Abstract

Background: Women with a prior stillbirth are at elevated risk for adverse outcomes in subsequent pregnancies. Identifying these outcomes and contributing factors is essential for improved antenatal surveillance and care. Objective: To assess pregnancy outcomes in women with a prior history of stillbirth and to classify the etiology of previous stillbirths using the ReCoDe system (Relevant Condition at Death). Materials and methods: This was a prospective observational study conducted at a tertiary care center in Pune, India, from June 2023 to June 2025. A total of 116 pregnant women with a prior history of stillbirth were enrolled after informing consent the subjects were enrolled in a study. Detailed demographic, obstetric, and clinical data were collected. Pregnancy outcomes were analyzed and the causes of previous stillbirth were categorized using the ReCoDe classification system. Results: In this study, the mean maternal age was 29.2 years. Most participants (67.2%) had a BMI in the overweight or obese range. Hypertensive disorders were significantly associated with placental abruption (p=0.01) and uteroplacental insufficiency (p=0.004). Gestational diabetes mellitus was present in 13.8% of cases. Fetal growth restriction (FGR) was significantly associated with preterm birth (p=0.01) and NICU admission (p=0.01). The recurrent stillbirth rate was 10.3%. The ReCoDe classification identified hypertensive disorders (26.7%) and placental abruption (18.1%) as the most common causes of prior stillbirths, while 31.9% remained unclassified. Conclusion: Women with prior stillbirths exhibit significantly higher rates of adverse maternal and fetal outcomes in subsequent pregnancies. Hypertensive disorders and FGR are major contributors. Structured antenatal monitoring and use of classification systems like ReCoDe can guide risk stratification and clinical management.

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