Facility-based stillbirth review processes used in different countries across the world: a systematic review

Boo, Yebeen Ysabelle; Gwacham-Anisiobi, Uchenna; Thakrar, Dixa B.; Roberts, Nia; Kurinczuk, Jennifer J; Lakhanpaul, Monica; Nair, Manisha

doi:10.1016/j.eclinm.2023.101976

Cited by 4 publications

(3 citation statements)

References 67 publications

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“…Such reviews can generate learning to inform the action plans and allow facilities to consider where the changes should be made to improve the quality of care they provide, enabling positive shortand medium-term outcomes, and ultimately reducing preventable stillbirths. 26 Similar to the findings of Altijani et al from an analysis of data from 886 505 Indian women from the annual health survey, 10 our study identified women's illiteracy as significantly associated with an increased risk of stillbirth. However, our findings also highlight that improving access to high-quality antenatal care and better management of pregnancy and fetal complications has the potential to attenuate or eliminate the risk of stillbirth associated with socioeconomic inequalities, such as those related to women's low education levels and low-income status.…”

Section: Discussionsupporting

confidence: 90%

“…Considering that intrapartum stillbirths are more closely related to various measures of obstetric care than antepartum stillbirths, 25 further investigation into the quality of care received by women who experienced intrapartum stillbirths through a stillbirth review process would be beneficial. Such reviews can generate learning to inform the action plans and allow facilities to consider where the changes should be made to improve the quality of care they provide, enabling positive short‐ and medium‐term outcomes, and ultimately reducing preventable stillbirths 26 …”

Section: Discussionmentioning

confidence: 99%

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Maternal and fetal factors associated with stillbirth in singleton pregnancies in 13 hospitals across six states in India: A prospective cohort study

Boo,

Bora,

Chhabra

et al. 2024

Intl J Gynecology & Obste

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ObjectiveThis study aimed to investigate the incidence of and risk factors for stillbirth in an Indian population.MethodsWe conducted a secondary data analysis of a hospital‐based cohort from the Maternal and Perinatal Health Research collaboration, India (MaatHRI), including pregnant women who gave birth between October 2018–September 2023. Data from 9823 singleton pregnancies recruited from 13 hospitals across six Indian states were included. Univariable and multivariable Poisson regression analysis were performed to examine the relationship between stillbirth and potential risk factors. Model prediction was assessed using the area under the receiver‐operating characteristic (AUROC) curve.ResultsThere were 216 stillbirths (48 antepartum and 168 intrapartum) in the study population, representing an overall stillbirth rate of 22.0 per 1000 total births (95% confidence interval [CI]: 19.2–25.1). Modifiable risk factors for stillbirth were: receiving less than four antenatal check‐ups (adjusted relative risk [aRR]: 1.75, 95% CI: 1.25–2.47), not taking any iron and folic acid supplementation during pregnancy (aRR: 7.23, 95% CI: 2.12–45.33) and having severe anemia in the third trimester (aRR: 3.37, 95% CI: 1.97–6.11). Having pregnancy/fetal complications such as hypertensive disorders of pregnancy (aRR: 1.59, 95% CI: 1.03–2.36), preterm birth (aRR: 4.41, 95% CI: 3.21–6.08) and birth weight below the 10th percentile for gestational age (aRR: 1.35, 95% CI: 1.02–1.79) were also associated with an increased risk of stillbirth. Identified risk factors explained 78.2% (95% CI: 75.0%–81.4%) of the risk of stillbirth in the population.ConclusionAddressing potentially modifiable antenatal factors could reduce the risk of stillbirths in India.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Maternal and fetal factors associated with stillbirth in singleton pregnancies in 13 hospitals across six states in India: A prospective cohort study

Boo,

Bora,

Chhabra

et al. 2024

Intl J Gynecology & Obste

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“…Improving the quality and efficiency of referral processes, as well as strengthening healthcare facilities' capacity to provide appropriate care, are critical interventions to prevent neonatal deaths [42]. In many cases of stillbirths as well as neonatal deaths, a well-equipped primary health care facility can avert the risk of poor fatal outcomes [43].…”

Section: Discussionmentioning

confidence: 99%

Uncovering the causes and socio-demographic constructs of stillbirths and neonatal deaths in an urban slum of Karachi

