Pregnancy after stillbirth: Maternal and neonatal outcomes and health service utilisation.

BACKGROUND: Stillbirth occurs in every 3.5 of 1,000 pregnancies in Ireland and is a devastating event for a family. Women who have a pregnancy after stillbirth require increased antenatal support.

OBJECTIVES: The aim of this study was to determine maternal and fetal outcomes and quantify health service utilisation in pregnancy after stillbirth.

STUDY DESIGN: A retrospective cohort study of all pregnancies after stillbirth was conducted from 2011-2017 in a large tertiary-referral university maternity teaching hospital with approximately 8,000 births annually.

RESULTS: There were 222 stillbirths from 2011-2017. Two thirds of women (64.3%; 145/222) had a pregnancy after stillbirth. Almost one fifth of these women (19.3%; 28/145) had a miscarriage, but 57.1% (16/28) had a subsequent livebirth, giving an overall live birth rate of 90.3% (131/145). The average interval from index loss to booking in the next pregnancy was 13 months, with almost half of the women (49.7%; 72/145) booking within one year. The average number of antenatal appointments was twice that expected (10; range 2-27), and the average number of ultrasound scans was five times higher than expected (5; range 0-29). Rates of induction of labour (48.1%; 63/131) and caesarean delivery (40.5%; 53/131) were significantly higher than national rates for multiparous women. Almost two thirds (63.5%; 40/63) cited previous history of stillbirth as the indication for induction. There was a significantly higher rate of preterm delivery (22.9%; 30/131). One in four babies (25.5%; 35/137) required admission to the neonatal intensive care unit, more than twice the number expected (median gestation 37+0 weeks; range 25+4 - 39+2).

CONCLUSIONS: Pregnancy after stillbirth is associated with increased surveillance and intervention. The women in this study had higher rates of caesarean section, induction of labour and preterm delivery compared to the general multiparous population. Decision-making for intervention was often based on previous history of stillbirth. Clinicians should be cognisant of additional supports required for this population, and focus on evidence-based interventions that improve maternal wellbeing and perinatal outcomes in pregnancy after stillbirth.