Smith LK, et al. - As international comparisons of stillbirth include only stillbirths from 28 or more completed weeks of gestational age, researchers investigated the reliability of including stillbirths before 28 completed weeks in such comparisons considering the increased registration of early stillbirths in high-income countries. In this population-based study, a third of stillbirths were excluded using the present definitions for international comparisons. Stillbirths at 24 weeks to less than 28 weeks were noted to be internationally consistent suggesting their inclusion in routinely reported comparisons as significant. This addition would have a significant impact, acknowledging the burden of perinatal death to families, and making international assessments more informative for clinical practice and policy. They recommend stabilization of ascertainment of fetal deaths at 22 weeks to less than 24 weeks so that reliable comparison of all stillbirths from 22 completed weeks of gestation onwards could be done.

Methods

• From 19 European countries participating in the Euro-Peristat project, national cohort data on livebirths and stillbirths from 22 completed weeks of gestation in 2004, 2010, and 2015, was used for this population-based study.
• Exclusion was performed of countries without national data for stillbirths by gestational age in these periods, or where data available were not comparable between 2004 and 2015.
• Countries with fewer than 10,000 births per year were also excluded because the proportion of stillbirths at 22 weeks to less than 28 weeks of gestation is small.
• A random-effects model was used to calculate pooled stillbirth rates and risk ratios (RR) by gestational age and country to calculate changes in rates between 2004 and 2015.

Results

• In 2015, stillbirths at 22 weeks to less than 28 weeks of gestation accounted for 32% of all stillbirths.
• A decline from 0·97 to 0·70 per 1000 births in pooled stillbirth rate at 24 weeks to less than 28 weeks was noted from 2004 to 2015; a reduction of 25% (RR 0·75, 95% CI 0·65–0·85).
• In 2015, researchers identified the pooled stillbirth rate at 22 weeks to less than 24 weeks of gestation of 0·53 per 1000 births that showed no significant change over time (RR 0·97, 95% CI 0·80–1·16) although changes varied widely between countries (RRs 0·62–2·09).
• They noted a wide variation in the percentage of all births occurring at 22 weeks to less than 24 weeks of gestation indicating international differences in ascertainment.