Muhammad,

Rizvee,

Khan

et al. 2024

PLoS ONE

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Introduction Neonatal deaths and stillbirths are significant public health concerns in Pakistan, with an estimated stillbirth rate of 43 per 1,000 births and a neonatal mortality rate of 46 deaths per 1,000 live births. Limited access to obstetric care, poor health seeking behaviors and lack of quality healthcare are the leading root causes for stillbirths and neonatal deaths. Rehri Goth, a coastal slum in Karachi, faces even greater challenges due to extreme poverty, and inadequate infrastructure. This study aims to investigate the causes and pathways leading to stillbirths and neonatal deaths in Rehri Goth to develop effective maternal and child health interventions. Methods A mixed-method cohort study was nested with the implementation of large maternal, neonatal and child health program, captured all stillbirths and neonatal death during the period of May 2014 till June 2018. The Verbal and Social Autopsy (VASA) tool (WHO 2016) was used to collect primary data from all death events to determine the causes as well as the pathways. Interviews were conducted both retrospectively and prospectively with mothers and caregivers. Two trained physicians reviewed the VASA form and the medical records (if available) and coded the cause of death blinded to each other. Descriptive analysis was used to categorize stillbirth and neonatal mortality data into high- and low-mortality clusters, followed by chi-square tests to explore associations between categories, and concluded with a qualitative analysis. Results Out of 421 events captured, complete VASA interviews were conducted for 317 cases. The leading causes of antepartum stillbirths were pregnancy-induced hypertension (22.4%) and maternal infections (13.4%), while obstructed labor was the primary cause of intrapartum stillbirths (38.3%). Neonatal deaths were primarily caused by perinatal asphyxia (36.1%) and preterm birth complications (27.8%). The qualitative analysis on a subset of 40 death events showed that health system (62.5%) and community factors (37.5%) contributing to adverse outcomes, such as delayed referrals, poor triage systems, suboptimal quality of care, and delayed care-seeking behaviors. Conclusion The study provides an opportunity to understand the causes of stillbirths and neonatal deaths in one of the impoverished slums of Karachi. The data segregation by clusters as well as triangulation with qualitative analysis highlight the needs of evidence-based strategies for maternal and child health interventions in disadvantaged communities.

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Definitions, terminology and standards for reporting of births and deaths in the perinatal period: International Classification of Diseases (ICD‐11)

Blencowe,

Hug,

Moller

et al. 2024

Intl J Gynecology & Obste

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Despite efforts to reduce stillbirths and neonatal deaths, inconsistent definitions and reporting practices continue to hamper global progress. Existing data frequently being limited in terms of quality and comparability across countries. This paper addresses this critical issue by outlining the new International Classification of Disease (ICD‐11) recommendations for standardized recording and reporting of perinatal deaths to improve data accuracy and international comparison. Key advancements in ICD‐11 include using gestational age as the primary threshold to for reporting, clearer guidance on measurement and recording of gestational age, and reporting mortality rates by gestational age subgroups to enable country comparisons to include similar populations (e.g., all births from 154 days [22+0 weeks] or from 196 days [28+0 weeks]). Furthermore, the revised ICD‐11 guidance provides further clarification around the exclusion of terminations of pregnancy (induced abortions) from perinatal mortality statistics. Implementing standardized recording and reporting methods laid out in ICD‐11 will be crucial for accurate global data on stillbirths and perinatal deaths. Such high‐quality data would both allow appropriate regional and international comparisons to be made and serve as a resource to improve clinical practice and epidemiological and health surveillance, enabling focusing of limited programmatic and research funds towards ending preventable deaths and improving outcomes for every woman and every baby, everywhere.

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Facility-based stillbirth review processes used in different countries across the world: a systematic review

Cited by 4 publications

References 67 publications

Maternal and fetal factors associated with stillbirth in singleton pregnancies in 13 hospitals across six states in India: A prospective cohort study

Maternal and fetal factors associated with stillbirth in singleton pregnancies in 13 hospitals across six states in India: A prospective cohort study

Uncovering the causes and socio-demographic constructs of stillbirths and neonatal deaths in an urban slum of Karachi

Definitions, terminology and standards for reporting of births and deaths in the perinatal period: International Classification of Diseases (ICD‐11)

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