Subsequent pregnancy outcome after previous foetal death

Abstract

Objective: A history of foetal death is a risk factor for complications and foetal death in subsequent pregnancies as most previous risk factors remain present and an underlying cause of death may recur. The purpose of this study was to evaluate subsequent pregnancy outcome after foetal death and to compare cases of recurrent foetal death.

Study design: A retrospective cohort study in a tertiary referral centre. All women with a stillbirth beyond 16 weeks of gestation between January 1999 and December 2004 (n=193) were identified. After providing informed consent, the medical records of 163 women were reviewed until August 2006 in terms of clinical, medical, obstetric and paediatric data of the pregnancy after the index pregnancy that resulted in foetal death. The cause of death for reported cases of foetal death and recurrent foetal death were classified by a multidisciplinary team according to the Tulip classification.

Results: Recurrent foetal death occurred in 11 cases, and various causes were identified. The cause of death was explained in seven cases. An association was found between the index foetal death and subsequent foetal death in some cases, especially in early gestation.

Conclusions: This study illustrates the importance of classifying the cause of recurrent foetal death and contributing risk factors using the same classification system. This provides more insight into the pathophysiological pathways leading to foetal death, and enables meaningful comparisons to be made in recurrent foetal death. This is required before preventive strategies can be instituted and implemented to reduce the risk of foetal death.