC services, Need for alternative services, and Advice: Mother to mother.ConclusionsParticipants spoke positively of the PALC services for themselves and their families. Anxieties over their subsequent pregnancy, and the desire for other health professionals to be more understanding were frequently raised. Recommendations were made to extend the PALC service and to develop similar services to support access for other families experiencing perinatal loss.

Role of cervical cerclage and prolonged antibiotic therapy with azithromycin in patients with previous perinatal loss amnionitis

In the group of 35 patients with cerclage, intermediate fetal mortality was reduced from 37.1% to 0 (p < 0.001); late fetal mortality rate from 8.5% to 2.8% (p = 0.606); prematurity from 65.7% to 5.7% (p < 0.001); newborn underweight from 11.4% to 5.7% (p = 0.671); newborns with very low weight from 34.2% to 0 (p < 0.001) and the abortion rate from 8.5% to 0 ( p < 0.001). In the group of 19 patients without buckling, intermediate fetal mortality was reduced from 26.3% to 10.5% (p = 402); late fetal mortality from 63.1% to 0 (p < 0.001); prematurity 78.9% to 31.5% (p < 0.009); the newborn of low weight from 31.5% to 10.5% (p = 0.234); newborns with very low weight from 68.4% to 15.7% (p < 0.003) and the abortion rate from 36.8 to 0 (p < 0.001). In conclusion, we believe the results of this study demonstrate the effectiveness of therapeutic and prophylactic cervical cerclage associated with prolonged antibiotic therapy

Healing Hearts with Time and Talent

Poster Presentation Purpose for the Program Nurses working in the maternal–child specialty are most challenged by bereaved families because they are the most vulnerable and needy in our care. Appropriate intervention can promote healing. By changing the nurses’ professional role from protective to supportive, interventions can focus on assisting the bereaved families make meaning of their loss. The creation of a program that finds ways to link time and talent offered by community members can be a win–win situation that benefits both groups. Proposed Change To enlist the aid of community groups and individuals who wanted to volunteer but were in need of direction to provide for those in need. The bereavement council from one labor, delivery, and recovery unit, with about 200 pregnancy losses per year, found difficulty with maintaining supplies for patient memory boxes. This group of nurses recognized the need to discover new resources to help. Implementation, Outcomes, and Evaluation Over the past 5 years, members of the bereavement council have uncovered numerous resources for assisting bereaved families. A local DJ started a program that provided an opportunity for the radio station listeners to make blankets and hats. A retired labor and delivery nurse joined forces with fellow nurses to create hand‐smocked dresses. Teenagers who needed to earn community service hours, scout troops, and local churches took on projects, such as decorating memory boxes and painting wooden ornaments. Several local photographers joined a national organization that offers families a photo session with their infant at no cost. The result of our community outreach program has been an increase in available items for the memory boxes, which gives nurses the opportunity to personalize the contents of these boxes for our families. Regular feedback with volunteers, which is offered through e‐mail and phone calls, indicates what works and what does not work to further personalize our care. Implications for Nursing Practice A renewed commitment to excellence is evident as our nursing staff delivers interventions that provide meaning to the tragedy of death, create a positive memory, and facilitate healing for parents who take home only a memory box. Many who have volunteered have shared stories of their own previous perinatal loss and indicated that through the process of helping others they have also healed themselves. Passion has been ignited in those who have the opportunity to help supply memory box items, evidenced by the generosity of community members and the beauty of the work donated.

