Trends in obstetric practices and meconium aspiration syndrome: a population-based study

Long-Term Pulmonary and Neurodevelopmental Outcomes of Meconium Aspiration Syndrome Affected Infants: A Retrospective National Population-Based Study in Taiwan

INTRODUCTION

Meconium aspiration syndrome (MAS) may cause severe pulmonary and neurologic injuries in affected infants after birth, leading to long-term adverse pulmonary or neurodevelopmental outcomes.

METHODS

This retrospective population-based cohort study enrolled 1,554,069 mother-child pairs between 2004 and 2014. A total of 8,049 infants were in the MAS-affected group, whereas 1,546,020 were in the healthy control group. Children were followed up for at least 3 years. According to respiratory support, MAS was classified as mild, moderate, and severe. With the healthy control group as the reference, the associations between MAS severity and adverse pulmonary outcomes (hospital admission, intensive care unit (ICU) admission, length of hospital stay, or invasive ventilator support during admission related to pulmonary problem) or adverse neurodevelopmental outcomes (cerebral palsy, needs for rehabilitation, visual impairment, or hearing impairment) were accessed.

RESULTS

MAS-affected infants had a higher risk of hospital and ICU admission and longer length of hospital stay, regardless of severity. Infants with severe MAS had a higher risk of invasive ventilator support during re-admission (odds ratio: 17.50, 95% confidence interval [CI]: 7.70-39.75, p < 0.001). Moderate (hazard ratio [HR]: 1.66, 95% CI: 1.30-2.13, p < 0.001) and severe (HR: 4.94, 95% CI: 4.94-7.11, p < 0.001) MAS groups had a higher risk of adverse neurodevelopmental outcome, and the statistical significance remained remarkable in severe MAS group after adjusting for covariates (adjusted HR: 2.28, 95% CI: 1.54-3.38, p < 0.001) Conclusions: Adverse pulmonary or neurodevelopmental outcomes could occur in MAS-affected infants at birth. Close monitoring and follow-up of MAS-affected infants are warranted.

A nationwide, prospective, cohort study on exogenous oxytocin and delays in early child development: the Japan environment and children's study

Although it remains debatable, exogenous oxytocin, commonly used for labour induction and augmentation, reportedly increases risks of neurodevelopment delay, attention-deficit/hyperactivity disorder, and autism spectrum disorder among children prenatally exposed to exogenous oxytocin. However, only few studies have objectively examined exogenous oxytocin's impact on early childhood development through scoring evaluations. This study investigated the association between exogenous oxytocin exposure and neurodevelopment in 3-year-old children using the Ages and Stages Questionnaires, Third Edition. In this nationwide prospective cohort study, we extracted data from 104,062 foetal records regarding exogenous oxytocin use during labour from the Japan Environment and Children's Study. Participants completed questionnaires throughout the pregnancy and postpartum periods. Outcomes comprised the developmental status less than each cut-off value for the five domains of the Ages and Stages Questionnaire, Third Edition. We conducted multivariable logistic regression analyses on the data of 55,400 children after controlling for confounders. Among the 55,400 included women, 19.0% (n = 10,506) used exogenous oxytocin during labour and 81.0% (n = 44,894) did not. Children exposed to exogenous oxytocin showed no significantly increased risk of developmental delay in any domain (communication: odds ratio [OR] 1.04, 95% confidence interval [CI] 0.92-1.16; gross motor: OR 0.97, 95% CI 0.87-1.08; fine motor: OR 1.00, 95% CI 0.92-1.09; problem-solving: OR 1.02, 95% CI 0.94-1.11; personal-social: OR 0.91, 95% CI 0.80-1.03).   Conclusion: Exogenous oxytocin for labour induction did not adversely affect early childhood development. Further studies accounting for the degree of exogenous oxytocin exposure are required to confirm these results. What is Known: • In developed countries, labour is induced in 20-25% of all pregnancies, for which oxytocin is commonly used. • Studies have associated risks of neurodevelopment delay, attention-deficit/hyperactivity disorder, and autism spectrum disorder with exposure to exogenous oxytocin. What is New: • Evaluation with the Ages and Stages Questionnaire, Third Edition, revealed that exogenous oxytocin use did not adversely affect early childhood development. • This prospective study reinforced the lack of evidence of an association between exogenous oxytocin use and early childhood development after adjustment for confounding and rigorous bias elimination.

