Materiały źródłowe

• #1 Stillbirths and stillbirth rates – UNICEF DATA

  https://data.unicef.org/topic/child-survival/stillbirths/

  Around 1.9 million stillbirths – babies born with no sign of life at 28 weeks of pregnancy or later – occurred worldwide in 2023. Many of these might have been prevented with proper care. According to the latest data, the global stillbirth rate last year was 14.3 stillbirths per 1,000 total births. This equates to 1 in 70 total births resulting in a stillborn baby, or one every 17 seconds. Still, this number may be an underestimate, as stillbirths are often underreported. […] Women in sub-Saharan Africa and South Asia bear the greatest burden of stillbirths in the world. In 2023, 8 in 10 stillbirths occurred in these two regions, with 50 per cent of the global total in sub-Saharan Africa and 31 per cent in South Asia. In sub-Saharan Africa, the estimated stillbirth rate of 22.2 stillbirths per 1,000 total births was eight times higher than the lowest regional average stillbirth rate of 2.6 found in Western Europe. South Asia had the second highest stillbirth rate, at 16.3 stillbirths per 1,000 total births.

• #2

  https://www.who.int/data/gho/indicator-metadata-registry/imr-details/2444

  Stillbirth rate (per 1000 total births) Short name: Stillbirth rate Data type: Rate Topic: Mortality and burden of disease Rationale: There are nearly 1.9 million stillbirths every year with over 40 per cent of all stillbirths occur during labour. The majority of stillbirths could be prevented with quality and respectful care during childbirth. In 2014, the World Health Assembly endorsed the Every Newborn Action Plan (ENAP) which includes a global target of 12 or fewer third trimester (late) stillbirths per 1,000 total births in every country by 2030. […] Definition: The stillbirth rate (SBR) is defined as the number of babies born with no signs of life at 28 weeks or more of gestation, per 1,000 total births. […] Method of estimation: For data from countries with civil registration and good coverage, data meeting definition criteria of greater than or equal to 28 completed weeks gestation or 1000g or more are taken directly from civil registration without adjustment. For other countries, stillbirth rates are estimated with a regression model. Method of estimation of global and regional aggregates: Estimation and projection of stillbirth rates is undertaken using a statistical model for all country years. In the model, the SBR is estimated assuming that the Observed log(SBR) = log(true SBR) + bias + measurement error where the true SBR in a country for 2000 to 2021 = country-intercept + SBR predicted by covariates + country-specific temporal smoothing process (explained further below). The model produces estimates of the SBR for 2000 to 2021 with uncertainty.

• #3 Stillbirth: Understanding Maternal Experiences | CDC Foundation

  https://www.cdcfoundation.org/programs/building-capacity-surveillance-among-recent-stillbirth

  Stillbirth, defined as the loss of a baby at or after 20 weeks of pregnancy, is devastating for expectant parents and their families. Tragically, more than 20,000 stillbirths a year occur in the United States. […] In general, this project will build the capacity for surveillance of maternal self-reported stillbirth experiences through: a) Identifying and funding jurisdictions to implement surveillance of maternal self-reported experiences from individuals who have recently experienced a stillbirth b) Providing capacity building to jurisdictions to improve data collection and engage with impacted communities to understand the contextual factors for stillbirth and assess opportunities to standardize and improve stillbirth reporting c) Supporting collaborative learning within and across jurisdictions d) Supporting dissemination of timely, high-quality data on maternal self-report experiences following a stillbirth. […] Program Description: To build capacity for population-based surveillance among individuals with a recent stillbirth within the United States.

• #4 Management of Stillbirth | ACOG

  https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2020/03/management-of-stillbirth

  The method and timing of delivery after a stillbirth depend on the gestational age at which the death occurred, maternal obstetric history (eg, previous hysterotomy), and maternal preference. […] The stillbirth rate in the United States was 5.96 per 1,000 live births, a decrease from 6.61 in 2006 and 6.05 per 1,000 births in 2012. […] There is ongoing discussion regarding the most useful calculation for analysis of stillbirth occurrences. Currently, fetal mortality rates are widely calculated using a birth-based approach: the number of stillbirths per 1,000 live births and stillbirths. […] The stillbirth rate among twin pregnancies is approximately 2.5 times higher than that of singletons (14.07 versus 5.65 per 1,000 live births and stillbirths). […] Women with a previous stillbirth are at increased risk of recurrence.

• #5 Stillbirth: Definition, Evaluation and Management – The ObG Project

  https://www.obgproject.com/2020/07/13/stillbirth-management-the-acog-smfm-consensus-document/

  Stillbirth is a devastating adverse pregnancy outcome, occurring in 1 out of 160 deliveries in the United States. It is often associated with non-modifiable, but common, risk factors such as race and pre-existing co-morbidities. Even after thorough evaluation, often the underlying cause remains unknown. ACOG has provided a comprehensive consensus document that addresses risk factors, causes, and management that includes bereavement support […] Fetal death is defined by the US National Center for Health Statistics as the delivery of a fetus showing no signs of life. Recommended to report all fetal deaths at ≥20 weeks or 350 grams (50%ile for GA 20 weeks) | Reporting varies among states. Excluded from stillbirth statistics: Terminations of pregnancy for fetal anomalies, Pre-viable premature rupture of membranes. From 2013, overall rate 5.95 per 1,000 live births. Similar rate between early (3 per 1,000 for 20 to 27 weeks) and late (2.97 per 1,000 for >28 weeks)

• #6 Her Child Was Stillborn. She Blames a System That Doesn’t Always Listen to Mothers. — ProPublica

  https://www.propublica.org/article/stillbirths-prevention-infant-mortality

  Every year more than 20,000 pregnancies in the U.S. result in a stillbirth, but not all of these tragedies were inevitable. As many as one in four stillbirths are potentially preventable. […] But federal agencies have not prioritized critical stillbirth-focused studies that could lead to fewer deaths. […] The deaths are not inevitable. One study found that nearly one in four U.S. stillbirths may be preventable. […] Federal agencies, state health departments, hospitals and doctors have also done a poor job of educating expectant parents about stillbirth or diligently counseling on fetal movement, despite research showing that patients who have had a stillbirth are more likely to have experienced abnormal fetal movements, including decreased activity. […] ACOG said it routinely reviewed its guidance on management of stillbirth but was unable to make significant updates due to the lack of new, evidence-based research.

• #7

  https://journals.lww.com/epidem/fulltext/2012/03000/commentary__stillbirth__still_important_and_still.12.aspx

  Were stillbirth to be listed among the leading causes of death in the United States, it would rank 11th, just ahead of chronic liver disease and cirrhosis. […] Three million annual deaths are not sufficient to make stillbirth an international health priority. […] Still, the Centers for Disease Control held workshops in 2005 on stillbirth surveillance, and this year the Lancet has published a series of papers on stillbirth as a global public health problem. […] Interesting epidemiologic research on stillbirth using large US databases has been published in recent years, and NICHD and several universities are collaborating in a national stillbirth surveillance and case-control study, the latter including near-universal autopsy and placental assessment essential prerequisites to any major advance in understanding. […] Stillbirth remains an enigma difficult to study; difficult even to describe. As long as stillbirths are as frequent as infant deaths (about 25,000 each in the United States annually), stillbirth merits the serious attention of epidemiologists.

• #8 Stillbirths and stillbirth rates – UNICEF DATA

  https://data.unicef.org/topic/child-survival/stillbirths/

  Around 1.9 million stillbirths – babies born with no sign of life at 28 weeks of pregnancy or later – occurred worldwide in 2023. Many of these might have been prevented with proper care. According to the latest data, the global stillbirth rate last year was 14.3 stillbirths per 1,000 total births. This equates to 1 in 70 total births resulting in a stillborn baby, or one every 17 seconds. Still, this number may be an underestimate, as stillbirths are often underreported. […] Women in sub-Saharan Africa and South Asia bear the greatest burden of stillbirths in the world. In 2023, 8 in 10 stillbirths occurred in these two regions, with 50 per cent of the global total in sub-Saharan Africa and 31 per cent in South Asia. In sub-Saharan Africa, the estimated stillbirth rate of 22.2 stillbirths per 1,000 total births was eight times higher than the lowest regional average stillbirth rate of 2.6 found in Western Europe. South Asia had the second highest stillbirth rate, at 16.3 stillbirths per 1,000 total births.

• #9 Stillbirths and stillbirth rates – UNICEF DATA

  https://data.unicef.org/topic/child-survival/stillbirths/

  Around 1.9 million stillbirths – babies born with no sign of life at 28 weeks of pregnancy or later – occurred worldwide in 2023. Many of these might have been prevented with proper care. According to the latest data, the global stillbirth rate last year was 14.3 stillbirths per 1,000 total births. This equates to 1 in 70 total births resulting in a stillborn baby, or one every 17 seconds. Still, this number may be an underestimate, as stillbirths are often underreported. […] Women in sub-Saharan Africa and South Asia bear the greatest burden of stillbirths in the world. In 2023, 8 in 10 stillbirths occurred in these two regions, with 50 per cent of the global total in sub-Saharan Africa and 31 per cent in South Asia. In sub-Saharan Africa, the estimated stillbirth rate of 22.2 stillbirths per 1,000 total births was eight times higher than the lowest regional average stillbirth rate of 2.6 found in Western Europe. South Asia had the second highest stillbirth rate, at 16.3 stillbirths per 1,000 total births.

