Helen D Bailey1,2, Akilew A Adane3,4, Scott W White5,6, Brad M Farrant3, Carrington C J Shepherd7,3,4. 1. Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, GPO Box U1987, 6845, Australia. Helen.bailey@curtin.edu.au. 2. Telethon Kids Institute, The University of Western Australia, West Perth 6872, P.O. Box 855, Nedlands, WA, Australia. Helen.bailey@curtin.edu.au. 3. Telethon Kids Institute, The University of Western Australia, West Perth 6872, P.O. Box 855, Nedlands, WA, Australia. 4. Ngangk Yira Institute for Change, Murdoch University, Murdoch, WA, Australia. 5. Division of Obstetrics and Gynaecology, The University of Western Australia, Nedlands, WA, Australia. 6. Maternal Fetal Medicine Service, King Edward Memorial Hospital, Subiaco, WA, Australia. 7. Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, GPO Box U1987, 6845, Australia.
Abstract
PURPOSE: There is scant literature about the management of stillbirth and the subsequent risk of severe maternal morbidity (SMM). We aimed to assess the risk of SMM associated with stillbirths compared with live births and whether this differed by the presence of maternal comorbidities. METHODS: In this retrospective cohort study, we used a population-based dataset of all stillbirths and live births ≥ 20 weeks' gestation in Western Australia between 2000 and 2015. SMM was identified using a published Australian composite for use with routinely collected hospital morbidity data. Maternal comorbidities were identified in the Hospital Morbidity Data Collection or the Midwives Notification System using a modified Australian chronic disease composite. Multivariable Poisson regression was used to estimate relative risks (RRs) and 95% confidence intervals (CIs) for factors associated with SMM in analyses stratified by the presence of maternal comorbidities. Singleton and multiple pregnancies were examined separately. RESULTS: This study included 458,639 singleton births (2319 stillbirths and 456,320 live births). The adjusted RRs for SMM among stillbirths were 2.30 (95% CI 1.77, 3.00) for those without comorbidities and 4.80 (95% CI 4.11, 5.59) (Interaction P value < 0.0001) for those with comorbidities compared to live births without and with comorbidities, respectively. CONCLUSION: In Western Australia between 2000 and 2015, mothers of stillbirths both with and without any maternal comorbidities had an increased risk of SMM compared with live births. Further investigation into why women who have had a stillbirth without any existing conditions or pregnancy complications develop SMM is warranted.
PURPOSE: There is scant literature about the management of stillbirth and the subsequent risk of severe maternal morbidity (SMM). We aimed to assess the risk of SMM associated with stillbirths compared with live births and whether this differed by the presence of maternal comorbidities. METHODS: In this retrospective cohort study, we used a population-based dataset of all stillbirths and live births ≥ 20 weeks' gestation in Western Australia between 2000 and 2015. SMM was identified using a published Australian composite for use with routinely collected hospital morbidity data. Maternal comorbidities were identified in the Hospital Morbidity Data Collection or the Midwives Notification System using a modified Australian chronic disease composite. Multivariable Poisson regression was used to estimate relative risks (RRs) and 95% confidence intervals (CIs) for factors associated with SMM in analyses stratified by the presence of maternal comorbidities. Singleton and multiple pregnancies were examined separately. RESULTS: This study included 458,639 singleton births (2319 stillbirths and 456,320 live births). The adjusted RRs for SMM among stillbirths were 2.30 (95% CI 1.77, 3.00) for those without comorbidities and 4.80 (95% CI 4.11, 5.59) (Interaction P value < 0.0001) for those with comorbidities compared to live births without and with comorbidities, respectively. CONCLUSION: In Western Australia between 2000 and 2015, mothers of stillbirths both with and without any maternal comorbidities had an increased risk of SMM compared with live births. Further investigation into why women who have had a stillbirth without any existing conditions or pregnancy complications develop SMM is warranted.
Authors: Vicki Flenady; Philippa Middleton; Gordon C Smith; Wes Duke; Jan Jaap Erwich; T Yee Khong; Jim Neilson; Majid Ezzati; Laura Koopmans; David Ellwood; Ruth Fretts; J Frederik Frøen Journal: Lancet Date: 2011-04-13 Impact factor: 79.321
Authors: Adam K Lewkowitz; Joshua I Rosenbloom; Julia D López; Matt Keller; George A Macones; Margaret A Olsen; Alison G Cahill Journal: Obstet Gynecol Date: 2019-11 Impact factor: 7.661
Authors: Elizabeth Wall-Wieler; Suzan L Carmichael; Ronald S Gibbs; Deirdre J Lyell; Anna I Girsen; Yasser Y El-Sayed; Alexander J Butwick Journal: Obstet Gynecol Date: 2019-08 Impact factor: 7.661
Authors: Brian T Bateman; Jill M Mhyre; Sonia Hernandez-Diaz; Krista F Huybrechts; Michael A Fischer; Andreea A Creanga; William M Callaghan; Joshua J Gagne Journal: Obstet Gynecol Date: 2013-11 Impact factor: 7.661
Authors: Alexander E P Heazell; Dimitrios Siassakos; Hannah Blencowe; Christy Burden; Zulfiqar A Bhutta; Joanne Cacciatore; Nghia Dang; Jai Das; Vicki Flenady; Katherine J Gold; Olivia K Mensah; Joseph Millum; Daniel Nuzum; Keelin O'Donoghue; Maggie Redshaw; Arjumand Rizvi; Tracy Roberts; H E Toyin Saraki; Claire Storey; Aleena M Wojcieszek; Soo Downe Journal: Lancet Date: 2016-01-19 Impact factor: 79.321
Authors: Stephanie A Leonard; Chris J Kennedy; Suzan L Carmichael; Deirdre J Lyell; Elliott K Main Journal: Obstet Gynecol Date: 2020-09 Impact factor: 7.623
Authors: Joy E Lawn; Hannah Blencowe; Peter Waiswa; Agbessi Amouzou; Colin Mathers; Dan Hogan; Vicki Flenady; J Frederik Frøen; Zeshan U Qureshi; Claire Calderwood; Suhail Shiekh; Fiorella Bianchi Jassir; Danzhen You; Elizabeth M McClure; Matthews Mathai; Simon Cousens Journal: Lancet Date: 2016-01-19 Impact factor: 79.321