Epidemiology and risk factors for acquiring and predicting disease severity in meconium aspiration syndrome

Background. Meconium aspiration syndrome (MAS) occurs in approximately 5% of babies born through meconium-stained amniotic fluid. Risk factors associated with severity of MAS in neonates from developing countries has been infrequently described.  Objective. To identify incidence and risk factors associated with the severity of MAS in a lower middle-income country.  Method. A retrospective descriptive analysis was conducted on records of neonates diagnosed with MAS at four regional hospitals in the eThekwini district of KwaZulu-Natal, South Africa, between 1 January 2015 and 31 December 2017.  Results. A total of 187 neonates had been diagnosed with MAS, of whom 157 survived. The overall incidence of MAS was 2 per 1 000 live births. All the neonates were born through thick meconium. The majority (n=119, 63.6%) of patients were male. Asphyxia was documented in 97 cases (51.9%) and was significantly associated with severe disease (p<0.001). Seizures were noted in 91patients (48.7%), of which 86 (94.5%) occurred in neonates with asphyxia. A quarter of the sample (n=47, 25%) were outborn, with severe disease associated significantly with this group (p=0.025). Multiple logistic regression showed that the occurrence of seizures was significantly associated with severe MAS, (adjusted odds ratio = 23.7, 95% confidence interval 7.58 - 97.7; p<0.001).  Conclusion. Neonates born through thick meconium, with moderate to severe asphyxia that is associated with seizures are at increased risk of developing severe MAS. Close monitoring of labour in the intrapartum period, early recognition of fetal distress and timely obstetric intervention are crucial to prevent asphyxia. 

Appropriate Management of the Nonvigorous Meconium-Stained Newborn Meconium

Before 2015, major changes in Neonatal Resuscitation Program (NRP) recommendations not supporting previously endorsed antepartum, intrapartum and postpartum interventions to prevent meconium aspiration syndrome were based on adequately powered multicenter randomized controlled trials. The 2015 and 2020 American Heart Association guidelines and 7th and 8th edition of NRP suggest not performing routine intubation and tracheal suctioning of nonvigorous meconium-stained newborns. However, this was given as a weak recommendation with low-certainty evidence. The purpose of this review is to summarize the evidence and explore the question of appropriate delivery room management for nonvigorous meconium-stained newborns.

The Effects of Different Types of Steroids on Clinical Outcomes in Neonates with Meconium Aspiration Syndrome: A Systematic Review, Meta-Analysis and GRADE Assessment

Background and Objectives: Meconium aspiration syndrome (MAS) is a condition caused by the aspiration of meconium-stainted amniotic fluid into the lungs, resulting in pulmonary inflammation, neonatal morbidity, and mortality. It is important that these MAS infants receive appropriate care to avoid further complications. Steroids have an anti-inflammatory effect and may be effective in the management of MAS. The objective of the this study was to evaluate the effect of different steroids on clinical outcomes in infants with MAS. Materials and Methods: We systematically searched of PubMed/Medline, Scopus, Embase, Clinical Trials.gov, and Cochrane Library databases from inception to 24 January 2021 without language restriction. Only randomized controlled trials (RCTs) evaluating the effects of steroids in neonates with MAS were included. We calculated relative risks and weighted mean differences (MDs) with 95% confidence intervals (CIs) using a random-effects model to determine the associations between MAS and steroids and GRADE approach was employed for quality of evidence. The main outcomes measures were duration of respiratory distress, oxygen requirement, hospitalization, need for mechanical ventilation, death, and adverse drug reactions. Results: Seven RCTs involving 397 patients were analyzed. Nebulized budesonide and intravenous (IV) methylprednisolone shortened the duration of respiratory distress (MD, −2.46 days; 95% CI, −3.09 to −1.83 and MD, −3.30 days; 95% CI, −4.07 to −2.52, respectively) (moderate certainty). There was a reduction in duration of oxygen requirement in nebulized budesonide use (MD, −2.40 days; 95% CI, −3.40 to −1.40) (low certainty) and IV methylprednisolone use (MD, −3.30 days; 95% CI, −4.07 to −2.52) (moderate certainty). Nebulized budesonide shortened hospitalization stay (MD, −4.47 days; 95% CI, −8.64 to −0.30 days) (low certainty) as IV methylprednisolone use (MD, −7.23 days; 95% CI, −8.19 to −6.07 days) (moderate certainty). None of steroids benefits in death (low certainty). Conclusions: Certain types of steroids may benefit the respiratory aspect, but there was no decrease in mortality in MAS infants.