Healthcare Utilization in the Pregnancy Following a Perinatal Loss

To evaluate the influence of previous perinatal loss, anxiety, depressive symptoms, impact of the previous loss, and maternal investment in the baby on mothers' healthcare utilization (HCU) during the subsequent pregnancy and postpartum periods. A longitudinal, cohort study design gathered telephone interview data from 36 mothers with a history of prior perinatal loss, 32 mothers with no loss history, and 38 first-time mothers. These data were collected during the third trimester of pregnancy until 8 months postpartum. Centers for Epidemiologic Studies-Depression Scale, Spielberger State-Trait Anxiety Scale, Pregnancy Outcome Questionnaire, Impact of Events Scale, Maternal Attitude Questionnaire, and a questionnaire regarding HCU. Mothers with a history of prior perinatal loss utilized more healthcare resources in the subsequent pregnancy when compared with non-loss controls. Increased HCU during pregnancy was associated with increased maternal anxiety and depressive symptoms after birth. Mothers with a history of prior perinatal loss may attempt to cope with their anxiety in pregnancy and depression in early postpartum with requests for additional healthcare resources. Nurses need to listen with compassion, providing appropriate education and information, and make referrals to mental healthcare providers and support groups as indicated. These nursing interventions during the subsequent pregnancy may be a better use of healthcare resources than providing extra, but medically unnecessary, laboratory and ultrasound testing for the sole purpose of fleeting reassurance.

Study of Oral Glucose Tolerance test (OGTT) in Pregnant Women and Fetal Outcome

Of the 8,065 women who attended the antenatal clinic (ANC) at Ramathibodo Hospital during 18 months period, 583 cases (7.23%) meet one or more of the criteria for GTT. Only 529 cases were completely followed up and analysed. One hundred and thirty eight cases (26.28%) showed abnormal curve while 391 cases (73.72%) were normal. Gestational diabetic mothers were advised to take low carbohydrate, high protein diet and their pregnancies were followed up closely and allowed to have spontaneous labor and deliveries. In cases with history of previous unexplained perinatal loss or who showed signs of fetal jeopardy or when the cervix was favorable, the pregnancies were terminated at 38 — 40 weeks. The perinatal mortality in gestational diabetes is 2.19% which is not statistically different from 1.7% of the overall patients of this hospital at the same period of time. It is felt from this study that in. gestational diabetes, if pregnancies are followed up closely with careful monitoring of the fetal status during pregnancies and labor, the outcome should improve and be the same as in nondiabetic mothers.

Pregnancy after perinatal loss: association of grief, anxiety and attachment

Objectives: The aim of this study was to explore the psychological experience of pregnancy after a previous perinatal loss and to bring to light the risk factors of psychological distress and disorders in instituting antenatal attachment with the subsequent child. Methods: 96 pregnant women, having experienced a previous perinatal loss answered several questionnaires which measured the feelings of perinatal grief (PGS), anxio‐depressive symptomatology (HADS), acceptance of pregnancy, identification with the maternal role (PSEQ) and perinatal attachment (MAAS). The control group included 74 women with no experience of perinatal loss. Results: Women having suffered from perinatal loss reported significantly higher scores of grief and anxio‐depressive symptoms compared to the control group. These variables were significant predictors of prenatal attachment. Conclusion: Findings reveal the intense psychological distress during pregnancy following a perinatal loss and underscore the need for psychosocial and clinical care when there is a perinatal loss, care that should be extended up to the birth of the subsequent child.

Psychosocial impact of mothers with perinatal loss and its contributing factors: an insight

To evaluate the psychosocial impact among mothers with perinatal loss and its contributing factors. A cross sectional study was conducted in University Kebangsaan Malaysia Medical Centre (UKMMC) from April 2008 to May 2009 using Edinburgh Postnatal Depression Scale (EPDS) and self administered questionnaire. Sixty-two respondents were included and most of them were working mothers (77.4%). The mean age of the respondents was (31.0+/-5.6) years and a majority of the subjects aged between 20-34 years (77.4%). According to the EPDS score, 53.2% of the respondents had a psychosocial impact with a total score of >9, out of 30. There was a significant relationship between psychosocial impact after perinatal loss and support from friends (P=0.019). However, there were no significant differences between psychosocial impact and history of previous perinatal loss, ethnicity, occupation, educational level, age or total income. Mothers with perinatal loss should be screened for psychosocial impact and offered support when needed. Family and friends should continue to provide emotional support. People who have experienced similar problem before will be able to provide better support than those who have not.

