What is the current trend of fetal mortality rate during labor?

Trends in Fetal Death Rate During Labor Over Recent Years

The fetal death rate during labor has declined significantly over the past several decades, but this decline has stagnated in recent years, with the U.S. perinatal mortality rate remaining stable since 2011. 1

Historical Trends and Current Status

• Fetal death rates declined by approximately 70% since the 1960s across all maternal age groups due to improvements in maternal health and obstetrical practices 2
• Despite this overall improvement, the perinatal mortality rate (which includes late fetal deaths at 28 weeks or more and early neonatal deaths under 7 days) showed no significant change from 2014-2016 1
• The United States continues to have higher rates of perinatal mortality compared to other developed countries, despite having the highest healthcare spending 3

Risk Factors Contributing to Current Fetal Death Rates

Maternal Factors

• Advanced maternal age: Women 35 years and older continue to have significantly higher rates of fetal death compared to younger counterparts:

  • 35-39 years: 1.9 times higher risk
  • 40+ years: 2.4 times higher risk 2
  • This risk persists despite better management of other risk factors 2

• Chronic health conditions:

  • Hypertensive disorders (preeclampsia, chronic hypertension, eclampsia) 4
  • Diabetes mellitus, especially with poor glucose control 4
  • Obesity 4
  • Substance use disorders, particularly opioid use 5

Healthcare Access Factors

• Level of obstetric care: Births in facilities with lower levels of perinatal care have higher rates of intrapartum fetal death:

  • Level 1 units (community hospitals): 61% excess risk compared to Level 3 units
  • Level 2 units (intermediate care): 35% excess risk compared to Level 3 units 6

• Lack of prenatal care: Women without adequate prenatal care have a 22% increased risk of neonatal mortality 3

• Rural healthcare disparities:

  • Rural residents have 9% higher probability of severe maternal morbidity and mortality during childbirth hospitalizations 5
  • Closure of obstetric units has resulted in loss of obstetric services in over 50% of U.S. rural counties 5

Racial and Ethnic Disparities

• Non-Hispanic Black women and American Indian/Alaska Native women have significantly higher pregnancy-related mortality ratios compared to non-Hispanic White women 5
• These disparities persist across various socioeconomic and healthcare access factors 5

Interventions Associated with Improved Outcomes

• Labor management interventions:

  • Augmentation of labor: 25% reduction in neonatal mortalities
  • Labor induction: 31% reduction in neonatal mortalities 3

• Standardized emergency obstetric care:

  • Implementation of safety bundles for obstetric emergencies (hemorrhage, severe hypertension, venous thromboembolism) 5
  • Improved systems for maternal transport to higher levels of care 5

Pitfalls in Interpretation and Monitoring

• Data collection challenges:

  • Changes in reporting methods (e.g., transition from last menstrual period to obstetric estimate of gestational age in 2014) create discontinuities in trend analysis 1
  • Systematic exclusion of fetal deaths from injury surveillance programs limits understanding of traumatic causes 7

• Underreporting of specific causes:

  • Motor vehicle crashes are the leading cause of fetal deaths related to maternal trauma but may be underreported 7
  • In some states, crash-related fetal deaths exceed crash-related infant deaths 7

Future Directions

• Development of standardized approaches to emergency obstetric care to address gaps in managing obstetric emergencies 5
• Implementation of risk-appropriate maternal care through regionalized perinatal systems 5
• Extended postpartum care beyond the traditional 6-week period to address complications that may emerge months or years after childbirth 5
• Improved tracking and surveillance of fetal deaths to better guide prevention efforts 7

Despite significant improvements in maternal and fetal care over the decades, the stagnation in fetal death rates in recent years highlights the need for continued focus on risk-appropriate care, standardized emergency protocols, and addressing persistent disparities in maternal healthcare access and outcomes.