Causes of stillbirths among women from South Africa: a prospective, observational study

Abstract

Background About 2·6 million third-trimester stillbirths occur annually worldwide, mostly in low-income and middleincome countries, where the causes of these deaths are rarely investigated.Methods We did a prospective, hospital-based, observational study in Soweto, South Africa, to investigate the causes of stillbirths in fetuses of at least 22 weeks' gestational age or with a birthweight of at least 500 g. Maternal clinical information was abstracted from medical records. Investigations included placental macroscopic and histopathological examination and fetal blood culture (including screening for pathogenic bacteria associated with stillbirth). Cases missing one or more of these investigations were considered to have incomplete samples and were excluded from the analysis of cause of stillbirth. Causes of stillbirths were assessed by individual case reviews by at least two obstetricians, and classified with a modified Stillbirth Collaborative Research Network classification system. Findings Between Oct 9, 2014, and Nov 8, 2015, we enrolled 354 stillbirths (born to 350 women). Among the women with available data, 133 (38%) of 350 had hypertension, median age was 27 years (IQR 23-33), 51 (18%) of 291 were obese, six (2%) of 344 had syphilis, and 94 (27%) of 350 had HIV. 63 (18%) of 341 fetuses showed intrauterine growth restriction. Of 298 cases (born to 294 mothers) with complete samples, the most common causes of stillbirth were maternal medical conditions (64 [21%] cases; among them 56 [19%] with hypertensive disorders and six [2%] with diabetes), placental or fetal infections (58 [19%]; 47 [16%] with fetal invasive bacterial infection), pathological placental conditions (57 [19%]; among them 27 [9%] with fetal membrane and placental inflammation and 26 [9%] with circulatory abnormalities), and clinical obstetric complications (54 [18%]; 45 [15%] with placental abruption). Six (2%) stillbirths were attributed to fetal, genetic, or structural abnormalities. In 55 (18%) cases, no cause of death was identified. The most common bacteria to which stillbirths due to fetal invasive infections were attributed were group B streptococcus (15 [5%] cases), E coli (12 [4%]), E faecalis (six [2%]), and S aureus (five [2%]).Interpretation Targeted investigation of stillbirths (even without fetal autopsy) can ascertain a cause of stillbirth in most cases. Further studies using such investigations are needed to inform the prioritisation of interventions to reduce stillbirths globally.

Maternal and newborn health indicators in Papua New Guinea – 2008–2018

“…Numerous specific bacteria were also implicated, most commonly Enterococcus faecalis (14%) and Escherichia coli (10%). 64 Given the low coverage of antenatal care in PNG and the high rates of STIs and potentially other infections, it is likely that these causes would be similar. Scaling up quality antenatal and intrapartum care is essential to addressing preventable stillbirth regardless of the rate.…”

Preterm prelabour rupture of membranes (PPROM) and pregnancy outcomes in association with HIV-1 infection in KwaZulu-Natal, South Africa

“…Overall, birth outcomes in our study population were better in the PPROM group than the non-PPROM group. There were no stillbirths in the PPROM group and a significantly higher proportion of stillbirths among women without PPROM which could have been due to other obstetric complications such as maternal hypertensive disorders, antepartum haemorrhage or fetal invasive bacterial infection [32]. Similarly, despite no difference in the gestational age between both groups, the PPROM group had a significantly lower proportion of newborns weighing < 2500 g. There was no evidence in our study of HIV contributing to worse pregnancy outcomes in the PPROM group.…”

Characteristics of online medical care consultation for pregnant women during the COVID-19 outbreak: a cross-sectional study

“…Bene ting from the widespread application of the ANC guideline, birth defects and cesarean section rates have been reduced, and many other adverse pregnancy outcomes have been avoided in China. [21][22][23][24][25][26][27] Nevertheless, during the COVID-19 outbreak, the routine ANC for pregnant women who are considered to be susceptible are extremely challenged. [28,29] In the past month, we noticed that some highly recommend antenatal check-ups had been canceled or postponed beyond its opportune gestational age by many pregnant women.…”