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Potentially Preventable Stillbirth in a Diverse U.S. Cohort

Page, Jessica, M., MD; Thorsten, Vanessa, MPH; Reddy, Uma, M., MD, MPH; Dudley, Donald, J., MD; Hogue, Carol J., Rowland, PhD; Saade, George, R., MD; Pinar, Halit, MD; Parker, Corette, B., DrPH; Conway, Deborah, MD; Stoll, Barbara, J., MD; Coustan, Donald, MD; Bukowski, Radek, MD, PhD; Varner, Michael, W., MD; Goldenberg, Robert, L., MD; Gibbins, Karen, MD; Silver, Robert, M., MD

doi: 10.1097/AOG.0000000000002421
Contents: Original Research
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OBJECTIVE: To estimate the proportion of potentially preventable stillbirths in the United States.

METHODS: We conducted a secondary analysis of 512 stillbirths with complete evaluation enrolled in the Stillbirth Collaborative Research Network from 2006 to 2008. The Stillbirth Collaborative Research Network was a multisite, geographically, racially, and ethnically diverse, population-based case–control study of stillbirth in the United States. Cases of stillbirth underwent standard evaluation that included maternal interview, medical record abstraction, biospecimen collection, postmortem examination, placental pathology, and clinically recommended evaluation. Each stillbirth was assigned probable and possible causes of death using the Initial Causes of Fetal Death algorithm system. For this analysis, we defined potentially preventable stillbirths as those occurring in nonanomalous fetuses, 24 weeks of gestation or greater, and weighing 500 g or greater that were 1) intrapartum, 2) the result of medical complications, 3) the result of placental insufficiency, 4) multiple gestation (excluding twin–twin transfusion), 5) the result of spontaneous preterm birth, or 6) the result of hypertensive disorders of pregnancy.

RESULTS: Of the 512 stillbirths included in our cohort, causes of potentially preventable stillbirth included placental insufficiency (65 [12.7%]), medical complications of pregnancy (31 [6.1%]), hypertensive disorders of pregnancy (20 [3.9%]), preterm labor (16 [3.1%]), intrapartum (nine [1.8%]), and multiple gestations (four [0.8%]). Twenty-seven stillbirths fit two or more categories, leaving 114 (22.3%) potentially preventable stillbirths.

CONCLUSION: Based on our definition, almost one fourth of stillbirths are potentially preventable. Given the predominance of placental insufficiency among stillbirths, identification and management of placental insufficiency may have the most immediate effect on stillbirth reduction.

Almost one fourth of stillbirths in the United States may be preventable.

University of Utah School of Medicine, Salt Lake City, Utah; RTI International, Research Triangle Park, North Carolina; Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; the University of Virginia. Charlottesville, Virginia; Rollins School of Public Health, Emory University, Atlanta, Georgia; the University of Texas Medical Branch at Galveston, Galveston, Texas; Brown University School of Medicine, Providence, Rhode Island; the University of Texas Health Science Center at San Antonio, San Antonio, Texas; McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; the University of Texas Health Science Center at Austin, Austin, Texas; and Columbia University, New York, New York.

Corresponding author: Robert M. Silver, MD, Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 North 1900 East, Room 2B308, Salt Lake City, UT 84132; email:

This work, including the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, and approval of the manuscript, was supported by grant funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development: U10-HD045953 Brown University, Rhode Island; U10-HD045925 Emory University, Georgia; U10-HD045952 University of Texas Medical Branch at Galveston, Texas; U10-HDO45955 University of Texas Health Sciences Center at San Antonio, Texas; U10-HD045944 University of Utah Health Sciences Center, Utah; and U01-HD045954 RTI International, RTP.

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented as a poster at the Society for Maternal-Fetal Medicine’s 36th Annual Pregnancy Meeting, February 1–6, 2016, Atlanta, Georgia.

Comments and views of the author(s) do not necessarily represent the views of the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.