Prediction of meconium aspiration syndrome by data available before delivery

OBJECTIVE

To identify risk factors associated with the occurrence of meconium aspiration syndrome (MAS) among neonates.

METHODS

A retrospective case-control study in a university affiliated tertiary medical center, including all neonates born with meconium stained amniotic fluid (MSAF) between March 2011 and March 2020. Patients were categorized by the occurrence of MAS. Demographic, pregnancy and delivery characteristics were compared between the two groups. Risk factors for MAS were analyzed.

RESULTS

Of 90 579 singleton deliveries, a total of 11 856 with MSAF were included. Of these newborns, 78 (0.66%) were diagnosed with MAS Four factors were independently associated with MAS: delivery at <38 0/7 weeks (aOR [95% CI]: 3.48 (1.02-11.84), P = 0.046); higher body mass index (aOR [95% CI]: 1.09 (1.02-1.16), P = 0.003); lower amniotic fluid index (aOR [95% CI]: 0.99 (0.98-0.99), P = 0.032); higher white blood cell count (aOR [95% CI]: 1.11 (1.02-1.20), P = 0.009). The presence of one, two and three of the above-mentioned risk factors yielded a risk for MAS of 0.8%, 2.5% and 100%, respectively.

CONCLUSION

We identified independent risk factors for MAS and developed a risk score calculator. This tool may assist physicians in the management of deliveries complicated by MSAF.

Oxytocin: at birth and beyond. A systematic review of the long-term effects of peripartum oxytocin

Oxytocin is one of the most commonly used medications during labour and delivery. Recent insights from basic neuroscience research suggest that the uterotonic effects of oxytocin may arguably be trivial when compared with its profound effects on higher-order human behaviour. The purpose of this review is to highlight the potential consequences of manipulating oxytocinergic signalling during the peripartum period and its long-term impact on the maternal-infant dyad. We identified four domains where modulation of oxytocinergic signalling might be consequential: postpartum depression; breastfeeding; neurodevelopment; and chronic pain, and performed a literature search to address the impact of peripartum oxytocin administration. We have shown modest, but inconsistent, evidence linking peripartum oxytocin administration with postpartum depression. Breastfeeding success appeared to be negatively correlated with peripartum oxytocin exposure, perhaps secondary to impaired primitive neonatal reflexes and maternal-infant bonding. The association between perinatal oxytocin exposure and subsequent development of neurodevelopmental disorders such as autism in the offspring was weak, but these studies were limited by the lack of information on the cumulative dose. Finally, we identified substantial evidence for analgesic and anti-hypersensitivity effects of oxytocin which might partly explain the low incidence of chronic pain after caesarean birth. Although most data presented here are observational, our review points to a compelling need for robust clinical studies to better dissect the impact of peripartum oxytocin administration, and as stewards of its use, increase the precision with which we administer oxytocin to prevent overuse of the drug.

Meconium Aspiration Syndrome: A Narrative Review

Meconium aspiration syndrome is a clinical condition characterized by respiratory failure occurring in neonates born through meconium-stained amniotic fluid. Worldwide, the incidence has declined in developed countries thanks to improved obstetric practices and perinatal care while challenges persist in developing countries. Despite the improved survival rate over the last decades, long-term morbidity among survivors remains a major concern. Since the 1960s, relevant changes have occurred in the perinatal and postnatal management of such patients but the most appropriate approach is still a matter of debate. This review offers an updated overview of the epidemiology, etiopathogenesis, diagnosis, management and prognosis of infants with meconium aspiration syndrome.

Meconium aspiration syndrome: incidence, associated risk factors and outcome-evidence from a multicentric study in low-resource settings in Nepal

AIM

The aim of this study was to identify the incidence, risk factors and outcome associated with meconium aspiration syndrome (MAS).

METHODS

An observational study was conducted in 12 public hospitals in Nepal from 1 July 2017 to 29 August 2018. All babies born within the study period were included in the study. Babies who were diagnosed as MAS were designated as outcome. Data were analysed with bivariate analysis followed by multiple regression analysis.

RESULTS

The overall incidence of MAS was 2.0 per 1000 livebirths. Babies born at post-term gestation (adjusted odds ratio (AOR) = 2.41; 95% confidence interval (CI): 1.05-5.55), nulliparity (AOR = 2.26; 95% CI: 1.20-4.28), instrumental delivery (AOR = 4.79; 95% CI: 2.52-9.10) and caesarean delivery (AOR = 3.67; 95% CI: 2.29-5.89) were significantly associated with MAS. Babies with MAS had a 10-fold risk for pre-discharge mortality (odds ratio = 9.87; 95% CI: 5.81-16.76).

