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The science and clinical practice of obstetrics focuses on human reproduction. The specialty promotes the health and well-being of the pregnant woman and her fetus through quality perinatal care. Such care entails recognition and treatment of complications, supervision of labor and delivery, initial care of the newborn, and management of the puerperium. Postpartum care promotes health and provides family planning options.
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Evidence-based medicine dominates the modern practice of obstetrics. As described by Williams in this textbook’s first edition, we too strive to present the scientific evidence for current obstetrical care. Still, high-quality data do not support most recommendations (Brock, 2021). Thus, much of our practice stems from expert-based opinions and historical experiences (Society for Maternal-Fetal Medicine, 2021). To help bridge knowledge gaps, we also rely on authoritative sources such as the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, as well as agencies such as the Centers for Disease Control and Prevention (CDC) and National Institutes of Health (NIH).
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The importance of obstetrics is demonstrated by the use of maternal and neonatal outcomes as an index of health and life quality among nations. Intuitively, indices showing poor obstetrical and perinatal outcomes could be assumed to reflect medical care deficiencies for the entire population.
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The National Vital Statistics System of the United States collects statistics on births and deaths, including fetal deaths. Legal authority for collection resides individually with the 50 states; two regions—the District of Columbia and New York City; and five territories—American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the Virgin Islands. The standard birth certificate includes information on medical and lifestyle risks, labor and delivery factors, and newborn characteristics. Importantly, the current death certificate contains a pregnancy checkbox (Hoyert, 2020).
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Standard definitions are encouraged by the World Health Organization as well as the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists (2019a). Uniformity allows data comparison between states or regions and between countries. Still, not all definitions are uniformly applied. For example, uniformity is incomplete among states regarding birthweight and gestational age criteria for reporting fetal deaths (American College of Obstetricians and Gynecologists, 2020a). Not all states follow this recommendation. Specifically, 28 states stipulate that losses beginning at 20 weeks’ gestation should be recorded as fetal deaths; eight states report all products of conception as fetal deaths; and still others use a minimum birthweight of 350 g, 400 g, or 500 g to define fetal death. To further the confusion, the National Vital Statistics Reports tabulates fetal deaths from pregnancies that are 20 weeks’ gestation or older (Centers for Disease Control and Prevention, 2020a). This is problematic because the 50th percentile for fetal weight at 20 weeks approximates 325 to 350 g—considerably less than the 500-g definition. In fact, ...