The Influence of Prior Perinatal Loss on Parents' Psychological Distress After the Birth of a Subsequent Healthy Infant

To evaluate the long-term influence of a previous perinatal loss on parents' psychological distress during a subsequent childbearing experience. A cohort design was used to examine 36 couples with a history of prior perinatal loss. Data were collected during the third trimester of pregnancy, 3 months postpartum, and again 8 months after birth. Outcome measures included posttraumatic stress (The Impact of Event Scale), depressive symptoms (Center for Epidemiologic Studies-Depression Scale), anxiety (Spielberger State-Trait Anxiety Inventory), and parental concerns and attitudes (Maternal/Paternal Attitudes Questionnaire). Levels of depressive symptoms (p<.001), anxiety (p<.001), and posttraumatic stress (p=.046) significantly decreased over time in this population. However, levels of posttraumatic stress remained in the moderate range even at 8 months after birth. Depression was significantly correlated with posttraumatic stress at each time point. In addition, depression was significantly related to posttraumatic stress, anxiety, and concerns parents had about their infant's well-being at T3. While levels of anxiety and depressive symptoms decreased for parents who have experienced a previous perinatal loss, posttraumatic stress levels remained moderately high. It is unclear how this compares to parents without losses. These may be the unique symptoms and concerns these parents have about their new infant. Parents with a history of prior loss should have assessments carefully tailored to their experiences to anticipate continued psychological distress.

Obstetric outcomes in immigrants of African nationality

African women delivering in the Maltese Islands are either regular or irregular migrants. The latter group presents significant socio-economic problems. Objective: This study sets out to compare the obstetric outcomes of African-nationals delivering in Malta to the general population. Study design: The obstetric data of three subgroups of women - those from the Maghreb region; the sub-Saharan and Horn of Africa; and the overall population registered for the Maltese Islands were obtained using the computerised National Obstetrics Information System. Results: Women from the sub-Saharan regions were statistically younger than those from the Maghreb region or the general population. African women from both regions were more likely to be multiparous; and were more likely to have experienced a previous perinatal loss. The multiple pregnancy rates were significantly higher in both African groups. Women from the sub-Saharan region were more likely to suffer from sexual and blood-borne infections. African women had lower obstetric intervention rates but higher operative deliveries. Infants born to African women were more likely to be premature and of low birth weight. Conclusion: Women originating from the African continent particularly from the sub-Saharan regions present socio- biological and cultural differences which can contribute towards adverse obstetric and perinatal outcomes.

Perinatal mortality: a sporadic event or a recurrent catastrophe?

The purpose of this study was to determine whether women who experienced perinatal mortality in their first delivery had, in their subsequent birth, a higher risk for adverse perinatal outcome. A population-based study was undertaken to compare all second deliveries of women with previous perinatal mortality in their first delivery to those with no such history. Deliveries occurred from 1988 to 2004 in a tertiary medical center. Patients lacking prenatal care, multiple gestations, and congenital malformations were excluded from the analysis. A multivariable logistic regression model and the Mantel-Haenszel procedure were carried out to control for confounders. During the study period, out of 25,876 singleton second deliveries, 230 (0.9%) cases were of patients with previous perinatal mortality. Multivariable analysis with backward elimination showed a significant association between previous perinatal mortality and the following conditions: hypertensive disorders (OR=2.6, 95% CI 1.7-3.9, P<0.001), diabetes mellitus (OR=2.4, 95% CI 1.5-3.7, P<0.001), fertility treatment (OR=2.7, 95% CI 1.6-4.7, P=0.001), and younger maternal age (OR=0.9, 95% CI 0.92-0.98, P<0.001). Controlling for preterm delivery, using the Mantel-Haenszel procedure, the association between previous and subsequent perinatal mortality remained significant (weighted OR=2.2, 95% CI 1.2-3.9, P=0.010). Previous perinatal loss poses an independent risk for subsequent perinatal mortality. Prospective studies are warranted in order to establish the appropriate means of surveillance and/or interventions needed to decrease future adverse perinatal outcomes.