How do late terminations of pregnancy affect comparisons of stillbirth rates in Europe? Analyses of aggregated routine data from the Euro-Peristat Project

Objective: To describe how terminations of pregnancy at gestational ages at or above the limit for stillbirth registration are recorded in routine statistics and to assess their impact on comparability of stillbirth rates in Europe. Design: Analysis of aggregated data from the Euro-Peristat project. Setting: Twenty-nine European countries. Population: Births and late terminations in 2010. Methods: Assessment of terminations as a proportion of stillbirths and derivation of stillbirth rates including and excluding terminations. Main outcome measures: Stillbirth rates overall and excluding terminations. Results: In 23 countries, it is possible to assess the contribution of terminations to stillbirth rates either because terminations are rare occurrences or because they can be distinguished from spontaneous stillbirths. Where terminations were reported, they accounted for less than 1.5% of stillbirths at 22+ weeks in Denmark, between 13 and 22% in Germany, Italy, Hungary, Finland and Switzerland, and 39% in France. Proportions were much lower at 24+ weeks, with the exception of Switzerland (7.4%) and France (39.2%). Conclusions: Terminations represent a substantial proportion of stillbirths at 22+ weeks of gestation in some countries. Countries where terminations occur at 22+ weeks should publish rates with and without terminations in order to improve international comparisons and the policy relevance of stillbirth statistics. Tweetable abstract: For valid comparisons of stillbirth rates, data about late terminations of pregnancy are needed.