Factors contributing to intrapartum stillbirth: a criteria-based audit to support midwifery practice in Zambia

Abstract

Background: Stillbirth is a poor pregnancy outcome and one that is common worldwide. It mostly occurs during the intrapartum period, which accounts for more than 50% of cases. Estimates suggest that 55% of stillbirths occur in low-to middle-income countries (Lawn et al, 2011). Objective: To establish factors contributing to intrapartum stillbirth in Mansa General Hospital, Lupala Province, Zambia. Methods: In this retrospective audit, the files of 115 women were purposively reviewed in an initial baseline clinical audit and strategies introduced to change practice. A further 31 files were reviewed in a subsequent re-audit. Data were entered and analysed using SPSS version 16.0. Results: The study found that only 36 (33.3%) labouring women in the initial audit and 20 (65%) in the re-audit were managed using a partograph. Obstructed labour was the main cause of intrapartum stillbirths, which was the case for 65 women (55.7%) at baseline and 12 (38.7%) in the re-audit. Antepartum haemorrhage was the cause for 27 (23.5%) stillbirths in the baseline audit and 5 (16.1%) in the re-audit. Suboptimal care was observed in the initial audit, but thanks to intervention strategies, care improved in the subsequent audit. Conclusions: Improving intrapartum care in labour wards by skilled birth attendants and an improved referral system is critical if stillbirths are to be averted.

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

“…The included studies had one or more of the following aims when conducting a stillbirth review: to prevent stillbirth, to improve all aspects of care by making adequate and informed recommendation guided by clear local/national/international criteria or practices 3 , 15 , 17 , 25 , 36 , 39 , 43 , 46 , 51 , 52 , 55 , 56 , 57 , 64 , 65 , 69 , 73 , 75 ; to analyse cause/s of stillbirth and/or any suboptimal care during the pregnancy 3 , 10 , 11 , 15 , 16 , 19 , 20 , 21 , 22 , 23 , 24 , 26 , 28 , 29 , 30 , 31 , 32 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 45 , 47 , 50 , 53 , 54 , 58 , 59 , 61 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 77 ; to evaluate the current review process or tool implemented and what the facilitators or barriers were…”

Approaches, enablers, barriers and outcomes of implementing facility-based stillbirth and neonatal death audit in LMICs: a systematic review

“…The second three studies used a confidential inquiry approach 19 or external researchers 20 or external and internal auditors. 21 These external multidisciplinary teams were not involved in the care of patients; they audited the cases and gave feedback to facility staff to implement recommendations.…”

“…No study reported newborn morbidity outcomes. One study 21 reported a reduction in the incidence of maternal obstetric complications such as obstructed labour and antepartum haemorrhage, which contributes to stillbirths, following the implementation of a fresh stillbirth audit using standards as a benchmark ( table 3 ).…”

“…23 One study used a criteria-based audit approach, where initial death audit of fresh stillbirths was undertaken and Open access developed standards as a benchmark to improve care. 21 This was followed up by reaudit of stillbirths to assess adherence to standards. Most death audit approach activities were implemented at the facility level (eg, conducting audits,recommending solutions, implementing recommendations and training).…”

“…Table templates for tables 2 and 3 were adapted from Lazzerini et al 27 Process Five studies reported changes in the process of care. One study 21 cited quantitative process outcomes against eight predefined standards, and all eight standards showed some significant improvement (table 3). Another study, 19 reported improvements in standard care and case management of complications during labour and delivery.…”