Varotsis Dante, Beacham Jordan, Gomez Julie, Hannan Zain, Boelig Rupsa C, Berghella Vincenzo, Gulersen Moti
Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA (Varotsis, Gomez, Boelig, Berghella, and Gulersen).
Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA (Beacham).
Am J Obstet Gynecol MFM. 2025 Sep;7(9):101725. doi: 10.1016/j.ajogmf.2025.101725. Epub 2025 Jul 11.
The rates of severe maternal morbidity in the United States continue to increase. The American College of Obstetricians and Gynecologists recommends close postpartum follow-up for patients at increased risk for severe maternal morbidity and mortality, such as those who suffer from preeclampsia or hypertension. Data on the association between stillbirth and severe maternal morbidity are limited.
This study aimed to evaluate the association between stillbirth and severe maternal morbidity in comparison with gestational age-matched and term live births.
This was a multicenter, retrospective cohort study that was performed at 3 centers within a hospital system from 2017 to 2023. Severe maternal morbidity was defined with guidance from the indicators outlined by the Centers for Disease Control and Prevention. The inclusion criteria for the stillbirth group were delivery of a fetus that showed no signs of life at 20 weeks' gestation or later. Cases with antepartum preeclampsia, multiple gestations, maternal age less than 18 years, duplicate records, and voluntary terminations of the pregnancy after 20 weeks' gestation were excluded. We selected gestational age- and term-matched live births as the control groups. A logistic regression analysis was performed to evaluate the odds of the composite severe maternal morbidity in stillbirths vs gestational age-matched and term-matched live births, separately, with adjustment for potential confounders. The data were presented as the adjusted odds ratios with 95% confidence intervals, and statistical significance was set at a P value of <.05.
Of the 29,060 deliveries during the study period, there were 129 (0.44%) stillbirths. Stillbirth was associated with significantly higher odds of severe maternal morbidity than term (adjusted odds ratio, 4.35; 95% confidence interval, 1.75-10.84) and gestational age matched livebirths (adjusted odds ratio, 3.39; 95% confidence interval, 1.72-6.66). There was no significant difference in the rate of postpartum hemorrhage when stillbirths were compared with gestational age-matched live births (10.1% vs 7.3%; P=.42), however, there were significantly more transfusions needed in the stillbirth group (10.1% vs 1.6%; P=.017). When compared with the term live births, there were significantly more transfusions (10.1% vs 1.6%; P<.001), intensive care admissions (2.3% vs 0%; P=.007), postpartum preeclampsia (2.3% vs 0%; P=.007), and sepsis (2.3% vs 0%; P=.007).
Stillbirth is associated with an increased risk for severe maternal morbidity when compared with gestational age- and term-matched live births. Increased postpartum surveillance should be implemented into practice, and preventative interventions, such as tranexamic acid administration, should be evaluated further in prospective studies.
美国严重孕产妇发病率持续上升。美国妇产科医师学会建议，对于严重孕产妇发病和死亡风险增加的患者，如患有先兆子痫或高血压的患者，应进行密切的产后随访。关于死产与严重孕产妇发病之间关联的数据有限。
本研究旨在评估死产与严重孕产妇发病之间的关联，并与孕周匹配和足月活产进行比较。
这是一项多中心回顾性队列研究，于2017年至2023年在一家医院系统内的3个中心进行。严重孕产妇发病是根据疾病控制和预防中心概述的指标进行定义的。死产组的纳入标准是分娩出的胎儿在妊娠20周或更晚时无生命迹象。排除产前先兆子痫、多胎妊娠、产妇年龄小于18岁、重复记录以及妊娠20周后自愿终止妊娠的病例。我们选择孕周和足月匹配的活产作为对照组。进行逻辑回归分析，分别评估死产与孕周匹配和足月匹配活产中复合严重孕产妇发病的几率，并对潜在混杂因素进行调整。数据以调整后的优势比及其95%置信区间表示，统计学显著性设定为P值<.05。
在研究期间的29,060例分娩中，有129例（0.44%）死产。与足月产（调整后的优势比，4.35；95%置信区间，1.75 - 10.84）和孕周匹配的活产（调整后的优势比，3.39；95%置信区间，1.72 - 6.66）相比，死产与严重孕产妇发病的几率显著更高相关。与孕周匹配的活产相比，死产时产后出血率无显著差异（10.1%对7.3%；P = 0.42），然而，死产组需要输血的情况显著更多（10.1%对1.6%；P = 0.017）。与足月活产相比，输血情况显著更多（10.1%对1.6%；P <.001）、重症监护入院情况（2.3%对0%；P = 0.007）、产后先兆子痫（2.3%对0%；P = 0.007）和败血症（2.3%对0%；P = 0.007）。
与孕周和足月匹配的活产相比，死产与严重孕产妇发病风险增加相关。应在实践中加强产后监测，并在前瞻性研究中进一步评估诸如使用氨甲环酸等预防性干预措施。
