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The risk factors for unexplained antepartum stillbirths in Scotland, 1994 to 2003.

Sutan R, Campbell D, Prescott GJ, Smith WC - J Perinatol (2009)

Bottom Line: In multivariable analysis only maternal age (adjusted odds ratio (OR): 1.8, confidence interval (CI): 1.1 to 3.0, P=0.02), smoking during pregnancy (adjusted OR: 2.0, CI: 1.1 to 3.5, P=0.02), and maternal height (adjusted OR: 1.4, CI: 1.1 to 1.8, P=0.01), remain significant.Screening of pregnancies based on these three risk factors had 4.2% sensitivity and 99.4% specificity.The remaining 82 will suffer needless anxiety and potentially diagnostic procedures.

View Article: PubMed Central - PubMed

Affiliation: Department of Community Health, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia. rosnah@medic.ukm.my

ABSTRACT

Objective: To determine the factors contributing to unexplained antepartum stillbirth in Scotland.

Study design: A 10-year birth database in Scotland was used to compare the unexplained antepartum stillbirth with other birth outcomes. The sample unit was a pregnant mother with a gestational age of 20 weeks and above and with a fetal birth weight of 200 g and above.

Result: Maternal age of 35 years and above, lower deprivation category, inaccessible area of residence, maternal smoking, maternal height of <160 cm and gestational age of above 39 weeks were significantly associated with unexplained antepartum stillbirth. In multivariable analysis only maternal age (adjusted odds ratio (OR): 1.8, confidence interval (CI): 1.1 to 3.0, P=0.02), smoking during pregnancy (adjusted OR: 2.0, CI: 1.1 to 3.5, P=0.02), and maternal height (adjusted OR: 1.4, CI: 1.1 to 1.8, P=0.01), remain significant. Screening of pregnancies based on these three risk factors had 4.2% sensitivity and 99.4% specificity. The prevalence of stillbirth for this population was 0.2%. A positive predictive value of only 1.2% implies that only 1 in 83 women with these three risk factors will have antepartum stillbirth. The remaining 82 will suffer needless anxiety and potentially diagnostic procedures.

Conclusion: Advanced maternal age, maternal smoking, and shorter maternal height were associated risk for unexplained antepartum stillbirth but screening based on these factors would be of limited value.

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Related in: MedlinePlus

Risk by week of gestation for stillbirth, explained and unexplained antepartum stillbirths, 1994 to 2003, for singleton iparous pregnancies. Note: The rate was calculated per 1000 total ongoing birth (live and still).
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fig1: Risk by week of gestation for stillbirth, explained and unexplained antepartum stillbirths, 1994 to 2003, for singleton iparous pregnancies. Note: The rate was calculated per 1000 total ongoing birth (live and still).

Mentions: The study includes all singleton pregnancies and assessed their outcomes comparing the unexplained antepartum stillbirth with all other outcomes (live births, explained antepartum and intrapartum stillbirth). There were 541 811 births between 1994 and 2003 including 1452 unexplained antepartum stillbirths out of a total of 2822 stillbirths. Table 1 shows the univariate analysis for cases classified as unexplained antepartum stillbirth versus others outcomes. χ2 tests showed that maternal age, marital status, deprivation category, smoking during pregnancy, parity, previous hospital admission, maternal height, maternal weight, history of previous stillbirth, gestational age, and birth weight were significant associated factors with the unexplained antepartum stillbirths and other outcomes. However, area of residence, diabetes status, previous caesarean section or abortion and sexr were not significant. The median maternal age for unexplained antepartum stillbirth is significantly lower than the other groups (35±Interquantile range 10 versus 40±2, P<0.01). The risk based on gestational age was calculated using cumulative probability as shown in Figure 1 and recommended 20 years ago by Yudkin et al.12, 13 The curve increases, especially after a gestational age of 39 weeks, for stillbirth and unexplained antepartum stillbirth compared with explained antepartum stillbirths.