• #10 Stillbirths and stillbirth rates – UNICEF DATA

  https://data.unicef.org/topic/child-survival/stillbirths/

  Around 1.9 million stillbirths – babies born with no sign of life at 28 weeks of pregnancy or later – occurred worldwide in 2023. Many of these might have been prevented with proper care. According to the latest data, the global stillbirth rate last year was 14.3 stillbirths per 1,000 total births. This equates to 1 in 70 total births resulting in a stillborn baby, or one every 17 seconds. Still, this number may be an underestimate, as stillbirths are often underreported. […] Women in sub-Saharan Africa and South Asia bear the greatest burden of stillbirths in the world. In 2023, 8 in 10 stillbirths occurred in these two regions, with 50 per cent of the global total in sub-Saharan Africa and 31 per cent in South Asia. In sub-Saharan Africa, the estimated stillbirth rate of 22.2 stillbirths per 1,000 total births was eight times higher than the lowest regional average stillbirth rate of 2.6 found in Western Europe. South Asia had the second highest stillbirth rate, at 16.3 stillbirths per 1,000 total births.

• #11 Stillbirths and stillbirth rates – UNICEF DATA

  https://data.unicef.org/topic/child-survival/stillbirths/

  The burden of stillbirths is not distributed evenly across countries. In 2023, stillbirth rates ranged from 1.7 stillbirths per 1,000 total births to 34.9 stillbirths per 1,000 total births. The risk of a stillbirth in the country with the highest stillbirth rate was about 21 times higher than the country with the lowest rate. Of the 22 countries where an estimated rate above 20 was observed, the majority (18) are in sub-Saharan Africa and the remaining three in South Asia or Middle East and Northern Africa. Comparatively, for 21 countries – mainly in Europe – the estimated stillbirth rate was below 2.5 stillbirths per 1,000 total births. This wide gap between countries within and across regions indicates the great potential to reduce preventable stillbirths. […] Most stillbirths are preventable, so long as proven interventions that improve the health of mothers and their babies along the continuum of care are available and accessed. Globally, in 2023, an estimated 46 per cent of all stillbirths were intrapartum (i.e., the baby died during labour). Almost all of the nearly 900,000 intrapartum stillbirth deaths could have been prevented with access to high-quality care during childbirth, including ongoing intrapartum monitoring and timely intervention in case of complications.

• #12 Stillbirths and stillbirth rates – UNICEF DATA

  https://data.unicef.org/topic/child-survival/stillbirths/

  The burden of stillbirths is not distributed evenly across countries. In 2023, stillbirth rates ranged from 1.7 stillbirths per 1,000 total births to 34.9 stillbirths per 1,000 total births. The risk of a stillbirth in the country with the highest stillbirth rate was about 21 times higher than the country with the lowest rate. Of the 22 countries where an estimated rate above 20 was observed, the majority (18) are in sub-Saharan Africa and the remaining three in South Asia or Middle East and Northern Africa. Comparatively, for 21 countries – mainly in Europe – the estimated stillbirth rate was below 2.5 stillbirths per 1,000 total births. This wide gap between countries within and across regions indicates the great potential to reduce preventable stillbirths. […] Most stillbirths are preventable, so long as proven interventions that improve the health of mothers and their babies along the continuum of care are available and accessed. Globally, in 2023, an estimated 46 per cent of all stillbirths were intrapartum (i.e., the baby died during labour). Almost all of the nearly 900,000 intrapartum stillbirth deaths could have been prevented with access to high-quality care during childbirth, including ongoing intrapartum monitoring and timely intervention in case of complications.

• #13 Stillbirths and stillbirth rates – UNICEF DATA

  https://data.unicef.org/topic/child-survival/stillbirths/

  Globally, some progress was made in reducing the stillbirth rate over the past two decades, which declined from 22.6 stillbirths per 1,000 total births in 2000 to 14.3 in 2023 – a reduction of 37 per cent. The total number of stillbirths declined by 39 per cent, from 3.1 million in 2000 to 1.9 million in 2023. […] Without urgent action, millions of families will experience the tragic stillbirth of a baby in the next decade. If the stillbirth rate for each country stays at the 2023 level, 13.7 million babies will be stillborn between now and 2030. Even more babies could be stillborn if investment is paused and stillbirth rates increase.

• #14 Stillbirths and stillbirth rates – UNICEF DATA

  https://data.unicef.org/topic/child-survival/stillbirths/

  Globally, some progress was made in reducing the stillbirth rate over the past two decades, which declined from 22.6 stillbirths per 1,000 total births in 2000 to 14.3 in 2023 – a reduction of 37 per cent. The total number of stillbirths declined by 39 per cent, from 3.1 million in 2000 to 1.9 million in 2023. […] Without urgent action, millions of families will experience the tragic stillbirth of a baby in the next decade. If the stillbirth rate for each country stays at the 2023 level, 13.7 million babies will be stillborn between now and 2030. Even more babies could be stillborn if investment is paused and stillbirth rates increase.

• #15 State of the nation report | MBRRACE-UK

  https://timms.le.ac.uk/mbrrace-uk-perinatal-mortality/surveillance/

  Rates of stillbirth, neonatal mortality and extended perinatal mortality are presented by country of residence for the UK and for each devolved nation for the period 2013 to 2023. This is to show trends in mortality rates over time and to enable individual nations to monitor the progress of initiatives to reduce perinatal mortality, […] Extended perinatal mortality rates decreased across the UK in 2023 (UK extended perinatal mortality rate: 4.84 per 1,000 total births). The long-term reduction in perinatal mortality is driven largely by a reduction in stillbirths. […] Compared with rates in 2022, stillbirth rates per 1,000 total births in 2023 were lower across the UK: 3.22 (UK); 3.27 (England); 2.95 (Scotland); 3.32 (Wales); and 2.51 (Northern Ireland). […] There were 2,128 stillbirths and 1,074 neonatal deaths in 2023. This was 1,158 (35.2%) fewer stillbirths and 362 (25.2%) fewer neonatal deaths compared with 2013.

• #16 State of the nation report | MBRRACE-UK

  https://timms.le.ac.uk/mbrrace-uk-perinatal-mortality/surveillance/

  Rates of stillbirth, neonatal mortality and extended perinatal mortality are presented by country of residence for the UK and for each devolved nation for the period 2013 to 2023. This is to show trends in mortality rates over time and to enable individual nations to monitor the progress of initiatives to reduce perinatal mortality, […] Extended perinatal mortality rates decreased across the UK in 2023 (UK extended perinatal mortality rate: 4.84 per 1,000 total births). The long-term reduction in perinatal mortality is driven largely by a reduction in stillbirths. […] Compared with rates in 2022, stillbirth rates per 1,000 total births in 2023 were lower across the UK: 3.22 (UK); 3.27 (England); 2.95 (Scotland); 3.32 (Wales); and 2.51 (Northern Ireland). […] There were 2,128 stillbirths and 1,074 neonatal deaths in 2023. This was 1,158 (35.2%) fewer stillbirths and 362 (25.2%) fewer neonatal deaths compared with 2013.

• #17 Stillbirths and stillbirth rates – UNICEF DATA

  https://data.unicef.org/topic/child-survival/stillbirths/

  Globally, some progress was made in reducing the stillbirth rate over the past two decades, which declined from 22.6 stillbirths per 1,000 total births in 2000 to 14.3 in 2023 – a reduction of 37 per cent. The total number of stillbirths declined by 39 per cent, from 3.1 million in 2000 to 1.9 million in 2023. […] Without urgent action, millions of families will experience the tragic stillbirth of a baby in the next decade. If the stillbirth rate for each country stays at the 2023 level, 13.7 million babies will be stillborn between now and 2030. Even more babies could be stillborn if investment is paused and stillbirth rates increase.

• #18

  https://www.who.int/data/gho/indicator-metadata-registry/imr-details/2444

  Stillbirth rate (per 1000 total births) Short name: Stillbirth rate Data type: Rate Topic: Mortality and burden of disease Rationale: There are nearly 1.9 million stillbirths every year with over 40 per cent of all stillbirths occur during labour. The majority of stillbirths could be prevented with quality and respectful care during childbirth. In 2014, the World Health Assembly endorsed the Every Newborn Action Plan (ENAP) which includes a global target of 12 or fewer third trimester (late) stillbirths per 1,000 total births in every country by 2030. […] Definition: The stillbirth rate (SBR) is defined as the number of babies born with no signs of life at 28 weeks or more of gestation, per 1,000 total births. […] Method of estimation: For data from countries with civil registration and good coverage, data meeting definition criteria of greater than or equal to 28 completed weeks gestation or 1000g or more are taken directly from civil registration without adjustment. For other countries, stillbirth rates are estimated with a regression model. Method of estimation of global and regional aggregates: Estimation and projection of stillbirth rates is undertaken using a statistical model for all country years. In the model, the SBR is estimated assuming that the Observed log(SBR) = log(true SBR) + bias + measurement error where the true SBR in a country for 2000 to 2021 = country-intercept + SBR predicted by covariates + country-specific temporal smoothing process (explained further below). The model produces estimates of the SBR for 2000 to 2021 with uncertainty.

