Materiały źródłowe

• #1 Management of Stillbirth | ACOG

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

  Stillbirth is one of the most common adverse pregnancy outcomes, occurring in 1 in 160 deliveries in the United States. […] 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. […] 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.

• #2 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. […] 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. […] 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. […] Overall, an estimated 750,000 babies died during labour in 2023 in sub-Saharan Africa and South Asia, accounting for 88 per cent of all intrapartum stillbirths worldwide. […] 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. […] Ambitiously, if each country’s stillbirth rate reached or fell below the current average rate in high-income countries (2.8 stillbirths per 1,000 total births) by 2030, 6.9 million lives could be saved over the current trend-maintained scenario.

• #3 Prediction of stillbirth: an umbrella review of evaluation of prognostic variables – PubMed

  https://pubmed.ncbi.nlm.nih.gov/32931648/

  Stillbirth accounts for over 2 million deaths a year worldwide and rates remains stubbornly high. Multivariable prediction models may be key to individualised monitoring, intervention or early birth in pregnancy to prevent stillbirth. […] The strongest evidence of association was for nulliparity and pre-existing hypertension. […] We have identified variables relevant to the development of prediction models for stillbirth. Age, parity and prior adverse pregnancy outcomes had a more convincing association than the best performing tests, which were PAPP-A, PlGF and UtAD. The evidence was limited by high heterogeneity and lack of data on intervention bias. […] Review shows key predictors for use in developing models predicting stillbirth include age, prior pregnancy outcome and PAPP-A, PLGF and Uterine artery Doppler.

• #4 Management of Stillbirth | ACOG

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

  The stillbirth rate for teenagers younger than 15 years of age is 15.88 per 1,000 live births. This is nearly three times the rate of the lowest risk group, aged 25-29 years, with a rate of 5.34 per 1,000 live births. […] The introduction of population-based screening for chromosomal abnormalities has contributed to lower rates of explained stillbirth or neonatal death resulting from chromosomal abnormalities. […] A significant proportion of stillbirths remains unexplained even after a thorough evaluation.

• #5 Predicting stillbirth in a low resource setting | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-016-1061-2

  Stillbirth is a major contributor to perinatal mortality and it is particularly common in low- and middle-income countries, where annually about three million stillbirths occur in the third trimester. This study aims to develop a prediction model for early detection of pregnancies at high risk of stillbirth. […] We developed a prediction model for stillbirth that comprised maternal comorbidity, place of residence, maternal occupation, parity, bleeding in pregnancy, and fetal presentation. […] We developed a simple but informative prediction model for early detection of pregnancies with a high risk of stillbirth for early intervention in a low resource setting. […] The final model comprised maternal comorbidity, place of residence, maternal occupation, parity, bleeding in pregnancy, and fetal presentation as independent predictors of stillbirth.

• #6 Predicting stillbirth in a low resource setting | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-016-1061-2

  The predictive performance of the model in terms of discrimination and calibration was very good also after internal validation. […] This study reaffirms stillbirth as an important public health issue; 6 in every 100 newborns delivered at the center were lifeless at birth, justifying the clinical relevance of an easy to use prediction model to detect high risk pregnancies at an early stage (i.e. the 2nd trimester). […] It allows for early detection of pregnancies at high risk of stillbirth for timely allocation of targeted interventions and to benefit from closer monitoring throughout the pregnancy.

• #7 Management of Stillbirth | ACOG

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

  Women with a previous stillbirth are at increased risk of recurrence. Compared with women with no history of stillbirth, women who had a stillbirth in an index pregnancy had an increased risk in subsequent pregnancies (pooled odds ratio, 4.83; 95% CI, 3.77-6.18), which remained significant after adjustment for confounding factors. […] 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 risk of stillbirth increases in all twins with advancing gestational age, and it is significantly greater in monochorionic as compared with dichorionic twins. […] The extremes of parity have also been associated with stillbirth. Higher rates of stillbirth are observed in nulliparous women as well as multiparas women with greater than three previous pregnancies when compared to women with one or two previous births.

• #8 Stillbirth: prevention and supportive bereavement care

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10410959/

  An increased rate of stillbirth among mothers who are not vaccinated and acquire a covid-19 infection during pregnancy has been described across different countries. […] Parents want to understand why their baby died and how to prevent future stillbirth. […] Identification of stillbirth causation is important. […] A recent systematic review of interventions for investigating and identifying the causes of stillbirth found no randomised clinical trials comparing stillbirth investigation strategies. […] The recurrence rate of stillbirth is estimated to be 2.5-2.9% in high income countries. […] Guidelines often focus on prevention of stillbirth in subsequent pregnancies while neglecting the psychological impact. […] For better outcomes in subsequent pregnancies, adaptations to care are required that include both parents and address prevention and psychosocial care.

