240293 Medical Complications Associated with Stillbirth

Monday, October 31, 2011: 9:15 AM

Katherine J. Gold, MD, MSW, MS , Departments of Family Medicine and Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
Rodney A. Hayward, MD , Department of Internal Medicine; Department of Health Management and Policy; Dept of Veterans Affairs-Ann Arbor, University of Michigan, Ann Arbor, MI
Karoline S. Puder, MD , Department of Obstetrics & Gynecology, Wayne State University, Detroit Medical Center, Detroit, MI
Marcie C. Treadwell, MD , Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI
Background: While stillbirth affects nearly 1 of 100 pregnancies in the United States and is twice as frequent in African-Americans, little is known about delivery complications associated with fetal death.

Methods: We abstracted medical charts of 579 stillborn infants from 1996-2006 at three hospitals in Southeastern Michigan, recording information about past medical history, current pregnancy, and labor and delivery details. We over-sampled African-American mothers as there is sparse data about stillbirth deliveries among this population.

Results: Of 548 mothers, mean maternal age was 29, 63% were African-American, 60% of mothers were single, and only half had private insurance. Nine of ten pregnancies were singletons, and 92% of infants were born via spontaneous vaginal deliveries and 8% by cesarean section. Median gestational age was 28 weeks. 26% of mothers experienced clinical chorioamnionitis, 10% had post-partum hemorrhage, 23% retained placenta, 15% abruption, and 29% breech delivery. Six percent of mothers experienced a serious maternal complication including disseminated intravascular coagulation, blood loss requiring transfusion, shock or hypotension, renal failure, respiratory failure requiring intubation, diabetic ketoacidosis, sepsis, unplanned hysterectomy, or maternal death.

Conclusions: Certain labor complications occur in much higher frequency during stillbirth delivery compared with deliveries of live infants, and many serious medical risks are associated with stillbirths. Quantifying these risks are important for optimizing medical care of bereaved mothers. Although African-American mothers had different risk factors for stillbirth, they had similar levels of delivery complications.

Learning Areas:
Clinical medicine applied in public health
Epidemiology
Public health or related research

Learning Objectives:
1. Describe medical complications associated with delivery of stillborn infants. 2. Explain any differences in delivery complications for African-American mothers.

Keywords: Fetal Mortality, Maternal Morbidity

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the primary investigator for the research project.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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