ORIGINAL ARTICLE   

Minerva Obstetrics and Gynecology 2024 Oct 08

DOI: 10.23736/S2724-606X.24.05580-5

Copyright © 2024 EDIZIONI MINERVA MEDICA

language: English

Is it possible to detect women at higher risk of intrapartum stillbirth? An area-based prospective cohort study

Gloria GUARIGLIA ¹ ✉, Cristina SALERNO ¹, Beatrice MELIS ¹, Martina BENUZZI ¹, Daniela MENICHINI ², Enrica PERRONE ³, Fabio FACCHINETTI ¹, Antonio LA MARCA ¹, Isabella NERI ¹, Francesca MONARI ¹

¹ Unit of Obstetrics and Gynecology, Mother-Infant Department, University of Modena and Reggio Emilia, Modena, Italy; ² Department of Biomedical, Metabolic and Neural Sciences, International Doctorate School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy; ³ Hygiene and Preventive Medicine Section, Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy

BACKGROUND: The aim of the study is to perform an overview of intrapartum stillbirth (SB) at term, assessing risk factors, causes of death and quality of pregnancy care.
METHODS: This is an area-based, prospective cohort study on pregnant women at ≥37 weeks from 2014 to 2021. We compared intrapartum SB’ information to alive birth and to antepartum deaths of the same period. Results of logistic regression are reported as the Odds Ratio (OR) with 95% confidence interval (95% CI) and the P value. A descriptive analysis about the causes of death and quality of pregnancy care is performed.
RESULTS: The overall rate of SB at term in Emilia-Romagna was 1.06 ‰ births. Among the 260 cases, 27 (10.4%) occurred during labor, with an intrapartum SB rate of 0.11‰. This SB rate was stable during years. SGA newborn (P=0.005, 95% CI 1.47-9.04, OR 3.63), low level of education (P<0.0001, 95% CI 2.98-16.11, OR 6.93), pre pregnancy BMI ≥ 25 kg/m² (P<0.0001, 95% CI 6.61-31.74, OR 14.50) are independent risk factors for intrapartum SB when compared to alive newborns. Compared with antepartum SB, excessive weight gain in pregnancy (RR 2.91, 1.43-3.98, P=0.001) represents a risk factor for intrapartum ones.
CONCLUSIONS: Preventing intrapartum SB at term in developed country should be based on both the appropriate antenatal management of fetal growth and the avoidance of maternal excessive weight gain. An effort toward pre conceptional intervention of improving maternal shape could be of value.

KEY WORDS: Stillbirth; Risk factors; Causes of death; Prevention and control