Stillbirth E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 657

Veröffentlichungsjahr: 2011

Beschreibung

Stillbirth remains a major and tragic obstetric complication

The number of deaths due to stillbirth are greater than those due to preterm birth and sudden infant death syndrome combined.

Stillbirth: Prediction, Prevention and Management provides a comprehensive guide to the topic of stillbirth. Distilling recent groundbreaking research, expert authors consider:

• The epidemiology of stillbirth throughout the world
• The various possible causes of stillbirth
• The psychological effects on mothers and families who suffer a stillbirth
• Management of stillbirth
• Managing pregnancies following stillbirth

Stillbirth: Prediction, Prevention and Management is packed with crucial evidence-based information and practical insights. It enables all obstetric healthcare providers to manage one of the most traumatic yet all too common situations they will encounter.

Leseprobe

Contents

List of Contributors

Preface

Part I: Epidemiology and Scope of the Problem

Chapter 1: High Income Countries

Stillbirth and the definition “problem”

Scope of the problem

Trends in stillbirth rates

Common causes of stillbirth

Causes of stillbirth by gestational age

Unexplained stillbirths

Placental dysfunction and fetal growth restriction

Abruptio placenta

Infection

Cord accidents

Multiple gestations

Maternal risk factors for stillbirth

Maternal age and parity

Previous obstetric history

Obesity

Preconception care

Alcohol, drug use, smoking and stillbirth

Racial factors and stillbirth

Decreased fetal movements

Suboptimal care

Strategies for prevention

References

Chapter 2: Low Income Countries

Stillbirth visibility in global data and policy

Counting stillbirths

Current global status for stillbirths

Stillbirth rate trends

Making stillbirth data count

Research priorities for stillbirth epidemiology in low- and middle-income countries

Conclusion

Acknowledgments

References

Chapter 3: Classification of Stillbirths

Revised Aberdeen classification system

Wigglesworth classification

Centre for Maternal and Child Enquiries

Perinatal Society of Australia and New Zealand Perinatal Death Classification

TULIP

ReCoDe

The Stockholm classification of stillbirth

Causes of death and associated conditions

INCODE (Initial Causes of Fetal Death)

Comparison of classification systems

Conclusion

References

Part II: Etiology/Causes

Chapter 4: Demographics and Exposures

Maternal age

Race and ethnicity

Pregnancy history

Social environment

Maternal substance use

Maternal nutrition

Maternal mental illness

Maternal health care

Summary and conclusions

References

Chapter 5: Infection

Mechanisms of infection leading to fetal death

Reasons for the apparent lack of association between infection and stillbirth

Bacterial infections

Viral diseases

Protozoal infections

Fungi

Evaluation

Reducing infection-related stillbirth

References

Chapter 6: Genetics

Cytogenetic causes of stillbirth

Cytogenetic abnormalities of the fetus

Placental cytogenetics

Single-gene disorders

Evaluation of stillborn pregnancies to identify genetic causes

Conclusion

References

Chapter 7: Fetal Growth Restriction

Unexplained stillbirths

Fetal growth restriction: the hidden factor

Pathological examination and IUGR

Assessing stillbirth by the fetal growth potential

Prevalence of IUGR amongst stillbirths

IUGR in epidemiological research

IUGR and clinical strategies for stillbirth prevention

Clinical practice points

References

Chapter 8: Maternal Medical Conditions

Type 1 and type 2 diabetes mellitus

Gestational diabetes mellitus

Chronic hypertension and hypertensive disorders of pregnancy

Obesity

Renal disease

Systemic lupus erythematosus

Thyroid disorders

Intrahepatic cholestasis of pregnancy

Conclusion/summary

References

Chapter 9: Vascular/Thrombotic

Thrombophilia and stillbirth

Other vascular risk factors

Management

Conclusion (Table 9.4)

References

Chapter 10: Placenta and Cord

General role of pathologist

Specific conditions

Research priorities

References

Chapter 11: Congenital Anomalies

Karyotypic abnormalities

Array comparative genomic hybridization

Hydrops fetalis

Autosomal recessive disorders

X-linked disorders

Structural anomalies without obvious chromosomal abnormalities

Fetal metabolic disorders

References

Part III: Management of the Patient with a Stillbirth

Chapter 12: Workup of the Patient with a Stillbirth

Components of evaluation for possible causes of stillbirth

Summary

References

Chapter 13: Psychosocial Care

ATTEND: toward a relationship-based, patient-centered model of psychosocial intervention

The Multidimensional Integrative Stillbirth Systems model

The unspeakable: macro trends in stillbirth

The insidious seeping into the psyche

Individual and familial challenges: micro systems

The micro system: traumatic loss and existential angst

Insulating factors

ATTEND: a model of patient- and relationship-centered caring

ATTEND model

The interdisciplinary team and the ATTEND model

Vicarious trauma

Summary

References

Chapter 14: Medical Management Including Delivery

Expectant management

Medical induction of labor

Surgical induction and evacuation

Fetal death in women with prior cesarean delivery

Cesarean delivery

Fetal death in multiple gestation

Other clinical considerations

Conclusions

References

Chapter 15: Management of the Subsequent Pregnancy

Recurrence risk

Other adverse pregnancy outcomes

Management of specific conditions associated with stillbirth

Management of the subsequent pregnancy following an unexplained stillbirth

References

Appendix: Multidimensional Integrative Stillbirth Systems Model

Index

This edition first published 2011, © 2011 by Blackwell Publishing Ltd

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Library of Congress Cataloging-in-Publication Data

Spong, Catherine Y.

