Combined tests could help combat stillbirth

Every day, six Australian ­babies die after 20 weeks’ gestation. But Melbourne researchers have discovered a new way to identify these at-risk babies.

Melbourne researchers are testing a new way of detecting babies that are growing poorly in late pregnancy, with the hope of reducing Australia’s stillbirth rate.

Every day, six Australian ­babies die after 20 weeks’ gestation, a rate that has remained unchanged for about 20 years despite advances in medical care and research.

The biggest risk factor for stillbirth is foetal growth restriction, when the placenta is no longer able to supply the baby with enough nutrients and oxygen to sustain its development.

And while pregnant women have their abdomens measured during routine antenatal checks, with any suspected growth-restricted babies sent for a scan, this approach detects only about quarter of babies destined to be born small.

Even if all women had a late pregnancy ultrasound, this approach would identify just over half the babies who are behind in weight and size.

And yet the risk of stillbirth increases three to four times for these babies.

The biggest risk for a stillbirth is foetal growth restriction, but the study aims to get better at identifying small babies. Picture: istock

Professor Sue Walker, lead researcher and director of the perinatal medicine at Mercy Hospital for Women, said more sophisticated ways of detecting placental insufficiency were urgently needed.

Prof Walker said a UK study had shown that if you could detect a baby was small during pregnancy, their risk of stillbirth was halved.

“That’s not because we’ve got a magic treatment to give these pregnancies. It’s because if the clinician knows the baby is small, and they have a suspicion the placenta isn’t working very well, they will monitor the baby more closely and deliver it in time before we have a stillbirth,” Prof Walker said.

“The tragedy at the moment is that most foetal growth restriction goes undetected during pregnancy.”

After promising results from a study of 2000 pregnant women who had blood tests at 28 and 36 weeks’ gestation, a team from Mercy Health and the University of Melbourne — led by Prof Walker and Professor Stephen Tong — found that signature molecules released by the placenta correlated to babies that were small or struggling.

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The $1.2 million federally funded study will see them recruit another 2000 Victorian women to combine that blood test with ultrasound scans to analyse the blood flow from mother to baby.

“The baby uses a whole lot of manoeuvres to try and maximise its chances of survival when the placenta starts to fail, such as diverting blood to its brain,” Prof Walker said.

“When these compensatory mechanisms finally fail, if we haven’t been able to detect and deliver that baby, then a stillbirth occurs.

“We need to get better at identifying small babies, and babies who don’t start small but slow their growth, so we can watch them more closely and deliver them in a timely manner.”

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