CONCLUSIONS

The findings in this study are consistent with that reported in other studies. MAS has a high risk of neonatal mortality. Thus, monitoring during pregnancy and labour is necessary for early identification of high-risk conditions associated with MAS. Strengthening of newborn care services is essential to curtail mortality.

The risk of meconium aspiration syndrome (MAS) increases with gestational age at term

Objective: To examine the risk of meconium aspiration syndrome (MAS) by the week of gestational age in pregnancies with meconium-stained amniotic fluid (MSAF).Methods: This is a retrospective cohort study derived from term pregnancies at a single tertiary institution over an 18-year period. Outcomes analyzed included MAS, acidemia, and Apgar scores. Univariate analysis was performed using chi-square and multivariable logistic regression was used to adjust for potential confounders.Results: A total of 34,303 deliveries ≥37 weeks were included; 23.7% were complicated by MSAF. Of the total study cohort, 272 (0.7%) neonates were diagnosed with MAS; this represented 3% of all deliveries complicated by MSAF. In the presence of MSAF, the risk of MAS increased with gestational age, from 1.3% at 38 weeks to 4.8% at 42 weeks (p < .001). Similarly, the risk of acidemia increased from 3.0% at 38 weeks to 7.0% at 42 weeks (p < .001). These findings were also demonstrated in patients with MAS in the absence of MSAF. The risk for both MAS and acidemia in the presence of MSAF persisted after controlling for potential confounders (aOR 1.31 [95% CI 1.18-1.46] and 1.20 [95% CI 1.05-1.37], respectively).Conclusion: In women with MSAF, as gestational age increases, the risk of meconium aspiration syndrome also increases. Other factors with late-term and post-term pregnancy besides the presence of meconium may contribute to the evolution of MAS.

Utility of the 5-Minute Apgar Score as a Research Endpoint

Although Apgar scores are commonly used as proxy outcomes, little evidence exists in support of the most common cutpoints (<7, <4). We used 2 data sets to explore this issue: one contained planned community births from across the United States (n = 52,877; 2012-2016), and the other contained hospital births from California (n = 428,877; 2010). We treated 5-minute Apgars as clinical "tests," compared against 18 known outcomes; we calculated sensitivity, specificity, positive and negative predictive values, and the area under the receiver operating characteristic curve for each. We used 3 different criteria to determine optimal cutpoints. Results were very consistent across data sets, outcomes, and all subgroups: The cutpoint that maximizes the trade-off between sensitivity and specificity is universally <9. However, extremely low positive predictive values for all outcomes at <9 indicate more misclassification than is acceptable for research. The areas under the receiver operating characteristic curves (which treat Apgars as quasicontinuous) were generally indicative of adequate discrimination between infants destined to experience poor outcomes and those not; comparing median Apgars between groups might be an analytical alternative to dichotomizing. Nonetheless, because Apgar scores are not clearly on any causal pathway of interest, we discourage researchers from using them unless the motivation for doing so is clear.

Meconium aspiration syndrome: Incidence and outcomes using discharge data

BACKGROUND

Meconium aspiration syndrome (MAS) is a leading cause of morbidity and mortality among term, otherwise healthy newborns, yet population studies are rare. Definitions, outcomes and International Classification of Diseases (ICD) codes are heterogenous, complicating estimates of incidence, outcomes and risks.

AIMS

To measure population incidence, risks and outcomes of MAS by ICD codes.

STUDY DESIGN

Retrospective population study.

SUBJECTS

Kids Inpatient Database (KID) 2012, a nationally representative weighted sample of newborn discharges in the United States.

OUTCOME MEASURES

Incidence, demographic distribution, and comorbidity associated with MAS.

RESULTS

In 2012 there were 9295 weighted discharges diagnosed MAS with symptoms (2.49/1000) and 4304 cases without symptoms (1.15/1000). Newborns with symptoms had nearly twice the length of stay (LOS) (6.68 vs 3.65 days, p 0.001) and nearly 3 times the total charges ($44,473 versus $15,461, p < 0.001) as those without symptoms. Incidence of death was over four times higher (7.7/1000 vs 1.7/1000, p < 0.001), persistent pulmonary hypertension 3 times higher (57.6/1000 vs 15.8/1000, p < 0.001), and hypoxic ischemic encephalopathy 5 times higher (6.2/1000 vs 1.2/1000, p < 0.001) among MAS cases with respiratory symptoms than MAS cases without respiratory symptoms. Odds ratio of MAS with symptoms was 1.54 (95% CI 1.39-1.73) for black newborns compared to whites.

