Global Network for Women's and Children's Health Research: probable causes of stillbirth in low‐ and middle‐income countries using a prospectively defined classification system

McClure, Elizabeth M; Garcés, Ana; Saleem, Sarah; Moore, Janet; Bose, Carl; Esamai, Fabian; Goudar, Shivaprasad S.; Chomba, Elwyn; Mwenechanya, Musaku; Pasha, Omrana; Tshefu, Antoinette; Patel, Archana; Dhaded, Sangappa; Tenge, Constance; Marete, Irene; Bauserman, Melissa; Sunder, Shiyam; Kodkany, Bhala; Carlo, Waldemar A.; Derman, Richard J.; Hibberd, Patricia L.; Liechty, E. A.; Hambidge, K. Michael; Krebs, Nancy F.; Koso‐Thomas, Marion; Miodovnik, Menachem; Wallace, D. D.; Goldenberg, Renato

doi:10.1111/1471-0528.14493

Cited by 52 publications

(72 citation statements)

References 36 publications

(79 reference statements)

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“…The relatively high proportion of stillbirths attributed to intrapartum hypoxia ( Hypoxic peripartum ) in LIC versus HIC and MIC is in line with recent evidence from low‐ and middle‐income countries (LMIC) and confirms the urgency of improving care during labour and birth, when half of all global stillbirths occur . Further, as in other reports, we identified infection as a top cause of stillbirths in LIC, confirming the importance of infection prevention and management . Our findings clearly highlight the importance of placental conditions as a major contributor to stillbirths in all settings, consistent with other recent studies .…”

Section: Discussionsupporting

confidence: 90%

Making stillbirths visible: a systematic review of globally reported causes of stillbirth

Reinebrant

Leisher

Coory

et al. 2017

BJOG

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145

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Background Stillbirth is a global health problem. The World Health Organization (WHO) application of the International Classification of Diseases for perinatal mortality (ICD‐PM) aims to improve data on stillbirth to enable prevention. Objectives To identify globally reported causes of stillbirth, classification systems, and alignment with the ICD‐PM. Search strategy We searched CINAHL, EMBASE, Medline, Global Health, and Pubmed from 2009 to 2016. Selection criteria Reports of stillbirth causes in unselective cohorts. Data collection and analysis Pooled estimates of causes were derived for country representative reports. Systems and causes were assessed for alignment with the ICD‐PM. Data are presented by income setting (low, middle, and high income countries; LIC, MIC, HIC). Main results Eighty‐five reports from 50 countries (489 089 stillbirths) were included. The most frequent categories were Unexplained, Antepartum haemorrhage, and Other (all settings); Infection and Hypoxic peripartum (LIC), and Placental (MIC, HIC). Overall report quality was low. Only one classification system fully aligned with ICD‐PM. All stillbirth causes mapped to ICD‐PM. In a subset from HIC, mapping obscured major causes. Conclusions There is a paucity of quality information on causes of stillbirth globally. Improving investigation of stillbirths and standardisation of audit and classification is urgently needed and should be achievable in all well‐resourced settings. Implementation of the WHO Perinatal Mortality Audit and Review guide is needed, particularly across high burden settings. Funding HR, SH, SHL, and AW were supported by an NHMRC‐CRE grant (APP1116640). VF was funded by an NHMRC‐CDF (APP1123611). Tweetable abstract Urgent need to improve data on causes of stillbirths across all settings to meet global targets. Plain Language Summary Background and methodsNearly three million babies are stillborn every year. These deaths have deep and long‐lasting effects on parents, healthcare providers, and the society. One of the major challenges to preventing stillbirths is the lack of information about why they happen. In this study, we collected reports on the causes of stillbirth from high‐, middle‐, and low‐income countries to: (1) Understand the causes of stillbirth, and (2) Understand how to improve reporting of stillbirths. FindingsWe found 85 reports from 50 different countries. The information available from the reports was inconsistent and often of poor quality, so it was hard to get a clear picture about what are the causes of stillbirth across the world. Many different definitions of stillbirth were used. There was also wide variation in what investigations of the mother and baby were undertaken to identify the cause of stillbirth. Stillbirths in all income settings (low‐, middle‐, and high‐income countries) were most frequently reported as Unexplained, Other, and Haemorrhage (bleeding). Unexplained and Other are not helpful in understanding why a baby was stillborn. In low‐income countries, stillbirths were often attribute...

