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Saturday, June 28, 2014

Trailers (87): Stillbirth rate for anomalous fetuses

Frey, et al. Stillbirth risk among fetuses with ultrasound-detected isolated congenital anomalies

Why should you read about this topic?

There are few things more feared by mothers than stillbirth.

What were the authors trying to do?

Estimate the risk of stillbirth among fetuses found to have a major isolated congenital anomaly on antepartum ultrasound

Who participated and in what setting?

Women (N=65,308) with singleton pregnancies undergoing routine anatomic survey at Wash U between 1990 and 2009, excluding those with chromosomal abnormalities and those with minor anomalies

What was the study design?

Retrospective cohort

What were the main outcome measures?

Stillbirth after 24 weeks gestation

What were the results?

Stillbirth rate was higher in fetuses with a major anomaly (55/1000 compared with 4/1000), and even higher when associated with growth restriction (birthweight<10%ile 127/1000 compared with 18/1000).  Stillbirth rates were similar prior to 32 weeks gestation compared with after 32 weeks.

What is the most interesting image in the paper?

Table 2

What were the study strengths and weaknesses?

Strengths: Large number of observations; acceptable loss-to-followup rate.  Weaknesses: retrospective; single center; perinatal database; long study span with changing technology; growth restriction defined by birthweight rather than EFW

What does the study contribute for your practice?

Stillbirth rate is increased in fetuses with an isolated major anomaly regardless of growth status.   One in every 18 pregnancies complicated by a single major anomaly will result in a fetal death