The stillbirth scandal

A leader in The Times of London (28th November 2012) entitled ‘‘The Stillbirth Scandal’’ raged against the fact that (in the UK), ‘‘every day as many as three babies are stillborn who could have lived’’. A linked article in The Times claimed that ‘‘hundreds of babies are dying because of failings in ante-natal care’’. A British Minister of Health, Dan Poulter, was quoted, ‘‘In my time working on maternity wards, I never experienced a greater tragedy than the death of a baby . . .our NHS needs to do a lot more to reduce the number of stillbirths’’. Are there any immediate ways in which our profession can contribute to reducing the scale of the tragedy – the estimated 4000 stillbirths a year in the UK alone? This is a figure which, shamefully, has not decreased in a decade. One obvious candidate is the antiphospholipid syndrome (APS). This syndrome, first described in detail in 1983, is now recognized as the commonest treatable cause of recurrent miscarriage. It is identified by relatively simple blood tests for antiphospholipid antibodies (aPL), and treated with the aim of reducing blood ‘stickiness’ – conventionally, in aPL-positive pregnancies, with aspirin plus or minus low molecular weight heparin. In the 30 years since the defining of the syndrome, the successful pregnancy rate in aPLpositive women has improved from less than 20% to over 90%, a success rate that has been mirrored in clinics worldwide. Undoubtedly, this has been the headline story of the syndrome. It is now recognized that the syndrome can also result in later pregnancy loss, including stillbirth (defined as death after the 24 week of pregnancy). Significantly, some of those women who suffered a stillbirth had previously had early miscarriages. How common is stillbirth in APS?