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Åmark, Hanna, Christina Pilo, and Ingela Hulthén Varli. "Stillbirth in term and late term gestations in Stockholm during a 20-year period, incidence and causes." PLOS ONE 16, no. 5 (May 25, 2021): e0251965. http://dx.doi.org/10.1371/journal.pone.0251965.
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Introduction The incidence of stillbirth has decreased marginally or remained stable during the past decades in high income countries. A recent report has shown Stockholm to have a lower incidence of stillbirth at term than other parts of Sweden. The risk of antepartum stillbirth increases in late term and postterm pregnancies which is one of the factors contributing to the current discussion regarding the optimal time of induction of labor due to postterm pregnancy. Material and methods This is a cohort study based on the Stockholm Stillbirth Database which contains all cases of stillbirth from 1998-2018 in Stockholm County. All cases were reviewed systematically and the cause of death was evaluated according to the Stockholm Stillbirth Classification. Stillbirths diagnosed between gestational week (GW) 37+0 and 40+6 n = 605 were compared to stillbirths diagnosed from GW 41+0 and onwards n = 157, according to the cause of stillbirth and pregnancy and maternal characteristics. The aim was to evaluate the incidence of stillbirth over time and the incidence of stillbirth diagnosed from GW 41+0. Results In Stockholm County the overall incidence of stillbirth has decreased from 4.6/1000 births during the period 1998-2004 to 3.4/1000 births during the period 2014-2018, p-value <0.001. When comparing the same time periods, the incidence of stillbirth diagnosed from GW 41+0 and onwards has decreased from 0.5/1000 births to 0.15/1000 births, p-value <0.001. Among women still pregnant at GW 41+0 the incidence of stillbirth has decreased from 1.8/ 1000 to 0.5/ 1000. When comparing stillbirths diagnosed at GW 37+0-40+6 with stillbirths diagnosed from GW 41+0 and onwards infection was a more common cause of stillbirth in the latter group. Conclusion In Stockholm County there was a decreasing incidence of stillbirth overall and in stillbirths diagnosed from 41+0 weeks of gestation and onwards during the period 1998-2018. In stillbirths diagnosed from GW 41+0 and onwards infection was a more common cause of death compared to stillbirths diagnosed between GW 37+0 and 40+6.
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Gordon, Louisa G., Thomas M. Elliott, Tania Marsden, David A. Ellwood, T. Yee Khong, Jessica Sexton, and Vicki Flenady. "Healthcare costs of investigations for stillbirth from a population-based study in Australia." Australian Health Review 45, no. 6 (2021): 735. http://dx.doi.org/10.1071/ah20291.
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ObjectiveStillbirth investigations incur healthcare costs, but these investigations are necessary to provide information that will help reduce the risk of a recurrent stillbirth, as well as advice regarding family planning and future pregnancies. The aims of this study were to determine the healthcare costs of investigations for stillbirths, identify drivers and assess cost differences between explained and unexplained stillbirths. MethodsData from 697 stillbirths were extracted from the Stillbirth Causes Study covering the period 2013–18. The dataset comprised all investigations related to stillbirth on the mother, baby and placenta. Unit costs applied were sourced from the Australian Medicare Benefits Schedule, local hospital estimates and published literature. Multivariable regression analyses were used to assess key factors in cost estimates. ResultsIn all, 200 (28.7%) stillbirths were unexplained and 76.8% of these had between five and eight core investigations. Unexplained stillbirths were twice as likely to have eight core investigations as explained stillbirths (16.5% vs 7.7%). The estimated aggregated cost of stillbirth investigations for 697 stillbirths was A$2.13 million (mean A$3060, median A$4246). The main cost drivers were autopsies or cytogenetic screening. Mean costs were similar when stillbirths had known or unknown causes and by reason for stillbirth among cases with definable causes. ConclusionInvestigations for stillbirth in Australia cost approximately A$4200 per stillbirth on average and are critical for managing future pregnancies and preventing more stillbirths. These findings improve our understanding of the costs that may be averted if stillbirths can be prevented through primary prevention initiatives. What is known about the topic?Approximately 2000 stillbirths occur each year in Australia, and this trend has not changed for several decades. Stillbirth investigations incur healthcare costs, but these investigations are necessary to provide information to help reduce the risk of a recurrent stillbirth and advice regarding family planning and future pregnancies. Recommendations for the core set of stillbirth investigations have recently been agreed upon by consensus. What does this paper add?The costs of stillbirth investigations are unknown in Australia. The assessment of these costs is challenging because not all investigations involved in stillbirths are recorded within formal administrative systems because a stillborn baby is not formally recognised as a patient. The present population-based analysis of 697 stillbirths in Australia estimated that, on average, A$4200 was spent on investigations for each stillbirth, with key drivers being autopsies and cytogenetic screening. These costs are typical, with most cases having between five and eight of the core eight recommended investigations. What are the implications for practitioners?There are cost implications for stillbirth investigations, and this analysis gives a true account of current practice in Australia. Together with the high downstream economic costs of stillbirths, the cost burden of stillbirth investigations is high but ultimately avoidable when practitioners adhere to the core investigations, build knowledge around preventable risk factors and use this information to reduce the number of stillbirths.
