stillbirth. For example, losses associated with placental
insufficiency, prematurity, or some genetic conditions
are more likely to recur, whereas those due to infection
or abnormalities of twinning are less likely. Also, fetal
death earlier in gestation is more likely to recur than
losses at term. Finally, patients with recurrent fetal death
are at much higher risk than those with sporadic loss.5
Strategies to prevent recurrence depend upon the
cause of the prior loss(es). Families with identified
genetic conditions may be counseled about reproductive
options including antenatal and preimplantation
genetic diagnosis. Improved medical care for maternal
disorders such as diabetes and hypertension can
substantially improve outcome in subsequent pregnancies.
The same is true for women with red cell
alloimmunization. Although not universally accepted,
there is evidence that treatment with thromboprophylaxis
can improve the live birth rate in women with
antiphospholipid syndrome.37,38