Stillbirth: The continuing enigma

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A man holds a woman. She looks unwell.
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Every day, more than 8,200 families experience a death of their baby before birth (28 weeks or greater). This number is two times higher than deaths due to HIV/AIDS yet there has been limited awareness of the magnitude and significance of these losses.

Presenting at the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) 2012 Annual Scientific Meeting in Canberra today, Professor Ruth Fretts is Assistant Professor of Obstetrics and Gynaecology and Reproductive Biology at Harvard Medical School and practices obstetrics and gynaecology at Harvard Vanguard Medical Associates in Boston MA, USA.

‘While there has been 30 years of data on child survival interventions, until recently stillbirths have not been counted even though they represent more than 60 per cent of perinatal loss. Indeed, most guides to pregnancy rarely discuss the topic of stillbirth even when the goal of prenatal care is to monitor and prevent maternal and fetal morbidity and mortality,’ according to Professor Fretts.

‘The effect of having a stillborn can last a lifetime, with mothers suffering the most. Long term effects include an increased risk of anxiety and marital dysfunction. Stillbirth represents a tip of the iceberg when it comes to women’s health. Low stillbirth rates are associated with maternal education and access to contraception,’ said the Professor.

Adequate prenatal care includes good dating of the pregnancy, screening for infection, an opportunity to screen for congenital anomalies and monitoring of changes in maternal and fetal status, timely access to antibiotics and caesarean section.

‘Unfortunately even in high resource settings as many as one third of stillbirths had substandard care. Challenges include increasing awareness of stillbirth for both providers and patients, standardising our approach to high risk situations, including a more comprehensive risk assessment which include maternal fetal and social risk factors, and perinatal audit,’ said Professor
Fretts today.

Professor Fretts will also be presenting on Wednesday 12 September on Preventing Stillbirth. She will explain that in settings where specific causes of stillbirth have been identified and specific
strategies for prevention have been implemented, there has been significant reduction of these losses. Therefore the important step to stillbirth prevention is to study it.

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Professor Fretts is a Medical Director for the FIRST CANDLE (an American not-for-profit organisation that supports bereaved parents) in the area of stillbirth prevention. She developed the stillbirth review committee at the Brigham and Women’s Hospital in Boston and has published in a number of journals.

Source: Australian Healthcare and Hospitals Association

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Date Created: September 18, 2012