Fetal mortality at and beyond term in singleton pregnancies in Baden-Wuerttemberg/Germany 2004–2009

OBJECTIVE: To evaluate the risk of intrauterine fetal death (IUFD) in low-risk pregnancies at and beyond term under conditions of fetal monitoring practiced in Baden-Wuerttemberg/Germany (BW). METHODS: We performed a retrospective analysis of 472,843 low-risk singleton pregnancies in BW, using data from the local National Medical Birth registry. The setting of fetal monitoring was uniform during the analyzed time period (2004–2009). We calculated the IUFD rate per 1,000 ongoing pregnancies for each gestational week and compared our results to other published studies using the same calculation scheme. RESULTS: Our study demonstrates a markedly lower risk of IUFD between 37+0/7 and 42+6/7 weeks of pregnancy when compared with data from Scotland, England, and Sweden collected between 1985 and 1996. When our data were compared to a recently published study from California reporting on deliveries between 1997 and 2006, the risk for IUFD was only significantly lower from 41 weeks onward. The distribution of weekly delivery rates shows a trend to earlier deliveries in weeks 37+0/7 to 39+6/7 for the actual cohorts from California and BW. CONCLUSION: In our study, the risk for IUFD in pregnancies going beyond term is remarkably lower than found in studies published about other countries. Our results do not support current guidelines which recommend a routine induction of labor in low risk pregnancies at 41+0/7 weeks of pregnancy.