Incidence of intrapartum stillbirth and associated risk factors in tertiary care setting of Nepal: a case-control study

Abstract

BackgroundEach year, 1.2 million intrapartum stillbirths occur globally. In Nepal, about 50 % of the total number of stillbirths occur during the intrapartum period. An understanding of the risk factors associated with intrapartum stillbirth will facilitate the development of preventative strategies to reduce the associated burden of death. This study was conducted in a tertiary-care setting with the aim to identify risk factors associated with intrapartum stillbirth.MethodsA case–control study was completed from July 2012 to September 2013. All women who had an intrapartum stillbirth during the study period were included as cases, and 20 % of women with live births were randomly selected upon admission to create the referent population. Relevant information was retrieved from clinical records for case and referent women. In addition, interviews were completed with each woman to determine their demographic and obstetric history.ResultsDuring the study period, 4,476 women were enrolled as referents and 136 women had intrapartum stillbirths. The following factors were found to be associated with an increased risk for intrapartum stillbirth: poor familial wealth quintile (Adj OR 1.8, 95 % CI-1.1–3.4); less maternal education (Adj OR, 3.2 95 % CI-1.8–5.5); lack of antenatal care (Adj OR, 4.8 95 % CI 3.2–7.2); antepartum hemorrhage (Adj OR 2.1, 95 % CI 1.1–4.2); multiple births (Adj. OR-3.0, 95 % CI- 1.9–5.4); obstetric complication during labor (Adj. OR 4.5, 95 % CI-2.9–6.9); lack of fetal heart rate monitoring per protocol (Adj. OR-1.9, 95 % CI 1.5–2.4); lack of partogram use (Adj. OR-2.1, 95 % CI 1.1–4.1); small-for-gestational age (Adj. OR-1.8, 95 % CI-1.2–1.7); preterm birth (Adj. OR-5.4, 95 % CI 3.5–8.2); and being born preterm with a small-for-gestational age (Adj. OR-9.0, 95 % CI 7.3–15.5).ConclusionBeing born preterm with a small-for-gestational age was associated with the highest risk for intrapartum stillbirth. Inadequate fetal heart rate monitoring and partogram use are preventable risk factors associated with intrapartum stillbirth; by increasing adherence to these interventions the risk of intrapartum stillbirth can be reduced. The association of the lack of appropriate antenatal care with intrapartum stillbirth indicates that quality antenatal care may improve fetal health and outcomes.Trial registrationISRCTN97846009

Ten years analysis of stillbirth in a tertiary hospital in sub-Sahara Africa: a case control study

“…The association between pre-eclampsia/eclampsia and stillbirth has been well described in literature as this usually leads to utero—placenta insufficiency, intrauterine growth restriction and consequently intrauterine foetal death. This association has been confirmed in numerous studies [ 14 , 15 , 17 ] and similarly in our study as the odds of developing stillbirth was about 3 times higher in women with a history of pre-eclampsia/eclampsia (OR 2.97, 95% CI 0.87–8.89, p value of 0.03). This association disappeared when we did a multivariate analysis (p = 0.80).…”

The Association of Women’s Empowerment with Stillbirths in Nepal

“…It has also been corroborated by a meta-analysis which mentioned that women aged 35 years and more contributed to stillbirth (Flenady et al 2011). Similar findings have been reported from other studies (Aminu et al 2014;KC et al 2016;Lawn et al 2016;Yudkin et al 1987).…”

“…A recent study conducted in Ethiopia found that women from a wealthy background were less likely to have stillbirths (Lakew et al 2017). Other studies have also found similar linkages for wealth status and stillbirths (Aminu et al 2014;KC et al 2016;Kwagala et al 2016).…”

“…Poorer women are already at a disadvantage as they suffer more stillbirths than women who are from well-off backgrounds (Flenady et al 2011). This is probably due, at least in part, to less access to prenatal care (KC et al 2016). Additional risk factors for stillbirths include previous stillbirths (Aminu et al 2014) and advanced maternal age, specifically being above 35 years of age (Flenady et al 2011).…”

Factors associated with stillbirth in selected countries of South Asia: A systematic review of observational studies

“…Six studies examined the association between prematurity and stillbirth; of which, four case control studies conducted in India [ 17 , 35 ], Bangladesh [ 36 ], and Nepal [ 33 ]; and two cross-sectional studies conducted in India [ 26 ], and Pakistan [ 29 ] found a significant association between premature labour and stillbirth ( Table 1 ). Maternal hypertensive disorder during pregnancy was associated with stillbirth in India [ 17 , 18 ], Pakistan [ 29 ], Nepal [ 32 ], and Bangladesh [ 25 ].…”