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Gibbins, Karen J., Halit Pinar, Uma M. Reddy, George R. Saade, Robert L. Goldenberg, Donald J. Dudley, Carolyn Drews-Botsch, et al. "Findings in Stillbirths Associated with Placental Disease." American Journal of Perinatology 37, no. 07 (May 14, 2019): 708–15. http://dx.doi.org/10.1055/s-0039-1688472.
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Objective Placental disease is a leading cause of stillbirth. Our purpose was to characterize stillbirths associated with placental disease. Study Design The Stillbirth Collaborative Research Network conducted a prospective, case–control study of stillbirths and live births from 2006 to 2008. This analysis includes 512 stillbirths with cause of death assignment and a comparison group of live births. We compared exposures between women with stillbirth due to placental disease and those due to other causes as well as between women with term (≥ 37 weeks) stillbirth due to placental disease and term live births. Results A total of 121 (23.6%) out of 512 stillbirths had a probable or possible cause of death due to placental disease by Initial Causes of Fetal Death. Characteristics were similar between stillbirths due to placental disease and other stillbirths. When comparing term live births to stillbirths due to placental disease, women with non-Hispanic black race, Hispanic ethnicity, lack of insurance, or who were born outside of the United States had higher odds of stillbirth due to placental disease. Nulliparity and antenatal bleeding also increased risk of stillbirth due to placental disease. Conclusion Multiple discrete exposures were associated with stillbirth caused by placental disease. The relationship between these factors and utility of surveillance warrants further study.
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Kerby, Alan, Daniel Shingleton, Gauri Batra, Megan C. Sharps, Bernadette C. Baker, and Alexander E. P. Heazell. "Placental Morphology and Cellular Characteristics in Stillbirths in Women With Diabetes and Unexplained Stillbirths." Archives of Pathology & Laboratory Medicine 145, no. 1 (March 13, 2020): 82–89. http://dx.doi.org/10.5858/arpa.2019-0524-oa.
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Context.— Women with diabetes have increased stillbirth risk. Although the underlying pathophysiological processes are poorly understood, stillbirth is frequently related to abnormal placental structure and function. Objective.— To investigate placental morphology and cellular characteristics in the placentas of women with diabetes who had stillbirths and stillbirths of unexplained cause. Design.— Placentas from women with uncomplicated live births, live births in women with diabetes, unexplained stillbirths, and stillbirths related to diabetes (n = 10/group) underwent clinical histopathologic assessment and were also investigated using immunohistochemical staining to quantify syncytial nuclear aggregates, proliferation, trophoblast area, vascularization, T cells, placental macrophages (Hofbauer cells), and the receptor for advanced glycation end products. Results.— Ki67+ cells were decreased in unexplained stillbirths compared with live births in women with diabetes. Both stillbirth groups had increased cytokeratin 7+/nuclear area compared with controls. Blood vessels/villi were decreased in unexplained stillbirth compared with live births from women with diabetes. Compared with uncomplicated controls, CD163+ macrophages were increased in live births in women with diabetes and unexplained stillbirths, and further increased in stillbirths related to diabetes. There was no change in CD3+ T cells or syncytial nuclear aggregates. Receptor for advanced glycation end products–positive cells were decreased in both stillbirth groups compared with diabetes-related live births. Co-localization of receptor for advanced glycation end products in macrophages was increased in both stillbirth groups compared with live birth groups. Conclusions.— Stillbirths related to diabetes exhibit placental phenotypic differences compared with live births. Further investigation of these parameters may provide understanding of the pathologic mechanisms of stillbirth and aid the development of stillbirth prevention strategies.