• #19

  https://www.who.int/health-topics/stillbirth

  A baby who dies after 28 weeks of pregnancy, but before or during birth, is classified as a stillbirth. There are nearly 2 million stillbirths every year one every 16 seconds. Over 40% of all stillbirths occur during labour a loss that could be avoided with improved quality and respectful care during childbirth including routine monitoring and timely access to emergency obstetric care when required. In 2014, the World Health Assembly endorsed the Every Newborn Action Plan (ENAP), which includes a global target of 12 or fewer third trimester (late) stillbirths per 1,000 total births in every country by 2030. In 2021, 139 mainly high-income and upper middle-income countries had met this target, but 56 countries will not each the ENAP target by 2030 if further efforts are not made. If current trends continue, 15.9 million babies will be stillborn; nearly half of these (7.7 million, 48%) will occur in sub-Saharan Africa. With quality health care throughout pregnancy and childbirth, most stillbirths are preventable. The major causes of stillbirth include pregnancy and childbirth-related complications, prolonged pregnancy, maternal infections such as malaria, syphilis and HIV, maternal conditions especially hypertension, and diabetes, and fetal growth restriction (when an unborn baby is unable to achieve its growth potential and therefore smaller than it should be).

• #20 3.2 million stillbirths: epidemiology and overview of the evidence review | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-9-S1-S2

  Risk factors and conditions associated with stillbirth overlap with those causing maternal deaths and also neonatal deaths, yet often stillbirth outcomes are not explicitly reported in studies. […] In low-income countries, stillbirth rates are between 10-fold and 20-fold higher than in middle- and high-income countries. […] If the coverage and quality of periconceptional, antenatal, and intrapartum (especially comprehensive obstetric) care were increased in low-income countries, stillbirth rates could be expected to decline markedly. […] It is clear that given the large number of deaths, equivalent or larger than many other global health priorities, stillbirths are not receiving adequate attention.

• #21 Management of Stillbirth | ACOG

  https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2020/03/management-of-stillbirth

  ABSTRACT: Stillbirth is one of the most common adverse pregnancy outcomes, occurring in 1 in 160 deliveries in the United States. In developed countries, the most prevalent risk factors associated with stillbirth are non-Hispanic black race, nulliparity, advanced maternal age, obesity, preexisting diabetes, chronic hypertension, smoking, alcohol use, having a pregnancy using assisted reproductive technology, multiple gestation, male fetal sex, unmarried status, and past obstetric history. […] The study of specific causes of stillbirth has been hampered by the lack of uniform protocols to evaluate and classify stillbirths and by decreasing autopsy rates. In any specific case, it may be difficult to assign a definite cause to a stillbirth. A significant proportion of stillbirths remains unexplained even after a thorough evaluation. Evaluation of a stillbirth should include fetal autopsy; gross and histologic examination of the placenta, umbilical cord, and membranes; and genetic evaluation.

• #22 Stillbirth surveillance and review in rural districts in Bangladesh | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-018-1866-2

  An estimated 2.6 million stillbirths occur every year, with the majority occurring in low- and middle-income countries. Understanding the cause of and factors associated with stillbirth is important to help inform the design and implementation of interventions aimed at reducing preventable stillbirths. […] Population-based surveillance with identification of all stillbirths that occurred either at home or in a health facility was introduced in four districts in Bangladesh. […] The population-based stillbirth rate obtained was 20.4 per 1000 births; 53.9% of all stillbirths occurred at home. […] The three most frequent causes of stillbirth were maternal hypertension or eclampsia (15.2%), antepartum haemorrhage (13.7%) and maternal infections (8.9%). […] However, it was not possible to identify a cause of death with reasonable certainty using information obtained via verbal autopsy in 51.9% of stillbirths.

• #23 State of the nation report | MBRRACE-UK

  https://timms.le.ac.uk/mbrrace-uk-perinatal-mortality/surveillance/

  In 2023, extended perinatal mortality rates across the UK continued to decline, reaching 4.84 per 1,000 total births, primarily driven by a reduction in stillbirths. Compared to 2022, stillbirth rates fell across all UK nations, while neonatal mortality rates also declined in England, Wales, and Northern Ireland. […] The leading causes of stillbirth were placental issues, congenital anomalies, umbilical cord complications, and fetal conditions, but 34% of stillbirths had an unknown cause. Neonatal deaths were most commonly attributed to congenital anomalies, neurological issues, extreme prematurity, cardio-respiratory complications, and infections. Congenital anomalies remained a significant contributor, accounting for 8% of stillbirths and 35% of neonatal deaths.

• #24 Stillbirth surveillance and review in rural districts in Bangladesh | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-018-1866-2

  An estimated 2.6 million stillbirths occur every year, with the majority occurring in low- and middle-income countries. Understanding the cause of and factors associated with stillbirth is important to help inform the design and implementation of interventions aimed at reducing preventable stillbirths. […] Population-based surveillance with identification of all stillbirths that occurred either at home or in a health facility was introduced in four districts in Bangladesh. […] The population-based stillbirth rate obtained was 20.4 per 1000 births; 53.9% of all stillbirths occurred at home. […] The three most frequent causes of stillbirth were maternal hypertension or eclampsia (15.2%), antepartum haemorrhage (13.7%) and maternal infections (8.9%). […] However, it was not possible to identify a cause of death with reasonable certainty using information obtained via verbal autopsy in 51.9% of stillbirths.

• #25 Continuing inequalities contribute to wide variation in rates of stillbirths and neonatal deaths across UK | University of Oxford

  https://www.ox.ac.uk/news/2023-09-14-continuing-inequalities-contribute-wide-variation-rates-stillbirths-and-neonatal

  The cause of death remains unknown for one third of stillborn babies with a further third being due to placental issues. […] The UK government, Royal Colleges, and Health Commissioners must support rigorous reviews of all stillbirths and neonatal deaths to identify common themes that can improve clinical care and service provision, delivery, and organisation reducing the need for future independent enquiries. […] UK governments and national organisations should continue to develop and implement targeted action at national and organisational levels to reduce inequalities and review perinatal pathology services as a national priority to address the unknown causes of stillbirths and ensure equal access to post-mortem services.

• #26 Challenges and Priorities for Surveillance of Stillbirths: A Report on Two Workshops

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2728657/

  Stillbirths, those with and without birth defects, are an important public health topic. The National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention conducted two workshops during April and July 2005. Both workshops explored the challenges of conducting surveillance of stillbirths. Workshop participants considered an approach that added the surveillance of stillbirths, those with and without birth defects, as part of existing population-based birth defects surveillance programs in Iowa and Atlanta. The workshops addressed three key aspects for expanding birth defects programs to conduct active, population-based surveillance on stillbirths: (1) case identification and ascertainment, (2) data collection, and (3) data use and project evaluation. Participants included experts in pediatrics, obstetrics, epidemiology, maternal-fetal medicine, perinatology and pediatric pathology, midwifery, as well as practicing clinicians and pathologists. Expanding existing birth defects surveillance programs to include information of stillbirths could potentially enhance the data available on fetal death reports and also could benefit such programs by improving the ascertainment of birth defects.

• #27 CDC Activities | Stillbirth | CDC

  https://www.cdc.gov/stillbirth/about/what-cdc-is-doing.html

  CDC works to learn more about who had a stillbirth and explores whether we know why. CDC does this by tracking how often stillbirth occurs and researching what causes stillbirth. […] NCBDDD is also funding four jurisdictions (Georgia, Illinois, Indiana, and southern Nevada) to start population-based surveillance systems to examine regional stillbirth prevalence. This work will focus on racial and ethnic differences, geographical differences, and underlying causes. This will provide more precise prevalence estimates and data for services and policy planning. […] Data about stillbirth are collected across the country on fetal death reports (reports for fetuses that do not survive pregnancy). […] Using these reports, the NCHS collects annual national statistical data on fetal deaths at 20 or more weeks of pregnancy (stillbirths). This data includes all 50 states, the District of Columbia, and 5 U.S. territories. This process provides estimates of the number of stillbirths that occur in the United States.

• #28 CDC Activities | Stillbirth | CDC

  https://www.cdc.gov/stillbirth/about/what-cdc-is-doing.html

  CDC works to learn more about who had a stillbirth and explores whether we know why. CDC does this by tracking how often stillbirth occurs and researching what causes stillbirth. […] NCBDDD is also funding four jurisdictions (Georgia, Illinois, Indiana, and southern Nevada) to start population-based surveillance systems to examine regional stillbirth prevalence. This work will focus on racial and ethnic differences, geographical differences, and underlying causes. This will provide more precise prevalence estimates and data for services and policy planning. […] Data about stillbirth are collected across the country on fetal death reports (reports for fetuses that do not survive pregnancy). […] Using these reports, the NCHS collects annual national statistical data on fetal deaths at 20 or more weeks of pregnancy (stillbirths). This data includes all 50 states, the District of Columbia, and 5 U.S. territories. This process provides estimates of the number of stillbirths that occur in the United States.

