Data are less clear for heritable thrombophilias
because they are common in healthy women. One
well-designed prospective randomized trial compared
low molecular weight heparin and low-dose
aspirin to low-dose aspirin alone in 160 women
with prior fetal death and thrombophilia.39 Pregnancy
outcome was dramatically improved in the
low molecular weight heparin group with a live
birth rate of 71% compared with 14% for low-dose
aspirin alone.39 These data are promising but must
be interpreted with caution. First, results have not
been confirmed in other trials. Second, the rate of
pregnancy loss in the control group was extremely
high (86%) and much higher than anticipated based
on risk factors. Thus, current data are insufficient to
recommend routine thromboprophylaxis for
women with thrombophilias.
Counseling regarding smoking cessation, weight
loss in obese women and the proper use of seat belts
during pregnancy also may reduce the rate of stillbirth.
Although of unproven efficacy these public health measures
make good common sense for all women.
Antenatal surveillance is widely recommended
in subsequent pregnancies for patients with prior
fetal death. Clinical usefulness has been suggested
by older studies and the test is likely to benefit the
subset of pregnancies at risk for placental insufficiency.
It is noteworthy that in addition to recurrent
pregnancy loss, prior fetal death increases the risk
for many obstetric complications, including IUGR,
abruption, and preterm birth. The most commonly
employed surveillance method is the nonstress test.
Although some authorities advise testing 2– 4 weeks
before the gestational age of the fetal death, initiat