Association of Stillbirths with Maternal and Fetal Risk Factors in a Tertiary Care Hospital in South India

Mali, Rajshekher V.; Dalal, Anita; Khursheed, Romana; Gan, Aditya

doi:10.1155/2021/8033248

Cited by 9 publications

(6 citation statements)

References 22 publications

(27 reference statements)

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“…The study has also revealed that congenital malformations, deformations, and chromosomal abnormalities were associated with stillbirth outcomes, i.e., there is a threefold higher risk of stillbirth among perinate with congenital abnormalities than their counterparts. This finding was consistent with studies conducted in Ethiopia ( 71 ), Cameroon ( 28 ), and India ( 26 ). This could be due to a lack of maturity of the vital organs for fetal survival making the fetus prone to fatal complications and death.…”

Section: Discussionsupporting

confidence: 92%

“…In general, multiple factors could result in stillbirth, which can generally be categorized as maternal, fetal, and facility-level factors ( 25 ). Congenital malformation, infection, gestational age, sex, and birth weight are the fetal factors related to stillbirth ( 26 – 30 ), while maternal health conditions before and during pregnancy, maternal age, maternal parity, history of ANC visit, mode of delivery, maternal education, wealth index, birth interval, previous history of stillbirth, fetal movement monitoring are the major maternal factors ( 31 – 35 ). On the other hand, factors such as intrapartum monitoring, clinical management, and capacity of diagnosis are some of the facility-level predictors of stillbirth ( 36 ).…”

Section: Introductionmentioning

confidence: 99%

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Determinants of stillbirth among reviewed perinatal deaths in Ethiopia

et al. 2022

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BackgroundThe global burden of stillbirth has declined over time. However, the problem is still prominent in South Asian and Sub-Saharan African countries. Ethiopia is one of the top stillbirth-reporting countries worldwide. Despite several measures taken to reduce the burden of stillbirth; the pace of decline was not as good as the post-neonatal death. Thus, this study is aimed at identifying potential factors related to stillbirth in Ethiopia based on nationally reviewed perinatal deathsMethodThe national perinatal death surveillance data were used for this study. A total of 3,814 reviewed perinatal death were included in the study. Two model families,namely generalized estimating equation, and alternating logistic regression models from marginal model family were employed to investigate the risk factors of stillbirth. The alternating logistic regression model was selected as the best fit for the final analysis.ResultAmong reviewed perinatal deaths nearly forty percent (37.4%) were stillbirths. The findings from the multivariate analysis demonstrated that the place of birth (in transit and at home), cause of death (infection, and congenital and chromosomal abnormalities), maternal health condition (women with complications of pregnancy, placenta, and cord), delay one (delay in deciding to seek care) and delay three (delay in receiving adequate care) were associated with an increased risk of having a stillbirth. On the other hand, maternal education (women with primary and above education level) and the type of health facility (women who were treated in secondary and tertiary health care) were associated with a decreased risk of having a stillbirth.ConclusionThe study identified that both individual (place of delivery, cause of death, maternal health condition, maternal education, and delay one) and facility level (type of health facility and delay three) factors contributed to stillbirth outcome. Therefore, policies that are aimed at encouraging institutional delivery, improving health seeking behavior, and strengthening facility-level readiness should be devised to reduce the high burden of stillbirth in Ethiopia.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Determinants of stillbirth among reviewed perinatal deaths in Ethiopia

et al. 2022

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“…Congenital malformations, deformations, and chromosomal abnormalities were also positively related to the three-timing of perinatal deaths. The finding was coherent with studies conducted in Ethiopia (Bahardar and North Shewa) [ 71 , 106 ] Cameroon [ 107 ], India [ 33 ], and Jordan [ 108 ]. This could be explained by the organ dysfunction as well as the lack of vital organs used for the survival of the fetus making them more vulnerable to fatal complications.…”

Section: Discussionsupporting

confidence: 87%

“…Maternal complications of pregnancy, complications of labour and delivery as well as complications of the placenta, cord, and membranes were mentioned as the leading cause. The finding was congruent with studies conducted in Ethiopia [ 78 ], Uganda [ 79 , 80 ], Tanzania [ 81 ], India [ 33 ], Jordan [ 82 ], and Taiwan [ 83 ]. The plausible explanation for this might be related to uteroplacental hypoperfusion, which results in fetal distress during the intrapartum period leading to fetal death.…”

