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Stillbirths: The way forward in high-income countries

Flenady, Vicki; Middleton, Philippa; Smith, Gordon; Duke, Wes; Erwich, Jan Jaap; Khong, T. Y.; Neilson, Jim; Ezzati, Majid; Koopmans, Laura; Ellwood, David; Fretts, Ruth

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Stillbirth rates in high-income countries declined dramatically from about 1940, but this decline has slowed or stalled over recent times. The present variation in stillbirth rates across and within high-income countries indicates that further reduction in stillbirth is possible. Large disparities (linked to disadvantage such as poverty) in stillbirth rates need to be addressed by providing more educational opportunities and improving living conditions for women. Placental pathologies and...[Show more]

dc.contributor.authorFlenady, Vicki
dc.contributor.authorMiddleton, Philippa
dc.contributor.authorSmith, Gordon
dc.contributor.authorDuke, Wes
dc.contributor.authorErwich, Jan Jaap
dc.contributor.authorKhong, T. Y.
dc.contributor.authorNeilson, Jim
dc.contributor.authorEzzati, Majid
dc.contributor.authorKoopmans, Laura
dc.contributor.authorEllwood, David
dc.contributor.authorFretts, Ruth
dc.date.accessioned2015-12-10T23:33:09Z
dc.identifier.issn0140-6736
dc.identifier.urihttp://hdl.handle.net/1885/69161
dc.description.abstractStillbirth rates in high-income countries declined dramatically from about 1940, but this decline has slowed or stalled over recent times. The present variation in stillbirth rates across and within high-income countries indicates that further reduction in stillbirth is possible. Large disparities (linked to disadvantage such as poverty) in stillbirth rates need to be addressed by providing more educational opportunities and improving living conditions for women. Placental pathologies and infection associated with preterm birth are linked to a substantial proportion of stillbirths. The proportion of unexplained stillbirths associated with under investigation continues to impede efforts in stillbirth prevention. Overweight, obesity, and smoking are important modifiable risk factors for stillbirth, and advanced maternal age is also an increasingly prevalent risk factor. Intensified efforts are needed to ameliorate the effects of these factors on stillbirth rates. Culturally appropriate preconception care and quality antenatal care that is accessible to all women has the potential to reduce stillbirth rates in high-income countries. Implementation of national perinatal mortality audit programmes aimed at improving the quality of care could substantially reduce stillbirths. Better data on numbers and causes of stillbirth are needed, and international consensus on definition and classification related to stillbirth is a priority. All parents should be offered a thorough investigation including a high-quality autopsy and placental histopathology. Parent organisations are powerful change agents and could have an important role in raising awareness to prevent stillbirth. Future research must focus on screening and interventions to reduce antepartum stillbirth as a result of placental dysfunction. Identification of ways to reduce maternal overweight and obesity is a high priority for high-income countries.
dc.publisherLancet Publishing Group
dc.sourceLancet, The (UK edition)
dc.subjectKeywords: article; autopsy; chorioamnionitis; congenital disorder; developed country; ethnicity; health care quality; health education; histopathology; human; hypertension; infant mortality; infection; maternal age; multiple pregnancy; obesity; placenta disorder; p
dc.titleStillbirths: The way forward in high-income countries
dc.typeJournal article
local.description.notesImported from ARIES
local.identifier.citationvolume377
dc.date.issued2011
local.identifier.absfor111402 - Obstetrics and Gynaecology
local.identifier.ariespublicationf2965xPUB1939
local.type.statusPublished Version
local.contributor.affiliationFlenady, Vicki , Mater Medical Research Institute
local.contributor.affiliationMiddleton, Philippa , University of Adelaide
local.contributor.affiliationSmith, Gordon , University of Cambridge
local.contributor.affiliationDuke, Wes , National Center on Birth Defects and Developmental Disabilities
local.contributor.affiliationErwich, Jan Jaap , Foundation Perinatal Audit In the Netherlands
local.contributor.affiliationKhong, T. Y., Women's and Children's Hospital
local.contributor.affiliationNeilson, Jim , University of Liverpool
local.contributor.affiliationEzzati, Majid , Imperial College London
local.contributor.affiliationKoopmans, Laura , Mater Medical Research
local.contributor.affiliationEllwood, David, College of Medicine, Biology and Environment, ANU
local.contributor.affiliationFretts, Ruth , Harvard Vanguard Medical Associates
local.contributor.affiliationEllwood, David, Canberra Hospital
local.description.embargo2037-12-31
local.bibliographicCitation.issue9778
local.bibliographicCitation.startpage1703
local.bibliographicCitation.lastpage1717
local.identifier.doi10.1016/S0140-6736(11)60064-0
dc.date.updated2016-02-24T08:20:08Z
local.identifier.scopusID2-s2.0-79955891569
CollectionsANU Research Publications

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