Stillbirth : prediction, prevention, and management / edited by Catherine Y. Spong.

p.; cm.

Includes bibliographical references and index.

ISBN 978-1-4443-3706-8 (hardcover : alk. paper) 1. Stillbirth. I. Title.

[DNLM: 1. Stillbirth. 2. Pregnancy Complications—etiology. 3. Pregnancy Complications—prevention & control. WQ 225]

RG631.S66 2011

618.3’92—dc22

2010047408

A catalogue record for this book is available from the British Library.

This book is published in the following electronic formats: ePDF 9781444398014; Wiley Online Library 9781444398038; ePub 9781444398021

List of Contributors

Hannah Blencowe

London School of Hygiene and Tropical Medicine,

London, UK

Janice L.B. Byrne MD

Division of Maternal-Fetal Medicine,

Department of Obstetrics and Gynecology, Division of Medical Genetics, Department of Pediatrics,

University of Utah Health Sciences Center,

Salt Lake City, UT, USA

Joanne Cacciatore PhD, FT, LMSW

Center for Loss and Trauma,

Arizona State University,

Phoenix, AZ, USA

Deborah L. Conway MD

Department of Obstetrics and Gynecology,

Division of Maternal-Fetal Medicine,

University of Texas School of Medicine at San Antonio,

San Antonio, TX, USA

Simon Cousens

London School of Hygiene and Tropical Medicine,

London, UK

Michael L. Draper MD

Division of Maternal-Fetal Medicine,

Department of Obstetrics and Gynecology,

University of Utah Health Sciences Center,

Salt Lake City, UT, USA

Donald J. Dudley MD

Department of Obstetrics and Gynecology,

University of Texas Health Science Center at San Antonio,

TX, USA

Fabio Facchinetti

Mother-Infant Department,

Unit of Obstetrics and Gynecology,

University of Modena and Reggio Emilia,

Modena, Italy

Ruth Fretts MD, MPH

Harvard Vanguard Medical Associates,

Wellesley,

MA, USA

Jason Gardosi MD, FRCOG

West Midlands Perinatal Institute,

Birmingham, UK

Robert L. Goldenberg MD

Department of Obstetrics and Gynecology,

Drexel University College of Medicine,

Philadelphia, PA, USA

Joy E. Lawn

Saving Newborn Lives/Save the Children-US,

Cape Town,

South Africa

Health Systems Research Unit,

Medical Research Council,

South Africa

Institute of Child Health,

London, UK

Elizabeth M. McClure MEd

Department of Statistics and Epidemiology,

RTI International,

Research Triangle Park, NC, USA

Francesca Monari

Mother-Infant Department,

Unit of Obstetrics and Gynecology,

University of Modena and Reggio Emilia,

Modena, Italy

Robert Pattinson

International Stillbirth Association Scientific Board,

Medical Research Council, University of Pretoria,

Pretoria, South Africa

Uma M. Reddy MD, MPH

Eunice Kennedy Shriver National Institute of Child Health and Human Development,

National Institutes of Health,

Bethesda, MD, USA

Raymond W. Redline MD

Department of Pathology and Reproductive Biology,

Case Western Reserve University School of Medicine,

Cleveland, OH, USA

Department of Pediatric and Perinatal Pathology,

University Hospitals Case Medical Center,

Cleveland, OH, USA

Carol J. Rowland Hogue PhD, MPH

Women’s and Children’s Center,

Department of Epidemiology,

Rollins School of Public Health, Emory University,

Atlanta, GA, USA

George Saade MD

Division of Maternal Fetal Medicine,

Department of Obstetrics and Gynecology,

University of Texas Medical Branch,

Galveston, TX, USA

Robert M. Silver MD

Division of Maternal-Fetal Medicine,

Department of Obstetrics and Gynecology,

University of Utah Health Sciences Center,

Salt Lake City, UT, USA

Cynthia Stanton

Johns Hopkins Bloomberg School of Public Health,

Baltimore,

MA, USA

Michael Varner MD

Division of Maternal-Fetal Medicine,

Department of Obstetrics and Gynecology,

University of Utah Health Sciences Center,

Salt Lake City, UT, USA

Ronald Wapner MD

Division of Maternal Fetal Medicine,

Department of Obstetrics and Gynecology,

Columbia University,

College of Physicians and Surgeons,

New York, NY, USA

Marian Willinger PhD

Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health,

Bethesda, MD, USA

Preface

Stillbirth is a tragic event, affecting not only the mother and father, but also their families, health care team, and community. The loss is felt immediately and persists long term, including during subsequent pregnancies. Stillbirth affects 1 in 200 pregnancies, accounting for more deaths than those due to preterm birth and sudden infant death syndrome (SIDS) combined. Despite this, no single resource for the caregiver has been available. Stillbirth has been neglected far too long. Recently, there has been a welcome surge of interest in investigating stillbirth and its causes, and this momentum has generated sufficient evidence to deserve a comprehensive assessment in a book format. This book has been crafted to fill the void as a single resource for caregivers, addressing the academic issues, psychological effects, and practical clinical management.

