Stillbirths constitute an important worldwide problem

Kolkata: Stillbirths constitute an important worldwide problem that has generally received little attention. The day of birth is potentially the most dangerous time for mothers and babies. Every year, worldwide, 303 000 women die during pregnancy and childbirth, 2.7 million babies die during the first 28 days of life and 2.6 million babies are stillborn, with 98 per cent occurring in low- and middle-income countries.   

Even in high-income countries, stillbirth remains a major, and potentially avoidable, health burden.   As a high proportion are unexplained, better understanding could help reduce avoidable stillbirths and decrease perinatal mortality.  Systematic efforts have been made to identify the causes.   

For example, it is known that stillbirths are closely associated with pregnancy complications and that hypertensive disorders in pregnancy are the most common pregnancy complications. Such disorders, which include chronic hypertension, superimposed preeclampsia, preeclampsia?eclampsia and gestational hypertension, occur in 3 to 8 per cent of pregnancies worldwide. 

These four subtypes may have different pathological mechanisms and clinical manifestations and may, therefore, play different roles in stillbirth.    

Few large-scale studies have investigated the relationship between the different hypertensive disorders in pregnancy and stillbirth. Moreover, little is known about whether the number of fetuses modifies their effect on the risk.    

Most previous studies of women with hypertensive disorders in pregnancy have been limited to singleton pregnancies and have shown that they are associated with an increased incidence of stillbirth. In contrast, hypertensive disorders appear to have a beneficial effect on fetal survival in twin pregnancies. 

An exploration of the different effects of hypertensive disorders in pregnancy on the risk of a stillbirth in singleton and multiple pregnancies would help improve patient management and prevent fetal deaths.(UNI)