Prediction and prevention of stillbirth: dream or reality

Stillbirth has a high global prevalence and has not improved despite other advances in maternal and perinatal outcomes in the last 20 years. The global applicability of research is challenged by the fact that most evidence originates from high-income countries, whereas the burden is greatest in low- and middle-income countries. Robust universally applicable evidence is therefore desired to address this problem.

Good quality evidence has identified key risk factors for stillbirth. However, an effective universally applicable model is yet to be developed. Published prediction models lack internal or external validation, suffer from the risk of bias or cannot be applied to different populations. Term induction of labour suggests good clinical outcomes with no increase in obstetric interventions but must be considered within the context of the healthcare system's feasibility, cost-effectiveness and the experiences of women.

The most realistic focus to reduce stillbirth is placental insufficiency. Globally, the greatest benefit will come from treating those with the highest risk of disease, such as those in low and middle-income countries. Further high-quality trials need to be conducted in these settings as a priority.