• #9 Stillbirth: prevention and supportive bereavement care | BMJ Medicine

  https://bmjmedicine.bmj.com/content/2/1/e000262

  Around half of the two million stillbirths occurring worldwide each year are preventable. […] However, some stillbirths are not currently preventable with evidence-based interventions, and some might never be. […] A growing body of evidence suggests beneficial effects for parents who received supportive care and were offered choices such as mode of birth and the option to see and hold their baby. […] Studies consistently highlight the scarcity of specific bereavement care training for healthcare providers. […] The recurrence rate of stillbirth is estimated to be 2.5-2.9% in high-income countries. […] An increased rate of stillbirth among mothers who are not vaccinated and acquire a covid-19 infection during pregnancy has been described across different countries. […] Vaccination may reduce stillbirth risk; a meta-analysis of 23 observational studies showed marginally lower stillbirth risk among individuals vaccinated against covid-19.

• #10 Poor Outcome in First Pregnancy May Predict Stillbirth in Second One | Guttmacher Institute

  https://www.guttmacher.org/journals/psrh/2004/poor-outcome-first-pregnancy-may-predict-stillbirth-second-one

  The odds that a second pregnancy will end in stillbirth are twice as high among women whose first pregnancy ends in the term delivery of an infant who is small for gestational age as among those whose first infant is born at term and is not undersized. […] The differential is even greater (odds ratios, 3.4-5.0) if the undersized infant is also born moderately or very preterm. […] In addition, women whose first pregnancy ends in stillbirth have elevated odds of having the same outcome in their second pregnancy (2.5). […] Overall, the 410,021 women included in the analyses had 2.6 stillbirths per 1,000 births in their second pregnancy. […] The rate was lowest among women whose first pregnancy ended in the term birth of an infant who was not undersized (2.4 per 1,000) and highest among those whose first infant was both small for gestational age and very preterm (19.0 per 1,000).

• #11 Poor Outcome in First Pregnancy May Predict Stillbirth in Second One | Guttmacher Institute

  https://www.guttmacher.org/journals/psrh/2004/poor-outcome-first-pregnancy-may-predict-stillbirth-second-one

  In addition, women whose first infant was stillborn were at increased risk of having their second pregnancy end in a stillbirth (2.5). […] These associations persisted after further adjustment for maternal body mass index and height. […] The researchers speculate that some of the same factors affecting fetal growth in a woman’s first pregnancy may affect fetal survival in her second pregnancy, and they note that the findings highlight the „central role of fetal growth restriction” in the etiology of stillbirth.

• #12

  https://link.springer.com/article/10.1007/s13755-020-00105-9

  Modelling the risk of abnormal pregnancy-related outcomes such as stillbirth and preterm birth have been proposed in the past. […] The best performing machine learning models achieved 0.76 AUC for early stillbirth, 0.63 for late stillbirth and 0.64 for preterm birth while using a external NYC test data. […] Various risk models to assess risk for stillbirth have been proposed; prediction performances range from 0.64 to 0.67 area under the curve (AUC) from receiver operating characteristic curve (ROC) with maternal demographics, and 0.82 AUC when biophysical variables were added. […] In this study, we show how machine learning (ML) methods could further improve the individual risk prediction beyond the traditional models. […] The incidence of PTB in the United States is estimated to be 1 in 10 births, making it considerably more prevalent when compared to stillbirth.

• #13 Stillbirth risk prediction using machine learning for a large cohort of births from Western Australia, 1980–2015 | Scientific Reports

  https://www.nature.com/articles/s41598-020-62210-9

  Quantification of stillbirth risk has potential to support clinical decision-making. […] The best performing classifier (XGBoost) predicted 45% (95% CI: 43%, 46%) of stillbirths for all women and 45% (95% CI: 43%, 47%) of stillbirths after the inclusion of previous pregnancy history. […] Almost half of stillbirths could be potentially identified antenatally based on a combination of current pregnancy complications, congenital anomalies, maternal characteristics, and medical history. […] The primary aim of this study was to quantify and validate the predictive accuracy of a comprehensive range of routinely collected risk factors for predicting stillbirth, including maternal characteristics and chronic medical conditions in current and previous pregnancies, obstetric complications and family history of stillbirth.

