Pregnancy Outcomes Following Previous Stillbirth: A 3-Year Single-Centre Retrospective Cohort Study

Background: Stillbirth is a devastating pregnancy outcome. In 2020, there were 2273 stillbirths in Australia. Up to 80% of affected patients become pregnant again within 12 to 18 months. However, subsequent pregnancies are often accompanied by both medical and emotional challenges. The primary aim of this study was to describe the antenatal, birth, and neonatal outcomes of pregnancy following a previous stillbirth, and to inform the establishment of a Pregnancy After Loss Clinic (PALC) at our institution. Secondary aims were to describe the characteristics of the index stillbirth and to explore potential differences in antenatal care and pregnancy outcomes in the subsequent pregnancy based on the gestational age and mode of the index stillbirth. Methods: This was a 3-year, single-centre retrospective quantitative cohort study investigating patients who completed a pregnancy beyond 20 weeks at the Royal Women’s Hospital between January 1, 2020, and December 31, 2022, following a previous pregnancy that ended in stillbirth. Descriptive statistical analyses and subgroup analyses were conducted to investigate the extent of care and outcomes in the subsequent pregnancy, based on the gestational age (<28 weeks or ≥28 weeks) and mode (fetal death in utero or termination of pregnancy) of index stillbirth. Results: Our study included 114 women and 120 infants. On average, 38 women with a history of stillbirth presented to the Royal Women’s Hospital each year. Most pregnancies followed fetal death in utero due to fetal anomaly. These women conceived again within 1.8 years of their index stillbirth and received increased antenatal surveillance. There were high rates of labour induction (39.5%, n = 45) and caesarean delivery (41.3%, n = 47). Nearly a quarter of neonates were admitted to subsequent neonatal care (23.3%, n = 28). However, overall neonatal outcomes were reassuring, with most infants born at term (75.4%, n = 86) and a mean birthweight of 2945.0 g (95% confidence interval (CI): 2795.3–3094.5 g). Conclusions: Pregnancy following a previous stillbirth involves increased care provision and higher rates of intervention, but both pregnancy and neonatal outcomes are otherwise reassuring.