Half of Stillbirths Related to Placental Pathology

Thanks to Niobe for sending in this article

Interview with Dr. Gordon Smith, MD
November 16, 2007 - Insidermedicine

Most stillbirths occur as a result of a failing placenta, and understanding placental development and functioning may hold the key to identifying those at high risk for stillbirth early on, according to research published in The Lancet.

According to the Antepartum Fetal Surveillance Guidelines put forth by the American College of Obstetricians and Gynecologists (ACOG):

• Women with high-risk factors for stillbirth should undergo antepartum fetal surveillance using the nonstress test (NST), contraction stress test (CST), biophysical profile (BPP), or modified BPP. Testing should be initiated at 32 to 34 weeks for most pregnancies and at 26 to 28 weeks for very high risk women.
• An abnormal NST or modified BPP usually should be further evaluated by either a CST or a full BPP. Subsequent management should then be predicated on the results of the CST or BPP, the gestational age, the degree of oligohydramnios (if assessed), and the maternal condition.
• In the absence of obstetric contraindications, delivery of the fetus with an abnormal test result often may be attempted by induction of labor with continuous monitoring of the fetal heart rate and contractions. If repetitive late decelerations are observed, cesarean delivery generally is indicated.

In an effort to better understand why stillbirth rates have remained the same or even risen slightly over the past several decades, the investigators reviewed the literature on this condition dating back as far as 1997. They discovered that the standard screening technique, consisting of measuring the height of the uterus with a tape measure, has not changed in four decades. While other more high tech screening procedures have been tried, none has been shown to improve outcomes.

We had a chance to speak with Dr. Gordon Smith from the University of Cambridge about his findings, and what must be done in the research community to address stillbirth.Most cases of stillbirth can be linked to a failing placenta, including premature detachment from the uterus, failure to provide the fetus with adequate oxygenated blood, and problems associated with pre-eclampsia.

When the placenta fails late in a pregnancy it typically failed to develop properly in the first place. As a result, a stillbirth that occurs late in pregnancy may be the result of improper placental development occurring very early on in the pregnancy.Today's research highlights the role of the developing placenta in stillbirth. One way of reducing the rate of stillbirth may be to further investigate how the placenta develops and functions. Such research may provide important insight into how to develop screening tools that identify those at highest risk for stillbirth.

For Insidermedicine in Depth, I'm Dr. Susan Sharma.