Risk factors for stillbirths: how much can a responsive health system prevent?

Abstract

BackgroundThe stillbirth rate is an indicator of quality of care during pregnancy and delivery. Good quality care is supported by a functional heath system. The objective of this study was to explore the risk factors for stillbirths, particularly those related to a health system.MethodsThis case-control study was conducted in two districts of Bihar, India. Information on cases (stillbirths) were obtained from facilities as reported by Health Management Information System; controls were consecutive live births from the same population as cases. Data were collected from 400 cases and 800 controls. The risk factors were compared using a hierarchical approach and expressed as odds ratio, attributable fractions and population attributable fractions.ResultsOf all the factors studied, 22 risk factors were independently associated with stillbirths. Health system-related factors were: administration of two or more doses of oxytocics to augment labour before reaching the facilities (OR 1.6; 95% CI 1.2–2.1), any complications during labour (OR 2.3;1.7–3.1), >30 min to reach a facility from home (OR 1.4;1.05–1.8), >10 min to attend to the pregnant woman after reaching the facility (OR 2.8;1.7–4.5). In the final regression model, modifiable health system-related risk factors included: >10 min taken to attend to women after they reach the facilities (AOR 3.6; 95% CI 2.5–5.1), untreated hypertension during pregnancy (AOR 2.9; 95% CI 1.5–5.6) and presence of any complication during labour, warranting treatment (AOR 1.7; 95% CI 1.2–2.4). Among mothers who reported complications during labour, time taken to reach the facility was significantly different between stillbirths and live births (2nd delay; 33.5 min v/s 25 min; p < 0.001). Attributable fraction for any complication during labour was 0.56 (95% CI 0.42–0.67), >30 min to reach the facility 0.48 (95% CI 0.31–0.60) and institution of management 10 min after reaching the facility 0.68 (95% CI 0.58–0.75). Reaching a facility within 30 min, initiation of management within 10 min of reaching the facility and timely management of complications during labour could have prevented 17%, 37% and 20% of stillbirths respectively.ConclusionA pro-active health system with accessible, timely and quality obstetric services can prevent a considerable proportion of stillbirths in low and middle income countries.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-1660-1) contains supplementary material, which is available to authorized users.

Incidence and maternal-fetal risk factors of stillbirth: A population-based historical cohort and a nested case-control study

“…The findings of this study showed that the cumulative incidence of stillbirth was 9.48 per 1000 live birth. In a study conducted by Tshibumbu et al, 2014 in Namibia, the rate of stillbirth was reported as 12 per 1000 births [18], and the incidence of the stillbirth in hospital in few months was 8% or 80 per associated with stillbirth, which was in line with the results of our study [21][22][23][24][25][26]. Gestational hypertension increases the risk placenta to be separated earlier by twofold, leading to fetal-growth disorders, by increasing the risk of maternal mortality by threefold [27].…”

Rate, determinants, and causes of stillbirth in Jordan: Findings from the Jordan Stillbirth and Neonatal Surveillance (JSANDS) system

“…The WHO has reported that deficiencies in the quality of antenatal care play significant role in increasing stillbirth rate (28). A wise coverage of basic antenatal care can prevent a significant proportion of stillbirths (29). Afulani reported a decrease in the odds of having a stillbirth by half with a high quality of antenatal care (30).…”

“…It is imperative, therefore, to increase our attention for stillbirths and preterm birth interventions, which will positively impact on the maternal and newborn health outcomes (31). Investing in the health care system and providing a good quality and timely maternal services may prevent significant ratio of stillbirths (29).…”

Rate, determinants, and causes of stillbirth in Jordan: Findings from the Jordan Stillbirth and Neonatal Deaths Surveillance (JSANDS) system

“…It is imperative, therefore, to increase our attention for stillbirths and preterm birth interventions, which will positively impact the maternal and newborn health outcomes (31). Investing in the health care system and providing good-quality and timely maternal services may prevent a signi cant ratio of stillbirths (32). In interpretation of the study ndings, one should consider that the study of speci c causes of stillbirth has been hampered by lack of investigations such as fetal autopsy and genetic evaluation.…”