Evaluation of causes of still birth in a tertiary care teaching hospital

Abstract

Background: Whenever pregnancy occurs there is an expectation that every pregnancy will end with the birth of a healthy baby, yet in a developing country like India 22 in every 1000 births are stillborn. The objective of this study was to evaluate the rate and causes of still birth in a tertiary care teaching hospital, Queen Mary, King George Medical college and university, Lucknow, Uttar Pradesh, India.Methods: Present study was an observational study in a tertiary care hospital. 7024 births occurred in the institution over a period of 1 year out of which 550 were stillbirths. Stillbirths which weighed over 500 grams were included in the study. After informed consent, details of history about epidemiological factors, obstetric history and medical history were obtained. Antenatal investigations including imaging, delivery details and stillborn morphological characteristics were analyzed to identify the cause of stillbirthResults: Out of 7024 deliveries, stillbirth rate was 78.30/1000 total births. Cause of intrapartum stillbirth showed statistically significant correlation with patient’s place of residence (rural>urban), distance of health centre from her house, time taken to reach first point of contact and her parity. The major obstetrical causes of stillbirth identified were APH 22.36%, hypertensive disorders of pregnancy 19.27%, IUGR 15.27%, unexplained causes 11.09%, mal-presentations 9.64%, rupture uterus 9.09% and obstructed labour 6.36%. Severe anemia was found in 24.91% as an associated obstetrical cause of stillbirth.Conclusions: The rate of stillbirth is higher as compared to the Indian data (22/1000 total births). Antepartum obstetric complications (APH, hypertensive disorder of pregnancy, IUGR) were the most common. 15.45% cases showed intrapartum causes of stillbirth (obstructed labour and rupture uterus) which was significantly higher than developed countries where such cases are negligible. The higher number of intrapartum deaths indicate that better healthcare services can drastically reduce stillbirth rates in developing countries.

A Tale of Stillbirths at a Tertiary Care Center in Northeast India

“…Assam is one of the educationally backward states in India, with particularly low literacy rate among the tea garden community. In this study, about one-third of mothers (31%) were illiterate, which was similar to a study done by Kothiyal S et al 6 (37.1%). In a study by Altijani et al, 10 illiteracy among mothers with stillbirth was reported to be much higher (51.6%).…”

“…The study by Altijani N et al 10 reported an incidence as high as 87.4% among the rural population. The distance traveled to reach the maternity center and time-taken findings were analogous to the study by Kothiyal S et al 6 The incidence of stillbirths increases with increasing gravidity. This was also seen by Archibong EI et al, 8 who reported 52.35% of stillbirths among grand multigravidae.…”

“…Most women belonged to lower socioeconomic groups (62.73%). Even Kothiyal S et al 6 reported a similar percentage of mothers from poor background (56%). The incidence of stillbirths was higher in rural population and this has been reported in multiple studies.…”