• #14 Stillbirth risk prediction using machine learning for a large cohort of births from Western Australia, 1980–2015 | Scientific Reports

  https://www.nature.com/articles/s41598-020-62210-9

  For our large population-based cohort of almost one million births and nearly 6,000 stillbirths, the XGBoost algorithm was able to use maternal socio-demographic characteristics, chronic maternal medical conditions, obstetric complications in current pregnancy, and other characteristics of the current pregnancy to predict approximately 45% of all stillbirths (at 5% FPR, and 55% at 10% FPR). […] Although our models can predict almost half of all stillbirths, their PPV remains relatively low at most 5.2% (at 5% FPR). […] We demonstrated that almost half of stillbirths could be potentially identified antenatally based on a combination of current pregnancy complications, congenital anomalies, maternal characteristics, and medical history, but that the greatest sensitivity is achieved using current pregnancy complications. […] Some machine learning classifiers (ensemble methods) offer some improvement for prediction compared to logistic regression.

• #15 Predicting singleton antepartum stillbirth by the demographic Fetal Medicine Foundation Risk Calculator—A retrospective case-control study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0260964

  To assess the risk of singleton intrauterine fetal death (IUFD) in women by the demographic setting of the online Fetal Medicine Foundation (FMF) Stillbirth Risk Calculator. […] Women in the IUFD cohort born a significantly higher overall risk with a median FMF risk score of 0.45% (IQR 0.230.99) compared to controls [0.23% (IQR 0.210.29); p0.001]. […] The FMF Stillbirth Risk Calculator based upon maternal demographic and obstetric characteristics only may help identify women at low risk of antepartum stillbirth. […] The results of univariable and multivariable regression analyses to predict the risk of antepartum stillbirth in our cohort are shown in Table 2. In univariable regression analysis, the risk of stillbirth was higher in women with type 2 diabetes, nulliparous women, and those with a history of stillbirth. In multivariable regression analysis, the risk of stillbirth increased with chronic hypertension, nicotine consumption, and diabetes.

• #16 Predicting singleton antepartum stillbirth by the demographic Fetal Medicine Foundation Risk Calculator—A retrospective case-control study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0260964

  The median risk score in the IUFD cohort was 0.45% (i.e., risk 1 in 222; IQR 0.230.99), whilst the median score in the group of matched live births was 0.23% (i.e., risk 1 in 435; IQR 0.210.29%; p0.001]. […] To evaluate the discriminative power of the FMF risk score we performed a ROC analysis and calculated an AUC of 0.72 (95% CI 0.670.78; p0.001) for predicting antepartum stillbirth in the total cohort. […] The online prediction tool achieved similar performance as in the reference group, and maternal, medical, and obstetric history yielded a high specificity and satisfactory sensitivity in discriminating between the outcomes live birth versus stillbirth, especially in cases of IUFD due to maternal disease, placental dysfunction, fetal anomaly, and of unknown cause. […] The demographic setting of the online Fetal Medicine Foundation Stillbirth Risk Calculator may be a useful tool to identify women at low risk of antepartum stillbirth.

• #17 OSF Preprints | Dynamic Prediction of Perinatal Outcome in Pregnancies After Stillbirth or Perinatal Death: A Pilot Study to Establish Proof-of-Concept and Explore Method Feasibility

  https://osf.io/preprints/osf/8awrq

  Objective To establish proof-of-concept for the dynamic prediction of adverse outcome in women with a history of stillbirth, repeatedly throughout the pregnancy. […] The present study supports proof-of-concept for dynamic prediction in pregnancy following stillbirth, which could be used to identify risks earlier in the pregnancy, while highlighting methodological challenges and requirements for subsequent large-scale model development studies.

• #18 Stillbirth: prevention and supportive bereavement care | BMJ Medicine

  https://bmjmedicine.bmj.com/content/2/1/e000262

  Identification of stillbirth causation is important. […] All parents should be offered thorough and appropriate investigations after stillbirth. […] Parents want to understand why their baby died and how to prevent future stillbirth. […] Recent innovations in the use of fetal MRI, CT, ultrasound, and microCT offer additional options when a traditional postmortem is unacceptable to parents. […] Parents must be counselled by appropriately knowledgeable and trained health professionals to make the right decision for them.

• #19

  https://link.springer.com/article/10.1007/s13755-020-00105-9

  Maximizing the prediction power derived from existing maternal characteristics data creates a solid base for future implementation of biomarkers and closer to clinically significant prediction algorithms for stillbirth and other pregnancy complications with complex etiology. […] The machine learning models used in this study provide a solid basis for adding biochemical and/or biophysical markers to further improve sensitivity and specificity of these risk models.

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