Trudell et al reported a calculator for predicting stillbirth in a pregnancy. This can help to identify a mother who may benefit from more aggressive management to reduce the risk. The authors are from Mercy Hospital St Louis, Washington University and University of South Florida.
Patient selection: pregnant woman
Outcome: stillbirth at or beyond 32 weeks of gestation excluding fetal anomalies and aneuploidy
Parameters:
(1) maternal age in years
(2) race
(3) nulliparity
(4) maternal body mass index (BMI) in kg per square meter
(5) smoking
(6) chronic hypertension
(7) pre-gestational diabetes
Parameter
Finding
Points
maternal age
<= 18 years
1
19 to 34 years
0
35 to 39 years
1
>= 40 years
2
race
Black
2
other
0
nulliparity
no
0
yes
1
maternal BMI
< 25 kg per sq m
0
25 to 29.9
1
30 to 34.9
2
>= 35 kg per sq m
1
smoking
no
0
yes
1
chronic hypertension
no
0
yes
2
pre-gestational diabetes
no
0
yes
3
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 13
• According to the Youden index a score >= 2 is associated with increased risk.
• A score >= 4 had an LR+ of 2. A score >= 5 had a LR+ of 3.3.
Performance:
• The area under the ROC curve is 0.64.
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