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Section: Discussionsupporting

confidence: 90%

Making stillbirths visible: a systematic review of globally reported causes of stillbirth

Reinebrant

Leisher

Coory

et al. 2017

BJOG

Self Cite

145

138

View full text Add to dashboard Cite

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“…The vast majority of stillbirths and neonatal deaths (perinatal deaths) occur in low‐ and some middle‐income countries (LMICs), comprising the majority of mortality in the under‐fives . Knowing why fetuses and newborns die is an important first step in developing and implementing interventions to reduce these deaths.…”

Section: Disclosure Of Interestsmentioning

confidence: 99%

“…Knowing why fetuses and newborns die is an important first step in developing and implementing interventions to reduce these deaths. Currently in LMICs, the cause of death is not routinely determined for stillbirths, and limited information has been available to determine the cause of neonatal deaths . When a cause of death is identified at all, it is often ascertained by a physician or other health professional based on clinical information, and therefore is, at best, an educated guess.…”

Section: Disclosure Of Interestsmentioning

confidence: 99%

“…Linking multiple studies and using techniques such as artificial intelligence should increase the efficiency of defining cause of stillbirth and neonatal death for large studies and programme monitoring. In the past, we have shown that computer algorithms are useful to determine the cause of death for stillbirths and neonatal deaths using basic clinical data . We believe that with more extensive data from the clinical course, laboratory and imaging, and with some but not extensive MITS and microbiology data, algorithms can be created to produce accurate cause‐of‐death results.…”

Section: Disclosure Of Interestsmentioning

confidence: 99%

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Thoughts on assigning cause of death for stillbirth and neonatal death: a commentary

Goldenberg

McClure

2019

BJOG

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“…Therefore, these classification systems provide a general idea of the context in which fetal death occurred, rather than providing unequivocal proof of the cause of death (e.g. total placental abruption [67, 68] or maternal trauma [69–71]).…”

Section: Introductionmentioning

confidence: 99%

Fetal death: an extreme manifestation of maternal anti-fetal rejection

Lannaman

Romero

Chaiworapongsa

et al. 2017

Journal of Perinatal Medicine

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Objective The aim of this study was to determine the association between chronic placental inflammation and amniotic fluid (AF) markers of maternal anti-fetal rejection as well as the presence of microorganisms in the AF fluid of patients with fetal death. Study Design This cohort study included 40 patients with fetal death whose placentas were examined for chronic inflammatory lesions and whose AF chemokine ligand (CXCL)10 and interleukin (IL)-6 concentrations were determined by immunoassays. AF was processed for bacteria, mycoplasmas and viruses using cultivation and molecular microbiologic techniques (i.e. PCR-ESI/MS). Results (1) The most prevalent placental findings were maternal vascular underperfusion (63.2%, 24/38), followed by chronic inflammatory lesions (57.9%, 22/38); (2) chronic chorioamnionitis (18/38) was three times more frequent than villitis of unknown etiology (6/38); (3) an elevated AF CXCL10 concentration (above the 95th centile) was present in 60% of the cases, and a receiver operating characteristics (ROC)-derived cut-off of 2.9 ng/mL had a sensitivity of 73% and a specificity of 75% in the identification of chronic placental inflammatory lesions; (4) only five cases had microbial invasion of the amniotic cavity, and the presence of microorganisms did not correlate with chronic placental inflammation. Conclusion In women with unexplained fetal death, there is an association between elevated AF CXCL10 and chronic placental inflammatory lesions. Therefore, we conclude that a subset of patients with fetal death may have endured a breakdown of maternal-fetal tolerance, which cannot be attributed to microorganisms in the amniotic cavity.

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Global Network for Women's and Children's Health Research: probable causes of stillbirth in low‐ and middle‐income countries using a prospectively defined classification system

Cited by 52 publications

References 36 publications

Making stillbirths visible: a systematic review of globally reported causes of stillbirth

Making stillbirths visible: a systematic review of globally reported causes of stillbirth

Thoughts on assigning cause of death for stillbirth and neonatal death: a commentary

Fetal death: an extreme manifestation of maternal anti-fetal rejection

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