CONCLUSIONS

Discharge data are useful for providing population estimates of MAS incidence. Prior studies have used consolidated ICD codes for MAS (with and without respiratory symptoms), yet these represent very different disease severities. Combining MAS diagnoses with and without respiratory symptoms misrepresents incidence and disease severity, complicating comparisons of outcomes and prevention strategies.

Management of Meconium-Stained Newborns in the Delivery Room

The approach to the management of meconium-stained newborns in the delivery room has been changing for over 40 years. The goal is to prevent meconium aspiration syndrome (MAS) and complications related to MAS. For decades, airway obstruction was believed to be a major component of MAS and, consequently, suction maneuvers to remove meconium from the airways were recommended to decrease the frequency and severity of MAS. Initial recommendations were based on observational studies. However, the incidence of MAS and mortality related to MAS has declined since the 1970s, mostly because of a decrease in the number of postterm deliveries. Recently updated guidelines by the American Heart Association and the Neonatal Resuscitation Program have reflected the strength of evidence supporting tracheal intubation and suctioning for nonvigorous, meconium-stained newborns. This article examines practice change since the 1970s in the delivery room management of meconium-stained newborns and evaluates evidence behind the changes.

Improving Long-Term Outcomes After Extracorporeal Membrane Oxygenation: From Observational Follow-Up Programs Toward Risk Stratification

Since the introduction of extracorporeal membrane oxygenation (ECMO), more neonates and children with cardiorespiratory failure survive. Interest has therefore shifted from reduction of mortality toward evaluation of long-term outcomes and prevention of morbidity. This review addresses the changes in ECMO population and the ECMO-treatment that may affect long-term outcomes, the diagnostic modalities to evaluate neurological morbidities and their contributions to prognostication of long-term outcomes. Most follow-up data have only become available from observational follow-up programs in neonatal ECMO-survivors. The main topics are discussed in this review. Recommendations for long-term follow up depend on the presence of neurological comorbidity, the nature and extent of the underlying disease, and the indication for ECMO. Follow up should preferably be offered as standard of care, and in an interdisciplinary, structured and standardized way. This permits evaluation of outcome data and effect of interventions. We propose a standardized approach and recommend that multiple domains should be evaluated during long-term follow up of neonates and children who needed extracorporeal life support.

A Family-Based Study of the Association Between Labor Induction and Offspring Attention-Deficit Hyperactivity Disorder and Low Academic Achievement

The current study examined associations between labor induction and both (1) offspring attention-deficit hyperactivity disorder (ADHD) diagnosis in a Swedish birth cohort born 1992-2005 (n = 1,085,008) and (2) indices of offspring low academic achievement in a sub-cohort born 1992-1997 (n = 489,196). Associations were examined in the entire sample (i.e., related and unrelated individuals) with adjustment for measured covariates and, in order to account for unmeasured confounders shared within families, within differentially exposed cousins and siblings. We observed an association between labor induction and offspring ADHD diagnosis and low academic achievement in the population. However, these associations were fully attenuated after adjusting for measured covariates and unmeasured factors that cousins and siblings share. The results suggest that observed associations between labor induction and ADHD and low academic achievement may be due to genetic and/or shared environmental factors that influence both mothers' risk of labor induction and offspring neurodevelopment.

Meconium aspiration syndrome: a role for fetal systemic inflammation

BACKGROUND

Meconium aspiration syndrome (MAS) is a leading cause of morbidity and mortality in term infants. Meconium-stained amniotic fluid (MSAF) occurs in approximately 1 of every 7 pregnancies, but only 5% of neonates exposed to MSAF develop MAS. Why some infants exposed to meconium develop MAS while others do not is a fundamental question. Patients with MSAF have a higher frequency of intraamniotic inflammation/infection than those with clear fluid. We propose that fetal systemic inflammation is a risk factor for the development of MAS in patients with MSAF.

OBJECTIVE

We sought to investigate whether intraamniotic inflammation and funisitis, the histopathologic landmark of a fetal inflammatory response, predispose to MAS.

STUDY DESIGN

A prospective cohort study was conducted from 1995 through 2009. Amniotic fluid (AF) samples (n = 1281) were collected at the time of cesarean delivery from women who delivered singleton newborns at term (gestational age ≥38 weeks). Intraamniotic inflammation was diagnosed if the AF concentration of matrix metalloproteinase-8 was >23 ng/mL. Funisitis was diagnosed by histologic examination if inflammation was present in the umbilical cord.

