Care in pregnancies after stillbirth or perinatal death- A cohort study to identify factors which predict perinatal outcome.

Abstract

Introduction: Stillbirth affects approximately 2 million families every year; one stillbirth occurs every 16 seconds. Women who have a history of stillbirth have an increased risk of recurrent stillbirth and other adverse outcomes in a subsequent pregnancy. The reasons underpinning these increased risks are incompletely understood which makes planning care in subsequent pregnancies challenging, leading to variation in care. We aimed to determine whether subsequent pregnancy outcome was related to the recorded cause of stillbirth, whether a second-trimester ultrasound screen can predict adverse outcome and whether abnormalities in placental morphology persisted in subsequent pregnancies. Methods: A single tertiary centre cohort study was conducted with both retrospective and prospective data collection. Participants were recruited from a dedicated antenatal service specialising in providing antenatal care to women with prior perinatal loss. Data were collected on the index stillbirth including classification of cause and placental histopathology results, maternal demographic during the index and subsequent pregnancy, subsequent pregnancy data including outcome and ultrasound measurements, and subsequent pregnancy histopathology reports. Immunohistochemistry analysis was preformed to compare microscopic placental appearances between the index pregnancy and subsequent pregnancy placenta in paired analysis. Results: Information regarding maternal characteristics and classification of cause of stillbirth alone do not provide significant prognostic information about the risk of adverse outcome in subsequent pregnancies. However, maternal vascular malperfusion and related placental bed disorders are particularly associated with recurrent problems. Women with a positive placental ultrasound screen were significantly more likely to have an adverse outcome. Placental phenotype was similar for both index and subsequent pregnancy in paired samples irrespective of subsequent pregnancy outcome suggesting persistence of placental disorders. Conclusion: Women who have previously experienced a stillbirth should be regarded as a “high-risk” group in subsequent pregnancies thus specialised antenatal care in a subsequent pregnancy following stillbirth is required. To date, prediction of recurrent stillbirth and adverse outcome remains a challenge. Further work is needed to better predict adverse outcome in a subsequent pregnancy after perinatal death.

Date of Award	16 Sept 2021
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Edward Johnstone (Co Supervisor) & Alexander Heazell (Main Supervisor)