• #29 U.S. stillbirth surveillance: The national fetal death file and other data sources – PubMed

  https://pubmed.ncbi.nlm.nih.gov/38143212/

  The National Vital Statistics System is the primary source of information on fetal deaths of 20 weeks of gestation or more in the United States. […] Improved national fetal death data and data from other sources will continue to add insights into the risks, causes and prevention of fetal death.

• #30 CDC Activities | Stillbirth | CDC

  https://www.cdc.gov/stillbirth/about/what-cdc-is-doing.html

  Recent activities have focused on improving the quality and timeliness of stillbirth data. […] DRH funds states and jurisdictions to collect population-based data on maternal experiences before, during, and shortly after pregnancy. […] Utah’s Study of the Associated Risks of Stillbirth (SOARS) provides essential data to better understand stillbirth. […] CDC has recently started a number of new stillbirth initiatives. Getting the results of these activities takes some time. In the meantime, CDC will work to increase awareness about stillbirth.

• #31 CDC Activities | Stillbirth | CDC

  https://www.cdc.gov/stillbirth/about/what-cdc-is-doing.html

  CDC works to learn more about who had a stillbirth and explores whether we know why. CDC does this by tracking how often stillbirth occurs and researching what causes stillbirth. […] NCBDDD is also funding four jurisdictions (Georgia, Illinois, Indiana, and southern Nevada) to start population-based surveillance systems to examine regional stillbirth prevalence. This work will focus on racial and ethnic differences, geographical differences, and underlying causes. This will provide more precise prevalence estimates and data for services and policy planning. […] Data about stillbirth are collected across the country on fetal death reports (reports for fetuses that do not survive pregnancy). […] Using these reports, the NCHS collects annual national statistical data on fetal deaths at 20 or more weeks of pregnancy (stillbirths). This data includes all 50 states, the District of Columbia, and 5 U.S. territories. This process provides estimates of the number of stillbirths that occur in the United States.

• #32 Journal of Medical Internet Research – The Jordan Stillbirth and Neonatal Mortality Surveillance (JSANDS) System: Evaluation Study

  https://www.jmir.org/2021/7/e29143/

  The Jordan Stillbirth and Neonatal Mortality Surveillance (JSANDS) is an electronic surveillance system that automatically transfers the data on births, stillbirths, and neonatal deaths to the concerned authorities in the Ministry of Health. JSANDS was implemented and tested in 5 maternity hospitals during the period spanning May 2019 through December 2020. […] The main objectives of this system are to measure the burden of PNN mortality, identify their causes, assess trends in these deaths, and identify risk groups. […] The JSANDS dashboard displays useful information on mortality indicators, including fetal death rate, neonatal mortality rate, perinatal death rate, and causes of stillbirths and neonatal deaths. […] JSANDS collects data on demographic, clinical, maternal, and other relevant characteristics for each live born baby, stillbirth, and neonatal death to allow detailed exploration of the causes of perinatal mortality in Jordan, to calculate and report indicators, to make comparisons between organizations, and to provide a clearer insight into the risk factors most commonly associated with stillbirth or neonatal death.

• #33 Journal of Medical Internet Research – The Jordan Stillbirth and Neonatal Mortality Surveillance (JSANDS) System: Evaluation Study

  https://www.jmir.org/2021/7/e29143/

  The Jordan Stillbirth and Neonatal Mortality Surveillance (JSANDS) is an electronic surveillance system that automatically transfers the data on births, stillbirths, and neonatal deaths to the concerned authorities in the Ministry of Health. JSANDS was implemented and tested in 5 maternity hospitals during the period spanning May 2019 through December 2020. […] The main objectives of this system are to measure the burden of PNN mortality, identify their causes, assess trends in these deaths, and identify risk groups. […] The JSANDS dashboard displays useful information on mortality indicators, including fetal death rate, neonatal mortality rate, perinatal death rate, and causes of stillbirths and neonatal deaths. […] JSANDS collects data on demographic, clinical, maternal, and other relevant characteristics for each live born baby, stillbirth, and neonatal death to allow detailed exploration of the causes of perinatal mortality in Jordan, to calculate and report indicators, to make comparisons between organizations, and to provide a clearer insight into the risk factors most commonly associated with stillbirth or neonatal death.

• #34 Challenges and Priorities for Surveillance of Stillbirths: A Report on Two Workshops

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2728657/

  One of the challenges to conducting epidemiologic studies of stillbirth has been the limited availability of reliable population-based surveillance data. By law, fetal deaths must be reported in the United States; however, reporting requirements and, to a lesser extent, the criteria used to define fetal death vary. As a result, the use of fetal death reports (FDRs) as a source of surveillance data has been problematic. […] Existing birth defects surveillance programs provide the necessary infrastructure and methodology to expand their surveillance capabilities to include stillbirths. Workshop participants agreed that clear definitions describing both ascertainment and reporting criteria of cases need to be established, with guidelines describing a systematic approach to reviewing the data. These guidelines should be consistent with the current approaches outlined in the Model Law and employed by NCHS for fetal deaths. These guidelines should include clear definitions and how to record the information sometimes necessary to distinguish among nonviable live births, antepartum and intrapartum fetal deaths, and ITOPs.

• #35 Challenges and Priorities for Surveillance of Stillbirths: A Report on Two Workshops

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2728657/

  One of the challenges to conducting epidemiologic studies of stillbirth has been the limited availability of reliable population-based surveillance data. By law, fetal deaths must be reported in the United States; however, reporting requirements and, to a lesser extent, the criteria used to define fetal death vary. As a result, the use of fetal death reports (FDRs) as a source of surveillance data has been problematic. […] Existing birth defects surveillance programs provide the necessary infrastructure and methodology to expand their surveillance capabilities to include stillbirths. Workshop participants agreed that clear definitions describing both ascertainment and reporting criteria of cases need to be established, with guidelines describing a systematic approach to reviewing the data. These guidelines should be consistent with the current approaches outlined in the Model Law and employed by NCHS for fetal deaths. These guidelines should include clear definitions and how to record the information sometimes necessary to distinguish among nonviable live births, antepartum and intrapartum fetal deaths, and ITOPs.

• #36 Management of Stillbirth | ACOG

  https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2020/03/management-of-stillbirth

  The relationship between previous adverse pregnancy outcomes and stillbirth is strongest in the case of explained stillbirth. However, there remains a persistent 1.7-fold to 2-fold increase in unexplained stillbirth associated with a history of adverse pregnancy outcomes. […] The study of specific causes of stillbirth has been hampered by the lack of uniform protocols to evaluate and classify stillbirths and by decreasing autopsy rates. […] Infection is associated with approximately 10-20% of stillbirths in developed countries and a greater percentage in developing countries. […] Umbilical cord abnormalities account for approximately 10% of stillbirths but this diagnosis should be made with caution. […] Evaluation of a stillbirth should include fetal autopsy; gross and histologic examination of the placenta, umbilical cord, and membranes; and genetic evaluation.

• #37 Management of Stillbirth | ACOG

  https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2020/03/management-of-stillbirth

  ABSTRACT: Stillbirth is one of the most common adverse pregnancy outcomes, occurring in 1 in 160 deliveries in the United States. In developed countries, the most prevalent risk factors associated with stillbirth are non-Hispanic black race, nulliparity, advanced maternal age, obesity, preexisting diabetes, chronic hypertension, smoking, alcohol use, having a pregnancy using assisted reproductive technology, multiple gestation, male fetal sex, unmarried status, and past obstetric history. […] The study of specific causes of stillbirth has been hampered by the lack of uniform protocols to evaluate and classify stillbirths and by decreasing autopsy rates. In any specific case, it may be difficult to assign a definite cause to a stillbirth. A significant proportion of stillbirths remains unexplained even after a thorough evaluation. Evaluation of a stillbirth should include fetal autopsy; gross and histologic examination of the placenta, umbilical cord, and membranes; and genetic evaluation.

• #38 Stillbirth Definition and Data Quality Assessment for Health Management Information Systems (HMIS) – UNICEF DATA

  https://data.unicef.org/resources/stillbirth-definition-and-data-quality-assessment-for-health-management-information-systems/

  Misclassification of stillbirths as miscarriages or neonatal deaths is common. […] In addition, inconsistent application of stillbirth definitions can also contribute to misclassification and thus impact comparability of stillbirth data. […] Including all births, whether live or stillborn, in a single data system is important in light of the substantial misclassification between stillbirths and very early neonatal deaths; while the underlying risk factors, cause of death, and public health interventions to address these deaths are similar, stillbirths are additionally associated with increased maternal morbidity and health care needs that may differ to those of very early neonatal deaths. […] This guideline seeks to support two specific audiences: (1) health care workers, to provide guidance on the data elements and indicators needed to collect high quality stillbirth data and data managers/public health professionals at local, regional and national level, to provide guidance on the data required to assess current stillbirth data quality and to execute relevant improvements to these data, thus driving informed policies to end preventable deaths.

