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waveman comments on How did my baby die and what is the probability that my next one will? - Less Wrong Discussion
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Comments (23)
My sympathies to you.
This is a pretty common situation in medicine - you have a problem and you have little idea what the numbers are and insight is very hard to come by. It is incredibly frustrating. There may be studies but they only report the risks for a small number of factors or even just one (eg risk of stillbirth by age of mother or given a prior stillbirth). The raw numbers from studies are usually not available to "lay people" to allow them to do their own analysis for their own circumstances which would provide a much better insight.
When you go and look at the studies you see results that differ by a factor of 5 or worse. Does low Testosterone halve (one study), or triple (another study) your chance of getting prostate cancer? Is the risk of death within 15 years from prostate cancer at stage T1C with Gleason score 6 without surgery or radiotherapy 3% (one study) or 20% (another)? What is the incidence of impotence after prostate removal (pick a number, any number between 20% and 80%)?
You are asking "what is the likely cause?" however it is fairly likely you will never know this. Most stillbirths are never explained. There are probably thousands of things it could have been. Human reproduction is a fallible process with many points of failure. I suggest you may have to move past this question at some point.
I guess what you really need to know is "what is the risk of another stillbirth given you have had one already?".
The base rate is about 1/160 to 1/200 births. I see nothing in your report that indicates an elevated risk. I assume you have looked at the risk factors including possible family history, and found nothing.
Acording to this meta-analysis http://www.bmj.com/content/350/bmj.h3080 the chance of a second stillbirth given a history of stilbirth is about 2.5% or 1/40. This is a lot higher than the base of ~1/200 but it is still pretty unlikely.
Sorry that's the best I can offer.
I have no medical qualifications but due to various health issues I have been reading medical books and papers and learning statistics for several decades.
I think this is probably the best answer so far.
deprimita_patro: Family history would be another factor. If you or your wife have living mothers or grandmothers it might be worth asking them if they've ever suffered stillbirths. If the total is large then edge that 1/40 estimate up a little. If it's zero you might be able to edge it down a little.
Sorry for your loss.
If it helps I know a few people who had stillbirths and subsequently had perfectly healthy babies.
Yep. This is the information needed.
Starting from here, since all known predictable causes were ruled out (presumably the more likely repeat failures), I think the probability is somewhere between 1/40 and 1/160.
Maybe you could get base rate variation based on age. And country.
The cooccurrence rate looks like good news to me. Or at least good news if you want to try again. I don't know that the difference between 0.5% and 2.5% would even register in my brain. If someone had told me that the base rate was 2.5%, it wouldn't deter me from wanting a child.
I've done some of my family tree. The sad thing about looking back at cemetery records is how many times you see children under 1 and 2 dying just 100, 150 years ago.
Sorry, not including this in the post was a huge oversight on my part. L has a cousin who has had two miscarriages, and I have an aunt who had several stillbirths followed by 3 live births of healthy children. We don't know the cause of any of these. We know of no other family members that have had similar misfortunes. I updated the post to reflect this.