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Parmar, Mehul T., Zalak V. Karena, and Kruti D. Shah. "One year observational study of stillbirths in a referral hospital of Saurashtra region." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 9, no. 1 (December 26, 2019): 18. http://dx.doi.org/10.18203/2320-1770.ijrcog20195572.
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Background: Stillbirths constitute a major part of perinatal death, and India ranks first in absolute number of stillbirths. The causes of stillbirth differ in different parts of the world and are affected by fetomaternal factors and type of antenatal and intrapartum care. The objective of this study was to evaluate the stillbirth rate as well as the aetiology and risk factors for stillbirths in our institute.Methods: All stillbirths delivered at or above 28 weeks of gestation or weighing more than 1000 gms in P. D. U. Medical College and Hospital, Rajkot during study period of 1 year were enrolled in the study. The stillbirth rate of the institute was studied. Socio-demographic, maternal and fetal factors of stillbirth cases were analysed.Results: Stillbirth rate of our institute was 41.63 per 1000 births. 70% cases belonged to rural region and 48% cases were referred to our hospital from other institutes. Stillbirth was found more in multigravida women with 67.2% cases. 57.01% stillborn babies were males, 34.71% of stillborns had extremely low birth weight and were pre-term. 54.78% stillborns were macerated. In 24.8% cases, aetiology of stillbirth was unknown. Antepartum haemorrhage contributed 19% cases, asphyxia -16.8% cases and pre-eclampsia-12.1% cases of stillbirth in our study.Conclusions: Proper screening and antenatal and intrapartum supervision and timely referral to the tertiary care centre can play an important role in decreasing the rate of stillbirths.
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Buralli, Rafael Junqueira, Zilda Pereira da Silva, Gizelton Pereira Alencar, Gerusa Maria Figueiredo, Mara Sandra Hoshida, Expedito J. A. Luna, Luciana Duzolina Manfré Pastro, et al. "Assessing the risks for stillbirth in São Paulo, Brazil: protocol for a multidisciplinary case–control study – FetRisks." BMJ Open 14, no. 6 (June 2024): e079261. http://dx.doi.org/10.1136/bmjopen-2023-079261.
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Stillbirth is a fundamental component of childhood mortality, but its causes are still insufficiently understood. This study aims to explore stillbirth risk factors by using a multidisciplinary approach to stimulate public policies and protocols to prevent stillbirth, improve maternal care and support bereaved families.Methods and analysisIn this case–control study with stillbirths and live births in 14 public hospitals in São Paulo, mothers are interviewed at hospitals after delivery, and hospital records and prenatal care registries are reviewed. Maternal and umbilical cord blood samples and placentas are collected to analyse angiogenesis and infection biomarkers, and the placenta’s anatomopathological exam. Air pollutant exposure is estimated through the participant’s residence and work addresses. Traditional and non-invasive autopsies by image-guided histopathology are conducted in a subset of stillbirths. Subsample mothers of cases are interviewed at home 2 months after delivery on how they were dealing with grief. Information contained in the official prenatal care registries of cases and controls is being compiled. Hospital managers are interviewed about the care offered to stillbirth mothers. Data analysis will identify the main risk factors for stillbirth, investigate their interrelations, and evaluate health services care and support for bereaved families. We hope this project will contribute to the understanding of stillbirth’s risk factors and related health services in Brazil, providing new knowledge about this central public health problem, contributing to the improvement of public policies and prenatal and puerperal care, helping to prevent stillbirths and improve the healthcare and support for bereaved families.Ethics and disseminationThis study protocol was approved by the Ethics Committee of the Municipal Health Secretary (process no 16509319.0.3012.5551) and of the Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (process no 16509319.0.0000.0068). Results will be communicated to the study participants, policy-makers and the scientific community.
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Lehtonen, Tanita, Tuomas Markkula, Pasi Soidinsalo, Saara Otonkoski, and Jukka Laine. "Causes of Stillbirth in Turku, Finland, 2001–2011." Pediatric and Developmental Pathology 20, no. 1 (February 2017): 5–15. http://dx.doi.org/10.1177/1093526616686236.