• #39 Stillbirth Definition and Data Quality Assessment for Health Management Information Systems (HMIS) – UNICEF DATA

  https://data.unicef.org/resources/stillbirth-definition-and-data-quality-assessment-for-health-management-information-systems/

  Misclassification of stillbirths as miscarriages or neonatal deaths is common. […] In addition, inconsistent application of stillbirth definitions can also contribute to misclassification and thus impact comparability of stillbirth data. […] Including all births, whether live or stillborn, in a single data system is important in light of the substantial misclassification between stillbirths and very early neonatal deaths; while the underlying risk factors, cause of death, and public health interventions to address these deaths are similar, stillbirths are additionally associated with increased maternal morbidity and health care needs that may differ to those of very early neonatal deaths. […] This guideline seeks to support two specific audiences: (1) health care workers, to provide guidance on the data elements and indicators needed to collect high quality stillbirth data and data managers/public health professionals at local, regional and national level, to provide guidance on the data required to assess current stillbirth data quality and to execute relevant improvements to these data, thus driving informed policies to end preventable deaths.

• #40

  https://link.springer.com/article/10.17269/s41997-021-00483-x

  Variation in reporting criteria bias international comparisons of stillbirth rates. […] Setting a lower viability threshold (e.g., 20 weeks gestation) for complete ascertainment and reporting of all spontaneous fetal deaths in Canada would permit comparisons with countries that favour such a threshold, and also countries that report fetal death using a higher viability threshold.

• #41

  https://link.springer.com/article/10.17269/s41997-021-00483-x

  Variation in reporting criteria bias international comparisons of stillbirth rates. […] Setting a lower viability threshold (e.g., 20 weeks gestation) for complete ascertainment and reporting of all spontaneous fetal deaths in Canada would permit comparisons with countries that favour such a threshold, and also countries that report fetal death using a higher viability threshold.

• #42 Challenges and Priorities for Surveillance of Stillbirths: A Report on Two Workshops

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2728657/

  One of the challenges to conducting epidemiologic studies of stillbirth has been the limited availability of reliable population-based surveillance data. By law, fetal deaths must be reported in the United States; however, reporting requirements and, to a lesser extent, the criteria used to define fetal death vary. As a result, the use of fetal death reports (FDRs) as a source of surveillance data has been problematic. […] Existing birth defects surveillance programs provide the necessary infrastructure and methodology to expand their surveillance capabilities to include stillbirths. Workshop participants agreed that clear definitions describing both ascertainment and reporting criteria of cases need to be established, with guidelines describing a systematic approach to reviewing the data. These guidelines should be consistent with the current approaches outlined in the Model Law and employed by NCHS for fetal deaths. These guidelines should include clear definitions and how to record the information sometimes necessary to distinguish among nonviable live births, antepartum and intrapartum fetal deaths, and ITOPs.

• #43 Challenges and Priorities for Surveillance of Stillbirths: A Report on Two Workshops

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2728657/

  One of the challenges to conducting epidemiologic studies of stillbirth has been the limited availability of reliable population-based surveillance data. By law, fetal deaths must be reported in the United States; however, reporting requirements and, to a lesser extent, the criteria used to define fetal death vary. As a result, the use of fetal death reports (FDRs) as a source of surveillance data has been problematic. […] Existing birth defects surveillance programs provide the necessary infrastructure and methodology to expand their surveillance capabilities to include stillbirths. Workshop participants agreed that clear definitions describing both ascertainment and reporting criteria of cases need to be established, with guidelines describing a systematic approach to reviewing the data. These guidelines should be consistent with the current approaches outlined in the Model Law and employed by NCHS for fetal deaths. These guidelines should include clear definitions and how to record the information sometimes necessary to distinguish among nonviable live births, antepartum and intrapartum fetal deaths, and ITOPs.

• #44 SOARS | Maternal and Infant Health Program

  https://mihp.utah.gov/study-of-associated-risk-of-stillbirth

  The Study of Associated Risks of Stillbirth (SOARS) is a surveillance project of the Centers for Disease Control and Prevention (CDC) and the Utah Department of Health and Human Services. […] SOARS was initiated in 2018 to help health officials learn more about why stillbirths occur. Understanding the potential causes of stillbirth can lead to recommendations, policies, and services to help prevent them. […] SOARS provides data not available in medical records or on fetal death certificates. […] SOARS will provide data to assist in identifying women who are at high risk for stillbirth, monitor risk factors, and identify areas for prevention. […] SOARS will assist in monitoring progress towards goals in reducing the rates of stillbirth in Utah. […] Findings from analyses of SOARS data can be used to enhance understanding of maternal behaviors and experiences and their relationship to stillbirth.

• #45 SOARS | Maternal and Infant Health Program

  https://mihp.utah.gov/study-of-associated-risk-of-stillbirth

  The Study of Associated Risks of Stillbirth (SOARS) is a surveillance project of the Centers for Disease Control and Prevention (CDC) and the Utah Department of Health and Human Services. […] SOARS was initiated in 2018 to help health officials learn more about why stillbirths occur. Understanding the potential causes of stillbirth can lead to recommendations, policies, and services to help prevent them. […] SOARS provides data not available in medical records or on fetal death certificates. […] SOARS will provide data to assist in identifying women who are at high risk for stillbirth, monitor risk factors, and identify areas for prevention. […] SOARS will assist in monitoring progress towards goals in reducing the rates of stillbirth in Utah. […] Findings from analyses of SOARS data can be used to enhance understanding of maternal behaviors and experiences and their relationship to stillbirth.

• #46

  https://www.who.int/health-topics/stillbirth

  Syphilis treatment in pregnancy could also prevent an estimated 200 000 stillbirths, while fetal heart rate monitoring and labour surveillance and prompt interventions when needed are crucial for preventing 832 000 intrapartum stillbirths and reducing neonatal deaths. More needs to be done to integrate stillbirth prevention within global and national agendas for high quality health care for women, adolescents, and babies. […] Improving systems for reporting births and neonatal deaths is a matter of human rights and a prerequisite for reducing stillbirths. In addition, there is a need to strengthen routine health information systems to accurately capture and report stillbirths for monitoring and improving the quality of care. WHO provides tools to help countries improve their data on both stillbirths and neonatal deaths.

• #47

  https://www.who.int/health-topics/stillbirth

  Syphilis treatment in pregnancy could also prevent an estimated 200 000 stillbirths, while fetal heart rate monitoring and labour surveillance and prompt interventions when needed are crucial for preventing 832 000 intrapartum stillbirths and reducing neonatal deaths. More needs to be done to integrate stillbirth prevention within global and national agendas for high quality health care for women, adolescents, and babies. […] Improving systems for reporting births and neonatal deaths is a matter of human rights and a prerequisite for reducing stillbirths. In addition, there is a need to strengthen routine health information systems to accurately capture and report stillbirths for monitoring and improving the quality of care. WHO provides tools to help countries improve their data on both stillbirths and neonatal deaths.

• #48 Perinatal Death Surveillance and Response | Global Reproductive Health | CDC

  https://www.cdc.gov/global-reproductive-health/php/perinatal-death-surveillance-response/index.html

  A Perinatal Death Surveillance and Response system collects and analyzes data on individual perinatal deaths (infant deaths that occur around the time of birth). […] A Perinatal Death Surveillance and Response (PDSR) system can help public health officials to collect information on stillbirths and newborn deaths and to better understand the causes of those deaths. […] CDC provides technical assistance to public health officials in some countries to set up or improve systems that identify, report, and review stillbirths and neonatal deaths in health facilities and in communities with high mortality.

• #49 Perinatal Death Surveillance and Response | Global Reproductive Health | CDC

  https://www.cdc.gov/global-reproductive-health/php/perinatal-death-surveillance-response/index.html

  A Perinatal Death Surveillance and Response system collects and analyzes data on individual perinatal deaths (infant deaths that occur around the time of birth). […] A Perinatal Death Surveillance and Response (PDSR) system can help public health officials to collect information on stillbirths and newborn deaths and to better understand the causes of those deaths. […] CDC provides technical assistance to public health officials in some countries to set up or improve systems that identify, report, and review stillbirths and neonatal deaths in health facilities and in communities with high mortality.

• #50 3.2 million stillbirths: epidemiology and overview of the evidence review – Healthy Newborn Network

  https://healthynewbornnetwork.org/resource/2010/3-2-million-stillbirths-epidemiology-and-overview-of-the-evidence-review/

  More than 3.2 million stillbirths occur globally each year, yet stillbirths are largely invisible in global data tracking, policy dialogue and programme implementation. […] Whilst there are estimates of the numbers of stillbirths, to date there has been no systematic global analysis of the causes of stillbirths. […] This first paper in the series outlines issues in stillbirth data availability and quality, the global epidemiology of stillbirths, and describes the methodology and framework used for the review of interventions and strategies.

• #51 Management of Stillbirth | ACOG

  https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2020/03/management-of-stillbirth

  The method and timing of delivery after a stillbirth depend on the gestational age at which the death occurred, maternal obstetric history (eg, previous hysterotomy), and maternal preference. […] The stillbirth rate in the United States was 5.96 per 1,000 live births, a decrease from 6.61 in 2006 and 6.05 per 1,000 births in 2012. […] There is ongoing discussion regarding the most useful calculation for analysis of stillbirth occurrences. Currently, fetal mortality rates are widely calculated using a birth-based approach: the number of stillbirths per 1,000 live births and stillbirths. […] The stillbirth rate among twin pregnancies is approximately 2.5 times higher than that of singletons (14.07 versus 5.65 per 1,000 live births and stillbirths). […] Women with a previous stillbirth are at increased risk of recurrence.

