The risk of perinatal death at term.

Preventing stillbirth has been increasingly recognised as an issue in obstetric care over recent years. Death of a normally formed baby at term is a particular focus as the loss could often have been prevented had the baby been known to be at risk. Reporting nationally collected data from the Netherlands, Eskes et al (BJOG 2019) observed 768 stillbirths or neonatal deaths not due to congenital anomaly among 574,781 women delivering at or after 39 weeks, about 1 death for every 750 births. More than half of deaths were antepartum stillbirths. The ARRIVE trial indicates that routine induction of labour at 39 weeks does not cause harm and is associated with reduced rates of caesarean delivery and other maternal and perinatal complications (Grobman WA, et al. N Engl J Med. 2018;379(6):513-23). While ARRIVE provides no direct evidence in relation to perinatal death, the Cochrane review indicates a ~70% reduction in risk with induction of labour at term (Middleton P, et al. Cochrane Database Syst Rev. 2018;5:CD004945). The relatively large proportion of stillbirths that occur ≥39 weeks and the relatively benign nature of induction of labour at this stage of pregnancy seem to present a great opportunity, given that a prevented stillbirth yields a life saved at its very beginning