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Variation in stillbirth rates across high-income countries and large equity gaps within high-income countries persist. If all high-income countries achieved stillbirth rates equal to the best performing countries, 19 439 late gestation (28 weeks or more) stillbirths could have been avoided in 2015. The proportion of unexplained stillbirths is high and can be addressed through improvements in data collection, investigation, and classification, and with a better understanding of causal pathways. Substandard care contributes to 20–30% of all stillbirths and the contribution is even higher for late gestation intrapartum stillbirths. National perinatal mortality audit programmes need to be implemented in all high-income countries. The need to reduce stigma and fatalism related to stillbirth and to improve bereavement care are also clear, persisting priorities for action. In high-income countries, a woman living under adverse socioeconomic circumstances has twice the risk of having a stillborn child when compared to her more advantaged counterparts. Programmes at community and country level need to improve health in disadvantaged families to address these inequities.

Pregnancies are an issue difficult to manage in recipients of solid organ grafts. Whereas most studies report on individual women who have received transplants, we retrospectively studied all gestations of women with liver (LT) or kidney transplants (KT) from October 1988 to August 2010 at one major transplantation center in Germany and compared the outcome.

Little is known about how women perceive the onset of labor. It is possible that the way in which labor onset is experienced influences the duration of labor and other aspects of labor dynamics. The authors administered a semistructured questionnaire to 235 women who were admitted at term in spontaneous labor. They were asked about when labor had begun, how they became aware of it, and whether and when the membranes had ruptured. Two investigators independently subdivided women’s experience of labor onset into 369 sampling units corresponding to 8 predefined categories. Each unit consisted of a sentence, phrase, or expression embodying a single meaning. Interrater agreement on categorizing sampling units was 0.91. Nearly two thirds of all units related to recurrent or nonrecurring forms of pain. Most women experienced the onset of labor as regular or irregular recurring pain. Multiparous women reported recurrent pain more often than nulliparas. For most parameters, including watery fluid, gastrointestinal symptoms, and altered sleep, the number of women was identical to the number of sampling units. Sixteen women reported 22 units relating to emotional reactions. One third of women (33.6) had membrane rupture before being admitted but only 21.6 associated it with the onset of labor. Women describe a wide range of symptoms and signs as heralding the onset of labor. No standardized experience of labor onset was found in this inquiry. A woman’s perception of labor onset could well be as reliable as any surrogate measure. Rather than asking parturients about when contractions began and when they became regular, caregivers should ask them when labor began and how they knew.