Perinatal mortality: A sporadic event or a recurrent catastrophe?

Objective: The purpose of this study was to determine whether women who experienced perinatal mortality in their first delivery had, in their subsequent birth, a higher risk for adverse perinatal outcome. Methods: A population-based study was undertaken to compare all second deliveries of women with previous perinatal mortality in their first delivery to those with no such history. Deliveries occurred from 1988 to 2004 in a tertiary medical center. Patients lacking prenatal care, multiple gestations, and congenital malformations were excluded from the analysis. A multivariable logistic regression model and the Mantel-Haenszel procedure were carried out to control for confounders. Results: During the study period, out of 25,876 singleton second deliveries, 230 (0.9%) cases were of patients with previous perinatal mortality. Multivariable analysis with backward elimination showed a significant association between previous perinatal mortality and the following conditions: hypertensive disorders (OR = 2.6, 95% CI 1.7-3.9, P < 0.001), diabetes mellitus (OR = 2.4, 95% CI 1.5-3.7, P < 0.001), fertility treatment (OR = 2.7, 95% CI 1.6-4.7, P = 0.001), and younger maternal age (OR = 0.9, 95% CI 0.92-0.98, P < 0.001). Controlling for preterm delivery, using the Mantel-Haenszel procedure, the association between previous and subsequent perinatal mortality remained significant (weighted OR = 2.2, 95% CI 1.2-3.9, P = 0.010). Conclusion: Previous perinatal loss poses an independent risk for subsequent perinatal mortality. Prospective studies are warranted in order to establish the appropriate means of surveillance and/or interventions needed to decrease future adverse perinatal outcomes.