The risk factors for unexplained antepartum stillbirths in Scotland, 1994 to 2003.

Sutan R, Campbell D, Prescott GJ, Smith WC - J Perinatol (2009)

Risk by week of gestation for stillbirth, explained and unexplained antepartum stillbirths, 1994 to 2003, for singleton iparous pregnancies. Note: The rate was calculated per 1000 total ongoing birth (live and still).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2864419&req=5

fig1: Risk by week of gestation for stillbirth, explained and unexplained antepartum stillbirths, 1994 to 2003, for singleton iparous pregnancies. Note: The rate was calculated per 1000 total ongoing birth (live and still).
Mentions: The study includes all singleton pregnancies and assessed their outcomes comparing the unexplained antepartum stillbirth with all other outcomes (live births, explained antepartum and intrapartum stillbirth). There were 541 811 births between 1994 and 2003 including 1452 unexplained antepartum stillbirths out of a total of 2822 stillbirths. Table 1 shows the univariate analysis for cases classified as unexplained antepartum stillbirth versus others outcomes. χ2 tests showed that maternal age, marital status, deprivation category, smoking during pregnancy, parity, previous hospital admission, maternal height, maternal weight, history of previous stillbirth, gestational age, and birth weight were significant associated factors with the unexplained antepartum stillbirths and other outcomes. However, area of residence, diabetes status, previous caesarean section or abortion and sexr were not significant. The median maternal age for unexplained antepartum stillbirth is significantly lower than the other groups (35±Interquantile range 10 versus 40±2, P<0.01). The risk based on gestational age was calculated using cumulative probability as shown in Figure 1 and recommended 20 years ago by Yudkin et al.12, 13 The curve increases, especially after a gestational age of 39 weeks, for stillbirth and unexplained antepartum stillbirth compared with explained antepartum stillbirths.

Bottom Line: In multivariable analysis only maternal age (adjusted odds ratio (OR): 1.8, confidence interval (CI): 1.1 to 3.0, P=0.02), smoking during pregnancy (adjusted OR: 2.0, CI: 1.1 to 3.5, P=0.02), and maternal height (adjusted OR: 1.4, CI: 1.1 to 1.8, P=0.01), remain significant.Screening of pregnancies based on these three risk factors had 4.2% sensitivity and 99.4% specificity.The remaining 82 will suffer needless anxiety and potentially diagnostic procedures.

View Article: PubMed Central - PubMed

Affiliation: Department of Community Health, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia. rosnah@medic.ukm.my

ABSTRACT

Objective: To determine the factors contributing to unexplained antepartum stillbirth in Scotland.

Study design: A 10-year birth database in Scotland was used to compare the unexplained antepartum stillbirth with other birth outcomes. The sample unit was a pregnant mother with a gestational age of 20 weeks and above and with a fetal birth weight of 200 g and above.

Result: Maternal age of 35 years and above, lower deprivation category, inaccessible area of residence, maternal smoking, maternal height of <160 cm and gestational age of above 39 weeks were significantly associated with unexplained antepartum stillbirth. In multivariable analysis only maternal age (adjusted odds ratio (OR): 1.8, confidence interval (CI): 1.1 to 3.0, P=0.02), smoking during pregnancy (adjusted OR: 2.0, CI: 1.1 to 3.5, P=0.02), and maternal height (adjusted OR: 1.4, CI: 1.1 to 1.8, P=0.01), remain significant. Screening of pregnancies based on these three risk factors had 4.2% sensitivity and 99.4% specificity. The prevalence of stillbirth for this population was 0.2%. A positive predictive value of only 1.2% implies that only 1 in 83 women with these three risk factors will have antepartum stillbirth. The remaining 82 will suffer needless anxiety and potentially diagnostic procedures.

Conclusion: Advanced maternal age, maternal smoking, and shorter maternal height were associated risk for unexplained antepartum stillbirth but screening based on these factors would be of limited value.

Show MeSH
Related in: MedlinePlus