Stillbirth, potentially preventable cases: an Italian retrospective study

ABSTRACT
Objective. The reduction in the global burden of child mortality is one of the Millennium developmental goals of the World of Health Organization (WHO). Understanding the pathophysiology underlying every single stillbirth case will allow the achievement of the WHO goal by implementing specific interventions. The aim of the study was to examine stillbirth cases occurred from 2012 to 2020 in a single tertiary obstetric care unit in Italy.
Materials and Methods. Stillbirths were identified by the hospital electronic archive system. Pre-pregnancy/pregnancy related risk factors and post-mortem examinations were recorded.
Results. A total of 53 stillbirth cases out of 19115 deliveries occurred in the study period (overall 2.77 cases every 1000 live births). The most frequent pre-pregnancy risk factors associated to events were maternal overweight/obesity (50.9%), nulliparity (49%), inherited coagulation disorders (26.4%) and sub clinical hypothyroidism (11.3%). The most common pregnancy related risk factors were growth restriction (56.6%), gestational diabetes mellitus (15%), hypertensive disorders of pregnancy (9.4%) and cord knot (7.5%). Among the 53 cases, 12 would have been potentially preventable with a better antenatal care (22.6%), seven of these occurred at a gestational age equal or more that 39 weeks of gestation. A significant drop in stillbirth incidence has been documented from 2019 (3.17 cases every 1000 live births before 2019 versus 1.19 cases every 1000 live births from 2019, respectively (p = 0.039)), when, a protocol for induction of labor specific for each pre-pregnancy and pregnancy related risk factors has been introduced in clinical practice.
Conclusions. A significant proportion of stillbirth cases are potentially preventable with a better antenatal care.