• #52

  https://www.who.int/data/gho/indicator-metadata-registry/imr-details/2444

  Stillbirth rate (per 1000 total births) Short name: Stillbirth rate Data type: Rate Topic: Mortality and burden of disease Rationale: There are nearly 1.9 million stillbirths every year with over 40 per cent of all stillbirths occur during labour. The majority of stillbirths could be prevented with quality and respectful care during childbirth. In 2014, the World Health Assembly endorsed the Every Newborn Action Plan (ENAP) which includes a global target of 12 or fewer third trimester (late) stillbirths per 1,000 total births in every country by 2030. […] Definition: The stillbirth rate (SBR) is defined as the number of babies born with no signs of life at 28 weeks or more of gestation, per 1,000 total births. […] Method of estimation: For data from countries with civil registration and good coverage, data meeting definition criteria of greater than or equal to 28 completed weeks gestation or 1000g or more are taken directly from civil registration without adjustment. For other countries, stillbirth rates are estimated with a regression model. Method of estimation of global and regional aggregates: Estimation and projection of stillbirth rates is undertaken using a statistical model for all country years. In the model, the SBR is estimated assuming that the Observed log(SBR) = log(true SBR) + bias + measurement error where the true SBR in a country for 2000 to 2021 = country-intercept + SBR predicted by covariates + country-specific temporal smoothing process (explained further below). The model produces estimates of the SBR for 2000 to 2021 with uncertainty.

• #53

  https://www.who.int/data/gho/indicator-metadata-registry/imr-details/2444

  Stillbirth rate (per 1000 total births) Short name: Stillbirth rate Data type: Rate Topic: Mortality and burden of disease Rationale: There are nearly 1.9 million stillbirths every year with over 40 per cent of all stillbirths occur during labour. The majority of stillbirths could be prevented with quality and respectful care during childbirth. In 2014, the World Health Assembly endorsed the Every Newborn Action Plan (ENAP) which includes a global target of 12 or fewer third trimester (late) stillbirths per 1,000 total births in every country by 2030. […] Definition: The stillbirth rate (SBR) is defined as the number of babies born with no signs of life at 28 weeks or more of gestation, per 1,000 total births. […] Method of estimation: For data from countries with civil registration and good coverage, data meeting definition criteria of greater than or equal to 28 completed weeks gestation or 1000g or more are taken directly from civil registration without adjustment. For other countries, stillbirth rates are estimated with a regression model. Method of estimation of global and regional aggregates: Estimation and projection of stillbirth rates is undertaken using a statistical model for all country years. In the model, the SBR is estimated assuming that the Observed log(SBR) = log(true SBR) + bias + measurement error where the true SBR in a country for 2000 to 2021 = country-intercept + SBR predicted by covariates + country-specific temporal smoothing process (explained further below). The model produces estimates of the SBR for 2000 to 2021 with uncertainty.

• #54

  https://www.who.int/data/gho/indicator-metadata-registry/imr-details/2444

  Stillbirth rate (per 1000 total births) Short name: Stillbirth rate Data type: Rate Topic: Mortality and burden of disease Rationale: There are nearly 1.9 million stillbirths every year with over 40 per cent of all stillbirths occur during labour. The majority of stillbirths could be prevented with quality and respectful care during childbirth. In 2014, the World Health Assembly endorsed the Every Newborn Action Plan (ENAP) which includes a global target of 12 or fewer third trimester (late) stillbirths per 1,000 total births in every country by 2030. […] Definition: The stillbirth rate (SBR) is defined as the number of babies born with no signs of life at 28 weeks or more of gestation, per 1,000 total births. […] Method of estimation: For data from countries with civil registration and good coverage, data meeting definition criteria of greater than or equal to 28 completed weeks gestation or 1000g or more are taken directly from civil registration without adjustment. For other countries, stillbirth rates are estimated with a regression model. Method of estimation of global and regional aggregates: Estimation and projection of stillbirth rates is undertaken using a statistical model for all country years. In the model, the SBR is estimated assuming that the Observed log(SBR) = log(true SBR) + bias + measurement error where the true SBR in a country for 2000 to 2021 = country-intercept + SBR predicted by covariates + country-specific temporal smoothing process (explained further below). The model produces estimates of the SBR for 2000 to 2021 with uncertainty.

• #55 3.2 million stillbirths: epidemiology and overview of the evidence review | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-9-S1-S2

  Risk factors and conditions associated with stillbirth overlap with those causing maternal deaths and also neonatal deaths, yet often stillbirth outcomes are not explicitly reported in studies. […] In low-income countries, stillbirth rates are between 10-fold and 20-fold higher than in middle- and high-income countries. […] If the coverage and quality of periconceptional, antenatal, and intrapartum (especially comprehensive obstetric) care were increased in low-income countries, stillbirth rates could be expected to decline markedly. […] It is clear that given the large number of deaths, equivalent or larger than many other global health priorities, stillbirths are not receiving adequate attention.

• #56 Management of Stillbirth | ACOG

  https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2020/03/management-of-stillbirth

  The method and timing of delivery after a stillbirth depend on the gestational age at which the death occurred, maternal obstetric history (eg, previous hysterotomy), and maternal preference. […] The stillbirth rate in the United States was 5.96 per 1,000 live births, a decrease from 6.61 in 2006 and 6.05 per 1,000 births in 2012. […] There is ongoing discussion regarding the most useful calculation for analysis of stillbirth occurrences. Currently, fetal mortality rates are widely calculated using a birth-based approach: the number of stillbirths per 1,000 live births and stillbirths. […] The stillbirth rate among twin pregnancies is approximately 2.5 times higher than that of singletons (14.07 versus 5.65 per 1,000 live births and stillbirths). […] Women with a previous stillbirth are at increased risk of recurrence.

• #57 Continuing inequalities contribute to wide variation in rates of stillbirths and neonatal deaths across UK | University of Oxford

  https://www.ox.ac.uk/news/2023-09-14-continuing-inequalities-contribute-wide-variation-rates-stillbirths-and-neonatal

  The report highlights persistent inequalities for mothers and babies from ethnic minorities and areas of deprivation which contribute to the wide variation in rates of stillbirths and neonatal deaths across the UK. […] Perinatal mortality rates increased in the UK in 2021 for the first time in seven years. […] The number of stillbirths also increased from 3.33 per 1,000 total births in 2020 to 3.54 per 1,000 total births in 2021; […] There was a wide variation in stillbirth and neonatal mortality rates that persisted even when accounting for the different types of care that organisations provide; […] Stillbirth and neonatal mortality rates increased across almost all gestational age groups. […] Inequalities in mortality rates by deprivation levels remain. […] Inequalities by ethnicity also remain, there were 7.52 stillbirths per 1,000 total births and 2.94 neonatal deaths per 1,000 live births to Black mothers and 5.15 stillbirths per 1,000 total births and 2.22 neonatal deaths per 1,000 live births to Asian mothers compared with 3.30 stillbirths per 1,000 total births and 1.68 neonatal deaths per 1,000 live births to white mothers;

• #58 NIH Study: U.S. Stillbirth Rate “Unacceptably High” — ProPublica

  https://www.propublica.org/article/stillbirths-rate-nih-cdc-prevention-research

  The newly released report, which called stillbirth a major public health concern, was the result of a congressional mandate that required the Department of Health and Human Services to develop a stillbirth task force. […] The working group also suggested that states could model their policies for stillbirth autopsies after policies relating to sudden infant death syndrome. […] The report also addressed the devastating psychological effects of a stillbirth. […] Black women are more than twice as likely and in some states close to three times as likely as white women to have a stillbirth, according to 2020 CDC data. […] The same week that the NIH stillbirth report was released, the CDC issued a separate report on maternal mortality that found that the rate of mothers dying while pregnant or shortly after birth increased in 2021, while the rate of maternal mortality in Black women was more than double that of white women.

• #59 Stillbirth Definition and Data Quality Assessment for Health Management Information Systems (HMIS) – UNICEF DATA

  https://data.unicef.org/resources/stillbirth-definition-and-data-quality-assessment-for-health-management-information-systems/

  Improvements are not only needed in the collection of data to count and classify these deaths – including birthweight, gestational age and vital status at birth – but also in data that capture the contextual conditions that contribute to stillbirths. […] High-quality comparable data can be utilized in many important ways: They can facilitate review of progress in reducing stillbirths that occur during deliveries at health facilities, allow regional and international comparisons to be made, improve clinical practice and epidemiological and health surveillance, and focus limited programmatic and research funds. […] Collecting information on timing of stillbirths — whether antepartum or intrapartum – is also an important quality-of-care indicator. […] Several challenges stand in the way of quality and comparable data on stillbirths, including omission of events and misclassification.