RESULTS

The prevalence of MSAF was 9.2% (118/1281), and 10.2% (12/118) of neonates exposed to MSAF developed MAS. There were no significant differences in the median gestational age or umbilical cord arterial pH at birth between neonates who developed MAS and those who did not (each P > .1). Mothers whose newborns developed MAS had a higher median of AF matrix metalloproteinase-8 (456.8 vs 157.2 ng/mL, P < .05). Newborns exposed to intraamniotic inflammation had a higher rate of MAS than those who were not exposed to intraamniotic inflammation [13.0% (10/77) vs 0% (0/32), P = .03], as did those exposed to funisitis [31.3% (5/16) vs 7.3% (6/82); relative risk, 4.3; 95% confidence interval, 1.5-12.3]. Among the 89 newborns for whom both AF and placental histology were available, MAS was more common in patients with both intraamniotic inflammation and funisitis than in those without intraamniotic inflammation and funisitis [28.6% (4/14) vs 0% (0/28), P = .009], while the rate of MAS did not show a significant difference between patients with intraamniotic inflammation alone (without funisitis) and those without intraamniotic inflammation and funisitis [10.9% (5/46) vs 0% (0/28)].

CONCLUSION

The combination of intraamniotic inflammation with fetal systemic inflammation is an important antecedent of MAS. This concept has implications for the understanding of the mechanisms of disease responsible for MAS and for the development of prognostic models and therapeutic interventions for this disorder.

Risk factors differentiating mild/moderate from severe meconium aspiration syndrome in meconium-stained neonates

Objective

The aim of this study was to compare the risk factors associated with mild/moderate meconium aspiration syndrome (MAS) with those associated with severe in meconium-stained term neonates.

Methods

Consecutive singleton term neonates (n=671) with meconium staining at birth from all deliveries (n=14,666) in our institution from January 2006 to December 2012 were included. Both maternal and neonatal variables were examined. Among the study population, for women who underwent the trial of labor (n=644), variables associated with labor were also examined. These variables were compared between the mild/moderate MAS group, the severe MAS group, and the MAS-absent group.

Results

MAS developed in 10.6% (71/671) of neonates with meconium staining at birth. Among the neonates with MAS, 81.7% had mild MAS, 5.6% had moderate MAS, and 12.7% had severe MAS. The presence of minimal variability was significantly increased in both the mild/moderate and the severe MAS groups. The frequencies of nulliparity, fetal tachycardia, and intrapartum fever were significantly increased in the mild/moderate MAS group, but not in the severe MAS group. While a longer duration of the second stage of labor was significantly associated with mild/moderate MAS, severe MAS was associated with a shorter duration of the second stage. Notably, low mean cord pH (7.165 [6.850-7.375]) was significantly associated with mild/moderate MAS, but not with severe MAS (7.220 [7.021-7.407]) compared with the absence of MAS (7.268 [7.265-7.271]).

Conclusion

Our data suggest the development of severe MAS is not simply a linear extension of the same risk factors driving mild/moderate MAS.

Trends and recurrence of stillbirths in NSW

OBJECTIVE

To examine the trend in stillbirth rates adjusted for the trends in the maternal risk profile, and to use local data to estimate the stillbirth recurrence risk.

METHODS

Linked hospital, birth and perinatal death review data were used to identify risk factors and stillbirths among women giving birth to singletons in NSW between 2001 and 2009. Logistic regression models were developed to predict stillbirth rates based on the changes in the maternal population.

RESULTS

Between 2001 and 2009 there were 3,449 stillbirths (4.4 per 1,000 births), with no significant change in rate overall (p=0.6) or across older gestational age categories (26-33 weeks p=0.67, ≥34 weeks p=0.36), and a slight increase at <26 weeks (p=0.01). However, when changes in the maternal population were taken into account, there was a significant increase in stillbirths at <26 weeks (p<0.001). Women with a stillbirth in a first pregnancy were at increased risk of stillbirth in their second pregnancy (4.3 95%CI 2.4-7.7).

CONCLUSION

There has been no decline in the stillbirth rate in NSW in recent years, which, at late gestations, may be accounted for by changes in the maternal population. At early gestations, there has been an increase in stillbirths where a decrease in rate may be expected based on the maternal population.

IMPLICATIONS

Further focus on addressing risk factors for stillbirths is needed to ensure continued progress is made in reducing stillbirths.