Section: Discussionsupporting

confidence: 85%

Timing of perinatal death; causes, circumstances, and regional variations among reviewed deaths in Ethiopia

et al. 2023

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Introduction Ethiopia is one of the countries facing a very high burden of perinatal death in the world. Despite taking several measures to reduce the burden of stillbirth, the pace of decline was not that satisfactory. Although limited perinatal mortality studies were conducted at a national level, none of the studies stressed the timing of perinatal death. Thus, this study is aimed at determining the magnitude and risk factors that are associated with the timing of perinatal death in Ethiopia. Methods National perinatal death surveillance data were used in the study. A total of 3814 reviewed perinatal deaths were included in the study. Multilevel multinomial analysis was employed to examine factors associated with the timing of perinatal death in Ethiopia. The final model was reported through the adjusted relative risk ratio with its 95% Confidence Interval, and variables with a p-value less than 0.05 were declared statistically significant predictors of the timing of perinatal death. Finally, a multi-group analysis was carried out to observe inter-regional variation among selected predictors. Result Among the reviewed perinatal deaths, 62.8% occurred during the neonatal period followed by intrapartum stillbirth, unknown time of stillbirth, and antepartum stillbirth, each contributing 17.5%,14.3%, and 5.4% of perinatal deaths, respectively. Maternal age, place of delivery, maternal health condition, antennal visit, maternal education, cause of death (infection and congenital and chromosomal abnormalities), and delay to decide to seek care were individual-level factors significantly associated with the timing of perinatal death. While delay reaching a health facility, delay to receive optimal care health facility, type of health facility and type region were provincial-level factors correlated with the timing of perinatal death. A statistically significant inter-regional variation was observed due to infection and congenital anomalies in determining the timing of perinatal death Conclusion Six out of ten perinatal deaths occurred during the neonatal period, and the timing of perinatal death was determined by neonatal, maternal, and facility factors. As a way forward, a concerted effort is needed to improve the community awareness of institutional delivery and ANC visit. Moreover, strengthening the facility level readiness in availing quality service through all paths of the continuum of care with special attention to the lower-level facilities and selected poor-performing regions is mandatory.

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“…The HTH stillbirth rate of 31.3 per 1000 births is higher than the 27 per 1000 births recorded in Hohoe Municipality of the Volta Region, the 23 per 1000 births in the Upper East Region and the current Ghana national stillbirth rate of 20 per 1000 births [17,24,25] but compares well with the 29.7 per 1000 births in a tertiary care hospital in South India [26]. Similarly, the stillbirth rate in the present study is higher than the pooled stillbirth rate for Africa of 21.3 per 1000 births [3] and the global stillbirths estimate of 13.9 per 1000 births for 2019 [1].…”

Section: Plos Onementioning

confidence: 64%

Stillbirth incidence and determinants in a tertiary health facility in the Volta Region of Ghana

Dah,

Osarfo,

Ampofo

et al. 2023

PLoS ONE

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Background Stillbirths are indicators of the quality of obstetrics care in health systems. Stillbirth rates and their associating factors vary by socio-economic and geographical settings. Published data on stillbirths and their associating factors in the Volta Region of Ghana are limited. This limits understanding of local factors that must be considered in designing appropriate interventions to mitigate the occurrence of stillbirths. This study determined the incidence of stillbirths and associated factors among deliveries at Ho Teaching Hospital (HTH) and contributes to understanding the consistent high stillbirths in the country and potentially in other low-resourced settings in sub-Saharan Africa. Method This was a prospective cohort study involving pregnant women admitted for delivery at HTH between October 2019 and March 2020. Data on socio-demographic characteristics such as age and employment, obstetric factors including gestational age at delivery and delivery outcomes like birthweight were collected using a pretested structured questionnaire. The primary outcome was the incidence of stillbirths at the facility. Summary statistics were reported as frequencies, percentages and means. Logistic regression methods were used to assess for association between stillbirths and independent variables including age and birthweight. Odds ratios were reported with 95% confidence intervals and associations with p-values < 0.05 were considered statistically significant. Results A total of 687 women and their 702 newborns contributed data for analysis. The mean age (SD) was 29.3 (6.3) years and close to two-thirds had had at least one delivery previously. Overall stillbirth incidence was 31.3 per 1000 births. Of the 22 stillbirths, 17 were antepartum. Pre-eclampsia was the most common hypertensive disorder of pregnancy observed (49.3%, 33/67). Among others, less than 3 antenatal visits and low birthweight increased the odds of stillbirths in the bivariate analysis. In the final multivariate model, pregnancy and delivery at 28–34 weeks gestation [AOR 9.37(95% CI 1.18–74.53); p = 0.034] and induction of labour [AOR 11.06 (95% CI 3.10–39.42); p < 0.001] remained significantly associated with stillbirths. Conclusion Stillbirth incidence was 31.3 per 1000 births with more than half being antepartum stillbirths. Pregnancy/delivery at 28–34 weeks’ gestation increased the odds of a stillbirth. Improving the quality of antenatal services, ensuring adherence to evidence-based protocols, accurate and prompt diagnosis and timely interventions of medical conditions in pregnancy particularly at 28–34 weeks’ gestation could reduce incidence of stillbirths.

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Association of Stillbirths with Maternal and Fetal Risk Factors in a Tertiary Care Hospital in South India

Cited by 9 publications

References 22 publications

Determinants of stillbirth among reviewed perinatal deaths in Ethiopia

Determinants of stillbirth among reviewed perinatal deaths in Ethiopia

Timing of perinatal death; causes, circumstances, and regional variations among reviewed deaths in Ethiopia

Stillbirth incidence and determinants in a tertiary health facility in the Volta Region of Ghana

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