Life-threatening delivery complications are more than four times as common during and after a stillbirth than a live birth, and some of these complications are more than 10 times as likely with stillbirths, a new Stanford study has found.
The research, which was published in Obstetrics & Gynecology, is the first large, population-based study to ask whether stillbirth puts women at greater risk than live birth. The researchers used data from more than 6 million California births between 1999 and 2011.
"We really need to start thinking more about the quality of maternity care for women whose pregnancies don't result in a live birth," said Elizabeth Wall-Wieler, PhD, the lead author of the new study. Maternal complications in stillbirth have seldom been studied because stillbirths themselves are rare, affecting six of every 1,000 births, she said.
However, although the rate of stillbirths hasn't changed, the rate of severe pregnancy complications has been rising in California and across the country. The new research is part of a broader effort by Stanford scientists to understand how to keep women safe as they give birth.
The scientists analyzed California data for 6.4 million live births and almost 26,000 stillbirths. About 1 in 100 women who had a live birth experienced severe delivery complications, while among women with stillbirths, the figure was almost 1 in 17. Women with stillbirth were 14 times more likely than women who had live births to go into shock or experience sepsis (a blood infection); 13 times more likely to have acute kidney failure; and 10 times more likely to suffer severe cardiac complications, including heart attacks.
The researchers also examined data on causes of fetal death to try to understand whether stillbirth and delivery complications had common causes. Certain causes of fetal death, including infection and hypertensive disorders such as preeclampsia, were strongly linked to delivery complications for the mother, they found.
The next step is to study whether changes in monitoring or medical care could lower risk for women who have stillbirths. "We need to ask if we can reduce complications for this very tragic, traumatic event," Wall-Wieler said.
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