• #60 Stillbirth Definition and Data Quality Assessment for Health Management Information Systems (HMIS) – UNICEF DATA

  https://data.unicef.org/resources/stillbirth-definition-and-data-quality-assessment-for-health-management-information-systems/

  Misclassification of stillbirths as miscarriages or neonatal deaths is common. […] In addition, inconsistent application of stillbirth definitions can also contribute to misclassification and thus impact comparability of stillbirth data. […] Including all births, whether live or stillborn, in a single data system is important in light of the substantial misclassification between stillbirths and very early neonatal deaths; while the underlying risk factors, cause of death, and public health interventions to address these deaths are similar, stillbirths are additionally associated with increased maternal morbidity and health care needs that may differ to those of very early neonatal deaths. […] This guideline seeks to support two specific audiences: (1) health care workers, to provide guidance on the data elements and indicators needed to collect high quality stillbirth data and data managers/public health professionals at local, regional and national level, to provide guidance on the data required to assess current stillbirth data quality and to execute relevant improvements to these data, thus driving informed policies to end preventable deaths.

• #61 Stillbirth Definition and Data Quality Assessment for Health Management Information Systems (HMIS) – UNICEF DATA

  https://data.unicef.org/resources/stillbirth-definition-and-data-quality-assessment-for-health-management-information-systems/

  Misclassification of stillbirths as miscarriages or neonatal deaths is common. […] In addition, inconsistent application of stillbirth definitions can also contribute to misclassification and thus impact comparability of stillbirth data. […] Including all births, whether live or stillborn, in a single data system is important in light of the substantial misclassification between stillbirths and very early neonatal deaths; while the underlying risk factors, cause of death, and public health interventions to address these deaths are similar, stillbirths are additionally associated with increased maternal morbidity and health care needs that may differ to those of very early neonatal deaths. […] This guideline seeks to support two specific audiences: (1) health care workers, to provide guidance on the data elements and indicators needed to collect high quality stillbirth data and data managers/public health professionals at local, regional and national level, to provide guidance on the data required to assess current stillbirth data quality and to execute relevant improvements to these data, thus driving informed policies to end preventable deaths.

• #62 3.2 million stillbirths: epidemiology and overview of the evidence review | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-9-S1-S2

  While the world’s neonatal deaths have received increasing global attention in recent years, stillbirths have remained virtually invisible to policymakers and funding agencies despite the fact that stillbirths have many common risk factors with neonatal deaths and maternal deaths. […] Stillbirth data are not tracked in the MDG indicators or included in the World Health Organization’s (WHO’s) annual World Health Report. […] Recognition of stillbirths as a public health concern is hampered by confusion and inconsistent application of definitions. […] The information gaps for stillbirths are immense. […] Given the lack of nationally representative data for most of the world, the only stillbirth rate data for over 90% of the burden relies on national level modelling. […] Stillbirth cause-of-death data are available through national perinatal surveillance systems in some high-income countries.

• #63 3.2 million stillbirths: epidemiology and overview of the evidence review | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-9-S1-S2

  While the world’s neonatal deaths have received increasing global attention in recent years, stillbirths have remained virtually invisible to policymakers and funding agencies despite the fact that stillbirths have many common risk factors with neonatal deaths and maternal deaths. […] Stillbirth data are not tracked in the MDG indicators or included in the World Health Organization’s (WHO’s) annual World Health Report. […] Recognition of stillbirths as a public health concern is hampered by confusion and inconsistent application of definitions. […] The information gaps for stillbirths are immense. […] Given the lack of nationally representative data for most of the world, the only stillbirth rate data for over 90% of the burden relies on national level modelling. […] Stillbirth cause-of-death data are available through national perinatal surveillance systems in some high-income countries.

• #64 3.2 million stillbirths: epidemiology and overview of the evidence review | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-9-S1-S2

  While the world’s neonatal deaths have received increasing global attention in recent years, stillbirths have remained virtually invisible to policymakers and funding agencies despite the fact that stillbirths have many common risk factors with neonatal deaths and maternal deaths. […] Stillbirth data are not tracked in the MDG indicators or included in the World Health Organization’s (WHO’s) annual World Health Report. […] Recognition of stillbirths as a public health concern is hampered by confusion and inconsistent application of definitions. […] The information gaps for stillbirths are immense. […] Given the lack of nationally representative data for most of the world, the only stillbirth rate data for over 90% of the burden relies on national level modelling. […] Stillbirth cause-of-death data are available through national perinatal surveillance systems in some high-income countries.

• #65

  https://www.who.int/health-topics/stillbirth

  A baby who dies after 28 weeks of pregnancy, but before or during birth, is classified as a stillbirth. There are nearly 2 million stillbirths every year one every 16 seconds. Over 40% of all stillbirths occur during labour a loss that could be avoided with improved quality and respectful care during childbirth including routine monitoring and timely access to emergency obstetric care when required. In 2014, the World Health Assembly endorsed the Every Newborn Action Plan (ENAP), which includes a global target of 12 or fewer third trimester (late) stillbirths per 1,000 total births in every country by 2030. In 2021, 139 mainly high-income and upper middle-income countries had met this target, but 56 countries will not each the ENAP target by 2030 if further efforts are not made. If current trends continue, 15.9 million babies will be stillborn; nearly half of these (7.7 million, 48%) will occur in sub-Saharan Africa. With quality health care throughout pregnancy and childbirth, most stillbirths are preventable. The major causes of stillbirth include pregnancy and childbirth-related complications, prolonged pregnancy, maternal infections such as malaria, syphilis and HIV, maternal conditions especially hypertension, and diabetes, and fetal growth restriction (when an unborn baby is unable to achieve its growth potential and therefore smaller than it should be).

• #66 3.2 million stillbirths: epidemiology and overview of the evidence review | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-9-S1-S2

  Risk factors and conditions associated with stillbirth overlap with those causing maternal deaths and also neonatal deaths, yet often stillbirth outcomes are not explicitly reported in studies. […] In low-income countries, stillbirth rates are between 10-fold and 20-fold higher than in middle- and high-income countries. […] If the coverage and quality of periconceptional, antenatal, and intrapartum (especially comprehensive obstetric) care were increased in low-income countries, stillbirth rates could be expected to decline markedly. […] It is clear that given the large number of deaths, equivalent or larger than many other global health priorities, stillbirths are not receiving adequate attention.

• #67

  https://www.who.int/health-topics/stillbirth

  A baby who dies after 28 weeks of pregnancy, but before or during birth, is classified as a stillbirth. There are nearly 2 million stillbirths every year one every 16 seconds. Over 40% of all stillbirths occur during labour a loss that could be avoided with improved quality and respectful care during childbirth including routine monitoring and timely access to emergency obstetric care when required. In 2014, the World Health Assembly endorsed the Every Newborn Action Plan (ENAP), which includes a global target of 12 or fewer third trimester (late) stillbirths per 1,000 total births in every country by 2030. In 2021, 139 mainly high-income and upper middle-income countries had met this target, but 56 countries will not each the ENAP target by 2030 if further efforts are not made. If current trends continue, 15.9 million babies will be stillborn; nearly half of these (7.7 million, 48%) will occur in sub-Saharan Africa. With quality health care throughout pregnancy and childbirth, most stillbirths are preventable. The major causes of stillbirth include pregnancy and childbirth-related complications, prolonged pregnancy, maternal infections such as malaria, syphilis and HIV, maternal conditions especially hypertension, and diabetes, and fetal growth restriction (when an unborn baby is unable to achieve its growth potential and therefore smaller than it should be).

• #68

  https://www.who.int/health-topics/stillbirth

  Syphilis treatment in pregnancy could also prevent an estimated 200 000 stillbirths, while fetal heart rate monitoring and labour surveillance and prompt interventions when needed are crucial for preventing 832 000 intrapartum stillbirths and reducing neonatal deaths. More needs to be done to integrate stillbirth prevention within global and national agendas for high quality health care for women, adolescents, and babies. […] Improving systems for reporting births and neonatal deaths is a matter of human rights and a prerequisite for reducing stillbirths. In addition, there is a need to strengthen routine health information systems to accurately capture and report stillbirths for monitoring and improving the quality of care. WHO provides tools to help countries improve their data on both stillbirths and neonatal deaths.

• #69 Indications for Outpatient Antenatal Fetal Surveillance | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2021/06/indications-for-outpatient-antenatal-fetal-surveillance

  The American College of Obstetricians and Gynecologists makes the following recommendations and conclusions regarding indications for antenatal fetal surveillance: […] This Committee Opinion provides guidance on and suggests surveillance for conditions for which stillbirth is reported to occur more frequently than 0.8 per 1,000 (the false-negative rate of a biophysical profile or modified biophysical profile) and which are associated with a relative risk (RR) or odds ratio for stillbirth of more than 2.0 compared with pregnancies without the condition. […] Antenatal fetal surveillance is performed to reduce the risk of stillbirth. […] A number of maternal, fetal, and placental complications have been shown to be associated with an increased risk of stillbirth. […] The risk of fetal stillbirth increases markedly in the last few weeks of pregnancy.

• #70 Indications for Outpatient Antenatal Fetal Surveillance | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2021/06/indications-for-outpatient-antenatal-fetal-surveillance

  ABSTRACT: The purpose of this Committee Opinion is to offer guidance about indications for and timing and frequency of antenatal fetal surveillance in the outpatient setting. Antenatal fetal surveillance is performed to reduce the risk of stillbirth. However, because the pathway that results in increased risk of stillbirth for a given condition may not be known and antenatal fetal surveillance has not been shown to improve perinatal outcomes for all conditions associated with stillbirth, it is challenging to create a prescriptive list of all indications for which antenatal fetal surveillance should be considered. This Committee Opinion provides guidance on and suggests surveillance for conditions for which stillbirth is reported to occur more frequently than 0.8 per 1,000 (the false-negative rate of a biophysical profile) and which are associated with a relative risk or odds ratio for stillbirth of more than 2.0 compared with pregnancies without the condition.