I would like to thank the many patients and their families who have shared their experiences with me. Their stories and the interest of other clinicians demonstrated the need for this book. Much gratitude to my colleagues and friends who wrote chapters—their expertise and passion for this topic are unparalleled. I must also thank my family for giving me the time to devote to this work and my parents and sister for their encouragement.

I hope that this contribution will assist multispecialty providers when caring for women with a stillbirth, both immediately and in subsequent pregnancies. I welcome comments on this edition (positive and negative) as I strive to improve it for the future.

Catherine Y. Spong

Bethesda, MD

PART I

Epidemiology and Scope of the Problem

CHAPTER 1

High Income Countries

Ruth Fretts, MD, MPH

Harvard Vanguard Medical Associates, Wellesley, MA, USA

Stillbirth and the definition “problem”

One of the difficulties in the study of stillbirth is that stillbirths are universally undercounted especially at lower ages of gestation. What constitutes a “stillbirth” varies considerably between countries, and while a universal definition has been desired, it is unlikely that a globally accepted definition will be agreed upon. The lower gestational age limit that divides a “miscarriage” from a “stillbirth” depends if a country has resources to collect information and if the intention of the data collection is to count the deaths that could possibly have “survived.” In the United Kingdom, reporting of deaths begins at 24 weeks (presumably because the mortality of those born prior to 24 is so high); in most developing countries there is very little data about losses prior to 28 weeks of gestation.

The term fetal death, fetal demise, stillbirth, and stillborn all refer to the delivery of a fetus showing no signs of life. The World Health Organization (WHO) defines stillbirth as a “fetal death late in pregnancy” and allows each country to define the gestational age at which a fetal death is considered a stillbirth for reporting purposes [1]. A moderate proportion of countries have extrapolated from the WHO’s definition of what constitutes the “perinatal period” to define stillbirth (≥500 g, or if the weight is not known, with a gestational age greater than 22 completed weeks (154 days)). But even among developed countries the gestational age at which fetal losses are reported ranges from 16 weeks (The Netherlands) to 28 weeks (Sweden) [2]. Sweden recently revised their reporting laws because of pressures from parental advocacy groups and increasing numbers of live-born infants born prior to 28 weeks, but the stillborn counterparts were not included in national statistics. Other factors that influence the reported stillbirth rate are the accuracy of gestational age dating; whether obstetric providers are accurately educated on the definition of a “liveborn” or “stillborn”; if terminations of pregnancy for lethal or sublethal anomalies are specifically excluded; and if the inevitable previable spontaneous losses that results in a stillborn had labor augmented are included.

Within the United States, terminations of pregnancy for anomalies and augmented previable losses are specifically excluded from the stillbirth statistics but misclassification of these losses is common. Duke et al. compared fetal death reports to the reports generated from the active birth defects surveillance program in the Atlanta area. They found that 13% of fetal deaths should have been excluded from the fetal death statistics because the losses involved induction or augmentation of labor [3]. It is probable that providers recognize the intention of parents (the strong desire to have had a viable healthy pregnancy) and may fill out a fetal death report rather than report the loss as a termination of pregnancy or abortion.

In the United States, because the definition of stillbirth is determined by each state, there are significant variations which can substantially change the reported stillbirth rate by as much as 50% [4]. National reporting uses 20 weeks of gestation or 350 g if the gestational age is not known. The standardized definition for fetal mortality used by the U.S. National Center for Health Statistics (NCHS) is similar to the WHO definition but adds that a stillbirth must have “the absence of breathing, heart beats, pulsation of the umbilical cord, or definite movements of voluntary muscles” [5]. As advances in obstetrics occur both the neonatal and stillbirth rates decrease but the stillbirths less so, leaving stillbirth the largest contributor to perinatal mortality [6].

Scope of the problem

Compared to other health outcomes and the disease burden, the scope of stillbirth has been overlooked by many, including those who have the opportunity to prioritize spending for research and ultimately to devise and implement prevention strategies. In the United States, the chances that a pregnancy will end as a stillbirth is about 1/200 for white women and 1/87 for black women [7]. Stillbirth occurs more often than deaths due to AIDS and viral hepatitis combined; stillbirth is 10 times more common than sudden infant death syndrome, nearly 5 times more common than infant deaths related to congenital anomalies, and 5 times more often than postnatal deaths due to prematurity [8].