Poster Session 1
Harbinder Brar, MD
Maternal - Fetal Medicine Attending and Clinical Geneticist
Riverside Genomics And Perinatal Institute
Riverside, California, United States
Leila Magistrado, MD
Raincross Medical Group
Raincross Medical Group, California, United States
Guillermo Gomez, MD
Magnolia OB/GYN
Magnolia OB/GYN, California, United States
Rodolfo Saenz, MD
Altais Medical Group
Riverside, California, United States
Serafin Salazar, MD
Raincross Medical Group
Raincross Medical Group, California, United States
Late stillbirths are commonly defined as fetal demises occurring after 28 weeks and may potentially be preventable in high risk pregnancies with antenatal testing. Our objectives were to analyze the rate of late stillbirth and assess the influence of varying types of insurance coverage and race on late stillbirth.
Study Design:
A retrospective review of late stillbirths over a 2 year period was performed. Demographics, sonograms, and risk factors for stillbirth were abstracted. Patients were divided into three groups (group 1: patients with PPO and HMO insurance, group 2: patients with Medicaid insurance, and group 3: patients with managed care Medicaid insurance). The overall late stillbirth rate was calculated as were the rates of late stillbirth for each group. Potentially preventable late stillbirths were defined as those in which no antenatal testing was performed within a week of the stillbirth.
Results:
A total of 6108 pregnancies with 61102 antepartum tests were analyzed. There were 42 late stillbirths with an overall late stillbirth rate of 6.87 per 1000 births. Group 1 had the lowest late stillbirth rate of 3.26 per 1000 births (8/2452) and group 2 had a late stillbirth rate of 6.57 per 1000 (12/1825) births. Group 3 had a late stillbirth rate of 12.01 per 1000 births (22/1831). There was a greater proportion of patients in group 2 and group 3 with three or more risk factors for stillbirth (736/1825=40.3% and 786/1831=42.9%) than in group 1 (17.9%), p< 0.05. There were no potentially preventable late stillbirths in group 1 whereas there were 5 potentially preventable late stillbirths in group 2 and 13 potentially preventable late stillbirths in group 3. One out of 8 late stillbirths in group 1 was African American, in comparison to 6/12 in group 2 and 12/22 in group 3 (p < 0.05).
Conclusion:
Health care disparities with respect to the late stillbirth rate exist, with a higher rate being seen in the indigent and African American population as well as in those with Medicaid and managed care Medicaid insurance. Future research should focus on efforts to address these healthcare inequities.
