Earlier fetal monitoring may reduce stillbirth rates without increasing neonatal morbidity

Key takeaways :

• Fetal monitoring from 39 weeks may reduce stillbirth among South Asian-born women.
• Stillbirth, early neonatal death and special care nursery admission decreased after initiation of fetal monitoring at 39 weeks.

Fetal monitoring from 39 weeks’ gestation may be an alternative to routine earlier labor induction to reduce stillbirth rates among certain women without causing increased neonatal morbidity, according to researchers.

The largest maternity service in Victoria, Australia, formerly began fetal monitoring at 41 weeks’ gestation. Because women of South Asian birth were at five times higher risk for stillbirth compared with Australian-born women by 41 weeks, the maternity service implemented a new guideline of twice weekly cardiotocography and measurement of amniotic fluid for all South Asian women in their practice at 39 weeks’ gestation.

“A policy of offering fetal monitoring from 39 weeks for women of South Asian background allowed identification of fetal compromise and guided timing of birth where relevant to significantly reduce the rates of stillbirth at term. Through offering monitoring, the rates of stillbirth at term become equivalent to all other women at the service,” Miranda L. Davies-Tuck, PhD, head of the perinatal epidemiology and clinical trials at Hudson Institute of Medical Research, Clayton, Australia, told Healio. “Additionally, while the rate of induction initially increased, it did not continue to increase over the study period. Therefore, a fall in stillbirth was not achieved by continuing increases in inductions.”

This cohort study, published in the American Journal of Obstetrics and Gynecology, included 3,506 South Asian-born women who gave birth prior to these new recommendations and 8,532 who gave birth after these new recommendations were implemented. All women gave birth between 2016 and 2020. Researchers determined differences in stillbirth rates, neonatal deaths, perinatal morbidities and interventions after July 2017 and assessed changes in stillbirth rates and labor induction.

After these new recommendations were implemented, researchers observed a 64% reduction in term stillbirth among South Asian-born women, from 2.3 per 1,000 births to 0.8 per 1,000 births (P = .047). Early neonatal death rates (3.1 vs. 1.3 per 1,000; P = .03) and special care nursery admission (16.5% vs. 11.1%; P < .001) rates also decreased after these new recommendations were implemented.

Researchers observed no significant differences in admission to NICUs, Apgar score less than 7 at 5 minutes, birth weight or differences in trends of labor induction per month.

According to Davies-Tuck, future research should include qualitative work capturing the views of women themselves as well as a large, multisite randomized controlled trial of monitoring and targeted earlier birth compared with routine earlier induction of labor and to determine if this approach works for other groups experiencing high stillbirth rates at term.

“The findings of this work provide a strategy to reduce stillbirth at term for South Asian women and can represent an alternative to offering earlier induction of labor,” Davies-Tuck said.

For more information:

Miranda L. Davies-Tuck, PhD, can be reached at miranda.davies@hudson.org.au.