Preventable causes of stillbirths at an inner city hospital

Black and Latino families run a disparately high risk of experiencing a stillbirth, defined as a fetal death, after 24 weeks of pregnancy. Stillbirths occur in about 1 in 200 pregnancies with 25,000 cases a year. The rates among minorities are 14.1/1000 and 13.65/1000. Many factors have been associated with high stillbirth rates, such as, low socioeconomic status, maternal age, maternal infections, genetic diseases, and lack of prenatal care. The public health impact of stillbirths can be hard to measure because of variability in the quality and completeness of the fetal death certificates. Examination of the placenta often reveals pathology, but examination by autopsy of the fetus occurs much less often. There are identifiable preventable factors associated with stillbirth, such as, extremes of maternal age, maternal infections, fetal infections, maternal drug use, and lack of prenatal care. Study of the factors holds promise for developing interventions to prevent stillbirths.

Objective: To ascertain leading preventable causes of stillbirths at Kings County Hospital from 2000-2006.

Design: Retrospective pediatric autopsy review of over 100 stillbirth cases from 2000-2006.

Setting: A large municipal inner-city hospital in Brooklyn, serving a predominantly poor population of Blacks, Latinos and various other immigrant groups.

Research questions: 1. What percentage of cases are autopsied? 2. What is the prevalence of preventable factors associated with stillbirths in this population?

Results: Preliminary results show that maternal infections and lack of prenatal care are the leading factors in stillbirths at this hospital. Complete analysis of findings promises to suggest effective preventive strategies.