Preventing Term Stillbirth in South Asian Born Mothers: A stepped wedge cluster randomised controlled trial

Despite decreases in the rates of both neonatal death and SIDS, the rate of stillbirth has remained largely unchanged in Australia for well over a decade. One group of women who have a much higher rate of stillbirth than other women giving birth in Australia are south Asian born women. These women – mainly Indian, Sri Lankan, Pakistani women – have a stillbirth rate twice that of both white Australian women and Chinese-born Australian women. The researchers have shown that this difference appears to be due to accelerated placental ageing in south Asian women such that South Asian women have shorter pregnancies, are more likely to have signs of fetal compromise at the end of pregnancy – including meconium-liquor, abnormal CTGs, higher emergency caesarean section rate for fetal distress – and their rate of stillbirth at the end of pregnancy increases faster and earlier than other women.

Most maternity hospitals offer induction of labour or fetal surveillance for women whose pregnancy extends beyond 41 weeks. This is to reduce the risk of stillbirth. However, this is too late for South Asian women. Dr Davies-Tuck’s observations suggest that this should be offered to South Asian women at 39 weeks to have the same impact. The researchers have recently changed their protocol to offer surveillance or induction of labour for South Asian women at 39 weeks. The researchers now propose to undertake a clinical trial of “earlier post-term” surveillance/induction in south Asian born women.

There are 10,000 south Asian born mothers giving birth each year in Australia. The researchers have shown that south Asian born mothers experience stillbirth at a rate of 5.1 per 1000 births, of which 40% of the stillbirths occur in late pregnancy. This trial of “earlier post-term surveillance” therefore has the potential to prevent up to 20 families each year in Australia from experiencing devastating stillbirth in late pregnancy.