Maternal and fetal characteristics and causes of stillbirth in a tertiary care hospital of Nepal: secondary analysis of registry-based surveillance data

Abstract

ObjectivesStillbirth is one of the vital indicators of quality care. This study aimed to determine maternal-fetal characteristics and causes of stillbirth in Nepal.DesignSecondary analysis of single-centred registry-based surveillance data.SettingThe study was conducted at the Department of Obstetrics and Gynecology, Chitwan Medical College Teaching Hospital, a tertiary care hospital located in Bharatpur, Nepal.ParticipantsAll deliveries of intrauterine fetal death, at or beyond 22 weeks’ period of gestation and/or birth weight of 500 g or more, conducted between 16 July 2017 and 15 July 2019 were included in the study.Main outcome measuresThe primary outcome measure of this study was stillbirth, and the secondary outcome measures were maternal and fetal characteristics and cause of stillbirth.ResultsOut of 5282 institutional deliveries conducted over 2 years, 79 (1.5%) were stillbirths, which gives the stillbirth rate of 15 per 1000 births. Of them, the majority (75; 94.9%) were vaginal delivery and only four (5.1%) were caesarean section (p<0.0001). The proportion of the macerated type of stillbirth was more than that of the fresh type (58.2% vs 41.8%; p=0.13). Only half of the mothers who experienced stillbirth had received antenatal care. While the cause of fetal death was unknown in one-third of cases (31.6%; 25/79), among likely causes, the most common was maternal hypertension (29.1%), followed by intrauterine infection (8.9%) and fetal malpresentation (7.6%). Four out of 79 stillbirths (5%) had a birth defect.ConclusionHigh rate of stillbirths in Nepal could be due to the lack of quality antenatal care. The country’s health systems should be strengthened so that pregnancy-related risks such as maternal hypertension and infections are identified early on. Upgrading mothers’ hygiene and health awareness is equally crucial in reducing fetal deaths in low-resource settings.

Stillbirths among Pregnant Women Admitted to Department of Obstetrics in a Tertiary Care Centre: A Descriptive Cross-sectional Study

“…It is detected that most stillbirths occur in the age group 20-35 years. 15 In our study, mothers with primiparity constituted 42% of all stillbirths. This result is comparable to the few other studies.…”

“…12 The incidence of stillbirth in our study is comparable to the incidence of 19.6, 23.5 and 22 per 1000 births observed in some other studies. [13][14][15] Compared to available studies on stillbirth, the incidence of stillbirth found in this study is possibly the highest compared to other South Asian countries. 16 It is found that stillbirth is more common among mothers aged 20-25 years (43.65%) in this study.…”

“…Similar findings of 'preterm stillbirths' were observed also in a few other studies. [12][13][14][15][16] Likewise, more than half of all stillbirths were found in preterm births in some studies. [18][19][20][21] In this study, few risk factors were found in 38.9% of cases of stillbirths.…”

Risk Factor of Stillbirth among Pregnant Women at Dr. Hasan Sadikin General Hospital Bandung from 2017–2020

“…The 12 Other studies done in Nepal from 2017-2019 and Ethiopia in 2018 showed similar results, where most of the cases have occurred at the age range of 21-30 years old (67.1%) and 20-34 years old (77.7%), respectively. 13,14 Stillbirth at 28 weeks gestation or after was more frequently seen in this study with a median of 30 weeks. Similar results were also reported in the United States of America from March 2020-September 2021, 55.8% with a median of 29 weeks.…”

“…6,12 Different results were also reported by a study in Nepal from 2017-2019, where one-third of stillbirth patients had unknown causes or possible causes of stillbirth. 13 Congenital abnormalities affect 31 (14.2%) stillbirth patients in this study. This finding is higher from the previous systematic review involving several countries worldwide, with an overall percentage of 11%, but lower than what was reported from a study in Qatar with the percentage of 21.6%.…”