• #71 Indications for Outpatient Antenatal Fetal Surveillance | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2021/06/indications-for-outpatient-antenatal-fetal-surveillance

  ABSTRACT: The purpose of this Committee Opinion is to offer guidance about indications for and timing and frequency of antenatal fetal surveillance in the outpatient setting. Antenatal fetal surveillance is performed to reduce the risk of stillbirth. However, because the pathway that results in increased risk of stillbirth for a given condition may not be known and antenatal fetal surveillance has not been shown to improve perinatal outcomes for all conditions associated with stillbirth, it is challenging to create a prescriptive list of all indications for which antenatal fetal surveillance should be considered. This Committee Opinion provides guidance on and suggests surveillance for conditions for which stillbirth is reported to occur more frequently than 0.8 per 1,000 (the false-negative rate of a biophysical profile) and which are associated with a relative risk or odds ratio for stillbirth of more than 2.0 compared with pregnancies without the condition.

• #72 Screening for stillbirth risk: Who benefits from additional testing? | Your Pregnancy Matters | UT Southwestern Medical Center

  https://utswmed.org/medblog/pregnancy-screening-stillbirth-risk/

  Although ACOG and SMFM recommend individualizing tests and frequency rates, the 2021 antenatal fetal surveillance guidelines provide a solid starting point for providers and patients concerned about stillbirth risk. […] The more tests you have, the more likely you are to get false-positive results, which can increase your anxiety and the risk of preterm delivery.

• #73 Screening for stillbirth risk: Who benefits from additional testing? | Your Pregnancy Matters | UT Southwestern Medical Center

  https://utswmed.org/medblog/pregnancy-screening-stillbirth-risk/

  Although ACOG and SMFM recommend individualizing tests and frequency rates, the 2021 antenatal fetal surveillance guidelines provide a solid starting point for providers and patients concerned about stillbirth risk. […] The more tests you have, the more likely you are to get false-positive results, which can increase your anxiety and the risk of preterm delivery.

• #74 Research shows that fetal surveillance from 39 weeks’ gestation reduces stillbirth in women of South Asian origin

  https://medicalxpress.com/news/2023-06-fetal-surveillance-weeks-gestation-stillbirth.html

  Research shows that fetal surveillance from 39 weeks’ gestation reduces stillbirth in women of South Asian origin. […] After previously identifying that women of South Asian origin (India, Pakistan, Bangladesh and Sri Lanka) had higher risk of stillbirth in late pregnancy, she recommended earlier fetal monitoring for this group of women, and the results were striking. […] „Following our recommendations, Victoria’s largest maternity service implemented the new clinical guideline to offer South Asian-born women fetal surveillance from 39 weeks instead of 41 weeks, which is the usual practice,” she said. […] „There was a 64% reduction in term stillbirth and significant reductions in rates of early neonatal death and special care nursery admission and the rates of stillbirth at term for South Asian women became equivalent to all other women.” […] „To our knowledge this is the first stillbirth prevention intervention for migrant women globally,” Dr. Davies-Tuck said.

• #75 Research shows that fetal surveillance from 39 weeks’ gestation reduces stillbirth in women of South Asian origin

  https://medicalxpress.com/news/2023-06-fetal-surveillance-weeks-gestation-stillbirth.html

  Research shows that fetal surveillance from 39 weeks’ gestation reduces stillbirth in women of South Asian origin. […] After previously identifying that women of South Asian origin (India, Pakistan, Bangladesh and Sri Lanka) had higher risk of stillbirth in late pregnancy, she recommended earlier fetal monitoring for this group of women, and the results were striking. […] „Following our recommendations, Victoria’s largest maternity service implemented the new clinical guideline to offer South Asian-born women fetal surveillance from 39 weeks instead of 41 weeks, which is the usual practice,” she said. […] „There was a 64% reduction in term stillbirth and significant reductions in rates of early neonatal death and special care nursery admission and the rates of stillbirth at term for South Asian women became equivalent to all other women.” […] „To our knowledge this is the first stillbirth prevention intervention for migrant women globally,” Dr. Davies-Tuck said.

• #76 NIH Study: U.S. Stillbirth Rate “Unacceptably High” — ProPublica

  https://www.propublica.org/article/stillbirths-rate-nih-cdc-prevention-research

  Federal officials have released a bleak assessment of the countrys progress in understanding and preventing stillbirths, calling the rate unacceptably high and issuing a series of recommendations to reduce it through research and prevention. […] The National Institutes of Health report, titled Working to Address the Tragedy of Stillbirth, mirrored findings of an investigation by ProPublica last year into the U.S. stillbirth crisis, in which more than 20,000 pregnancies every year are lost at 20 weeks or more and the expected baby is born dead. […] ProPublica found that federal health agencies had not prioritized stillbirth-focused research, data collection or analysis, and that those agencies, along with state health departments, hospitals and medical providers, had done a poor job of raising awareness about stillbirth risk and prevention.

• #77 NIH Study: U.S. Stillbirth Rate “Unacceptably High” — ProPublica

  https://www.propublica.org/article/stillbirths-rate-nih-cdc-prevention-research

  Federal officials have released a bleak assessment of the countrys progress in understanding and preventing stillbirths, calling the rate unacceptably high and issuing a series of recommendations to reduce it through research and prevention. […] The National Institutes of Health report, titled Working to Address the Tragedy of Stillbirth, mirrored findings of an investigation by ProPublica last year into the U.S. stillbirth crisis, in which more than 20,000 pregnancies every year are lost at 20 weeks or more and the expected baby is born dead. […] ProPublica found that federal health agencies had not prioritized stillbirth-focused research, data collection or analysis, and that those agencies, along with state health departments, hospitals and medical providers, had done a poor job of raising awareness about stillbirth risk and prevention.

• #78 NIH Study: U.S. Stillbirth Rate “Unacceptably High” — ProPublica

  https://www.propublica.org/article/stillbirths-rate-nih-cdc-prevention-research

  Federal officials have released a bleak assessment of the countrys progress in understanding and preventing stillbirths, calling the rate unacceptably high and issuing a series of recommendations to reduce it through research and prevention. […] The National Institutes of Health report, titled Working to Address the Tragedy of Stillbirth, mirrored findings of an investigation by ProPublica last year into the U.S. stillbirth crisis, in which more than 20,000 pregnancies every year are lost at 20 weeks or more and the expected baby is born dead. […] ProPublica found that federal health agencies had not prioritized stillbirth-focused research, data collection or analysis, and that those agencies, along with state health departments, hospitals and medical providers, had done a poor job of raising awareness about stillbirth risk and prevention.

• #79 Continuing inequalities contribute to wide variation in rates of stillbirths and neonatal deaths across UK | University of Oxford

  https://www.ox.ac.uk/news/2023-09-14-continuing-inequalities-contribute-wide-variation-rates-stillbirths-and-neonatal

  The cause of death remains unknown for one third of stillborn babies with a further third being due to placental issues. […] The UK government, Royal Colleges, and Health Commissioners must support rigorous reviews of all stillbirths and neonatal deaths to identify common themes that can improve clinical care and service provision, delivery, and organisation reducing the need for future independent enquiries. […] UK governments and national organisations should continue to develop and implement targeted action at national and organisational levels to reduce inequalities and review perinatal pathology services as a national priority to address the unknown causes of stillbirths and ensure equal access to post-mortem services.

• #80

  https://www.who.int/health-topics/stillbirth

  Syphilis treatment in pregnancy could also prevent an estimated 200 000 stillbirths, while fetal heart rate monitoring and labour surveillance and prompt interventions when needed are crucial for preventing 832 000 intrapartum stillbirths and reducing neonatal deaths. More needs to be done to integrate stillbirth prevention within global and national agendas for high quality health care for women, adolescents, and babies. […] Improving systems for reporting births and neonatal deaths is a matter of human rights and a prerequisite for reducing stillbirths. In addition, there is a need to strengthen routine health information systems to accurately capture and report stillbirths for monitoring and improving the quality of care. WHO provides tools to help countries improve their data on both stillbirths and neonatal deaths.

• #81

  https://www.who.int/health-topics/stillbirth

  Syphilis treatment in pregnancy could also prevent an estimated 200 000 stillbirths, while fetal heart rate monitoring and labour surveillance and prompt interventions when needed are crucial for preventing 832 000 intrapartum stillbirths and reducing neonatal deaths. More needs to be done to integrate stillbirth prevention within global and national agendas for high quality health care for women, adolescents, and babies. […] Improving systems for reporting births and neonatal deaths is a matter of human rights and a prerequisite for reducing stillbirths. In addition, there is a need to strengthen routine health information systems to accurately capture and report stillbirths for monitoring and improving the quality of care. WHO provides tools to help countries improve their data on both stillbirths and neonatal deaths.

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