Perinatal Outcomes in Pregnancies Immediately following Stillbirth: A Multicenter, Prospective, Observational Study

Area of Science:

• Obstetrics and Gynecology
• Perinatal Medicine
• Reproductive Health

Background:

• Stillbirth is a devastating pregnancy outcome with significant emotional and physical impact.
• Subsequent pregnancies after stillbirth require careful management to optimize outcomes.
• The role of pharmacological interventions, such as low-dose aspirin (LDA) and low molecular weight heparin (LMWH), in improving outcomes following stillbirth is an area of ongoing research.

Purpose of the Study:

• To evaluate the outcomes of pregnancies immediately following stillbirth in relation to specific prescribed treatments.
• To determine the efficacy of LDA and LMWH, alone or in combination, in reducing adverse neonatal and maternal outcomes.
• To stratify outcomes based on the cause of previous fetal death and treatment regimens.

Main Methods:

• A prospective, observational study involving 308 pregnancies across four Italian University Hospitals between 2014 and 2022.
• Patients had a history of stillbirth (≥22 weeks gestation).
• Outcomes were analyzed based on the ReCoDe classification of the previous fetal death cause and treatments including LDA, LMWH, both, progesterone, or other drugs.

Main Results:

• Overall, 14.94% of subsequent pregnancies had adverse neonatal outcomes, and 24.68% had adverse maternal outcomes.
• In cases with previous placental vascular disorders (PVDs), combined LDA + LMWH treatment reduced adverse neonatal outcomes by 75% (OR: 0.25; P=0.049).
• However, LDA + LMWH prescribed without specific indications significantly increased adverse maternal outcomes (OR: 3.07; P=0.036).

Conclusions:

• Low-dose aspirin and LMWH should be reserved for pregnancies with a history of placental vascular disorders to improve neonatal outcomes.
• The use of LDA + LMWH in the absence of placental indications is associated with an increased risk of maternal complications.
• Targeted prescription of LDA + LMWH based on the etiology of stillbirth is crucial for optimizing maternal and neonatal safety.