Association Between Obstetric and Medical Risk Factors With Stillbirths in 4 Tertiary Hospitals in a Low Income Country

Abstract

Background The burden of stillbirth in Africa is high. The burden of stillbirth in Kenya is unknown, and very few studies have investigated the association between medical and obstetric risk factors and the occurrence of stillbirth in a Kenyan setting. The aim of this study was to evaluate the association between obstetric and medical risk factors with stillbirths in Nairobi, Kenya. This information is key to the healthcare system while formulating policies and interventions to mitigate preventable stillbirths. Methods This was a case-control study conducted in four Kenyan hospitals between August 2018 and April 2019. Two hundred and fourteen women with stillbirths and 428 with livebirths > 28 weeks were enrolled and evaluated. Data was collected via interviews and data abstraction from medical records. The outcome variables were stillbirth and livebirth; the exposure variables were sociodemographic characteristics, medical and obstetric risk factors. Sociodemographic characteristics were compared using the two-sample t-test for continuous variables and Chi-square or Fisher's exact tests for categorical variables. The association between the medical and obstetric risk factors with stillbirth was assessed using univariate and multivariate analysis using logistic regression. Statistical significance was defined as a two-tailed p-value of ≤0.05. Results Mothers with obstetric complications had higher odds of stillbirth: pre-eclampsia (OR 9.1, 95% CI 2.6–32.5, P = 0.001), eclampsia (OR 9.2, 95% CI 2.6–32.5, P = 0.001), placenta previa (OR 8.6 95% CI 2.8–25.9, P = 0.001), abruptio placenta (OR 6.9 95% CI 2.2–21.3, P = 0.001), early preterm delivery 28-34weeks (OR 9.5, 95% CI 5.7–16), late preterm delivery between 34–37 weeks (OR 2.0 95% CI 1.3–3.3) and previous preterm birth (OR 4.7, 95% CI 1.2–18.7, P = 0.01). Women with gestational diabetes mellitus had a 11fold higher likelihood of a stillbirth, OR 11.5 95% CI 2.5–52, P = 0.001). There was no association between intrauterine growth restriction (IUGR), multiple gestation, congenital anomalies, previous stillbirth, previous abortion, HIV and anaemia with stillbirth. Conclusion: Our findings reiterate the significance of medical and obstetric complications in association with stillbirth in a Kenyan urban setting. Proper antepartum care and surveillance to identify and manage medical and obstetric conditions with a potential of causing stillbirth are recommended.