Grand Rounds

How Many Stillbirths Could Be Prevented by Induction in Low-Risk Women at 39 Weeks?

BACKGROUND AND PURPOSE:

Po et al. (AJOG, 2019) sought to predict the potential reduction in stillbirths with the adoption of the ARRIVE protocol of induction at 39 weeks for nulliparous, low risk women

Retrospective study
Data sources
- US vital statistics data from Live Birth and Fetal Death certificates (2014 to 2016)
- Singleton deliveries ≥39 weeks | No preexisting maternal risk factors
- Exclusions: Pregestational diabetes | Chronic hypertension | Scheduled cesarean delivery | Unknown delivery method | Unknown gestational age
Study design
- Researchers determined the number of stillbirths in low risk women from 39 weeks on
- Assumption: Not all stillbirths in the 39th week would be prevented by induction in the 39th week as some stillbirths would have occurred in the 39^th week prior to delivery
  - Authors assumed that half of 39-week stillbirths could be prevented by induction
Primary outcome
- Determine stillbirth rate at ≥39 weeks in singleton, low-risk pregnancies and predict potential impact of the 39-week induction policy
- Calculate number of inductions required to prevent 1 stillbirth based on the above results

12,098,773 total births | 155,753 stillbirths
At ≥39 weeks, 3874 stillbirths were recorded
- Low risk: 3584 stillbirths | Stillbirth rate of 0.60 per 1000 births
The total number of preventable stillbirths during the 3-year study period was 2650 (883 stillbirths per year)
Using ‘conservative’ assumption that only 50% of 39-week stillbirths would be prevented by 39-week induction
- Total preventable stillbirths with 39 week policy: 2650 (approximately 883 per year)
- 1675 inductions would be required to prevent 1 stillbirth

Implementing the ARRIVE protocol could potentially prevent 883 stillbirths per year in the US; however, 1675 inductions would be required to prevent one stillbirth
Authors state that these results could help aid clinicians and patients with decision making

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