Epidemiology of stillbirths based on different gestational thresholds at a tertiary hospital

Abstract

INTRODUCTION The stillbirth rate (SBR) is an important public health indicator. We studied the distribution of maternal and fetal characteristics and time trends of the SBR at KK Women’s and Children’s Hospital (KKH), Singapore, from 2004 to 2016 based on various definitions of stillbirth. METHODS Data was obtained from the Data Warehouse and Stillbirth Reporting System of KKH from 2004 to 2016. SBRs were calculated based on three definitions (fetal deaths at ≥ 20 weeks, 24 weeks or 28 weeks of gestation per 1,000 total births) and were described with maternal and fetal characteristics, and by year. RESULTS From 2004 to 2016, the SBR declined by 44.7%, 25.5% and 18.9% based on Definitions I, II and III, respectively. The SBR at KKH in 2016 was 5.2 (Definition I), 4.1 (Definition II) and 3.0 (Definition III) per 1,000 total births. The SBR was significantly higher in women aged ≥ 35 years, nulliparas and female fetuses. The number of live births at 24–27+6 weeks of gestation was more than four times higher than that of stillbirths (822 vs. 176). There were 104 (12.7%) neonatal deaths during this gestation period, giving a high survival rate of 87.3%. CONCLUSION The SBR in KKH is relatively lower than that in other developed countries. There is a need to consider revising our hospital and national definitions of the stillbirth lower boundary from 28 weeks to 24 weeks of gestation. This would allow us to make better comparisons with other developed countries, in line with improvements in healthcare.

Fetal death and its association with indicators of social inequality: 20-year analysis in Tacna, Peru

“…Fetal mortality rates can vary greatly depending on the socioeconomic and educational level of the country where the study is carried out. For example, a study conducted in nine hospitals in South Africa involving 9,811 pregnant women reported a fetal mortality rate of 15.5 per 1,000 births between 2017 and 2020 [ 26 ], while another study in a hospital in Singapore involving 157,039 pregnant women between 2004 and 2016 reported a fetal mortality rate of 5.1 per 1,000 births [ 27 ].…”