Incidence and first trimester risk factors of stillbirth in Indonesia

Abstract

Abstract Objectives To determine the incidence and the risk factors of stillbirth from maternal biophysical, ultrasound, and biochemical markers at 11–13 weeks of gestation in the Indonesian population. Methods This was a retrospective cohort study of pregnant women for first-trimester preeclampsia screening at 11–13 weeks of gestation in some clinics and hospital in Jakarta. Maternal characteristics and history, mean arterial pressure (MAP) measurement, uterine artery pulsatility index (UtA-PI) ultrasound, maternal ophthalmic peak ratio (Oph-PR) Doppler, and placental growth factor (PlGF) serum were collected during the visit. Stillbirth was classified into placental dysfunction-related when it occurred with preeclampsia or birth weight <10th percentile and non-placental dysfunction-related. Bivariate and multivariate logistic regression analyses were employed to determine the risk factors associated with stillbirth. Results Of 1,643 eligible participants, 13 (0.79 %) stillbirth cases were reported. More than half of the stillbirths (7) were placental dysfunction-related. After adjusted with maternal age, body mass index (BMI), and parity status, chronic hypertension (aOR (adjusted odds ratio)) 24.41, 95 % CI {confidence interval} 5.93–100.43), previous pregnancy with preeclampsia (aOR 15.79, 95 % CI 4.42–56.41), MAP >101.85 (aOR 26.67, 95 % CI 8.26–86.06), UtA-PI >1.90 (aOR 10.68, 95 % CI 2.34–48.58, and PlGF <28.77 pg/mL (aOR 18.60, 95 % CI 5.59–61.92) were associated with stillbirth. Conclusions The incidence of stillbirth in the population is comparable to studies conducted in developed countries. Most routine variables assessed at the 11–13 weeks combined screening for preeclampsia are associated with the risk of stillbirth.