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The objective of the study was to examine the causes of stillbirth in the district of Southwest Finland and to assess the importance of postmortem examination and the selection of a suitable classification system for classifying stillbirths. This study is a cohort study where the fetal autopsies were performed in the Department of Pathology at Turku University Hospital, Finland, 2001–2011. Stillbirths from singleton pregnancies at the gestational age of ≥ 24 + 0 weeks (if unknown, gestational weight ≥ 500 g) (n = 98) were selected. In addition, stillbirths from multiple gestations (n = 6) were also analyzed. The causes of stillbirths were classified according to the Relevant Condition at Death classification system. Maternal risk factors and the role of fetal gestational age and weight for the causes of stillbirth were assessed. The most common causes of singleton stillbirth were lethal congenital anomalies, placental insufficiencies, and constricting loops and knots of the umbilical cord. The cause of singleton stillbirth could be determined for 78% of the cases, leaving 22% unclassified. There were no significant differences in the causes of stillbirth by gestational age or weight. Smoking may increase the incidence of placental abruption ( P < 0.01). The most common causes of stillbirth in Turku, Finland, are consistent with findings from other high-income countries. With careful postmortem examination and ancillary studies, it is possible to find the cause of stillbirth for most of the cases. Even if the stillbirth is left unexplained, many other harmful conditions can be excluded thus benefiting both the parents and the health care unit.
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Tanner, Darren, Sushama Murthy, Juan M. Lavista Ferres, Jan-Marino Ramirez, and Edwin A. Mitchell. "Risk factors for late (28+ weeks’ gestation) stillbirth in the United States, 2014–2015." PLOS ONE 18, no. 8 (August 30, 2023): e0289405. http://dx.doi.org/10.1371/journal.pone.0289405.
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Background In the United States (US) late stillbirth (at 28 weeks or more of gestation) occurs in 3/1000 births. Aim We examined risk factors for late stillbirth with the specific goal of identifying modifiable factors that contribute substantially to stillbirth burden. Setting All singleton births in the US for 2014–2015. Methods We used a retrospective population-based design to assess the effects of multiple factors on the risk of late stillbirth in the US. Data were drawn from the US Centers for Disease Control and Prevention live birth and fetal death data files. Results There were 6,732,157 live and 18,334 stillbirths available for analysis (late stillbirth rate = 2.72/1000 births). The importance of sociodemographic determinants was shown by higher risks for Black and Native Hawaiian and Other Pacific Islander mothers compared with White mothers, mothers with low educational attainment, and older mothers. Among modifiable risk factors, delayed/absent prenatal care, diabetes, hypertension, and maternal smoking were associated with increased risk, though they accounted for only 3–6% of stillbirths each. Two factors accounted for the largest proportion of late stillbirths: high maternal body mass index (BMI; 15%) and infants who were small for gestational age (38%). Participation in the supplemental nutrition for women, infants and children program was associated with a 28% reduction in overall stillbirth burden. Conclusions This study provides population-based evidence for stillbirth risk in the US. A high proportion of late stillbirths was associated with high maternal BMI and small for gestational age, whereas participation in supplemental nutrition programs was associated with a large reduction in stillbirth burden. Addressing obesity and fetal growth restriction, as well as broadening participation in nutritional supplementation programs could reduce late stillbirths.
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Lethro, Pema, Kinga Jamphel, Vandana Joshi, Chandralal Mongar, Lobzang Tshering, and Tashi Tshomo. "Stillbirth rate in Bhutan: a retrospective facility-based study." Bhutan Health Journal 4, no. 2 (November 15, 2018): 35–38. http://dx.doi.org/10.47811/bhj.66.
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Introduction: Stillbirth is an important public health concern; yet there is no reliable stillbirth rate for Bhutan. Hence the aim of this study was to estimate the stillbirth rate for Bhutan.
Methods: A retrospective study was carried out for live and stillbirths recorded in delivery registers of all 253 health facilities across the country for a period of one year commencing 1st January till 31st December 2015.
Results: There were a total of 11,126 live births and 108 stillbirths documented in delivery registers. The stillbirth rate from this data set was 10 per 1000 live births.
Conclusions: The stillbirth rate for Bhutan from this study is 10 per 1000 live births lower than 16 per 1000 live births estimated in Lancet Series 2015. In order to find the true burden of stillbirths in the country, a surveillance may be instituted which can facilitate the prevention efforts while at the same time enable to strengthen information system.
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Malango, A. E. "Pathological Study of Stillbirths Placentas at Muhimbili National Hospital, Tanzania." American Journal of Clinical Pathology 154, Supplement_1 (October 2020): S22—S23. http://dx.doi.org/10.1093/ajcp/aqaa161.041.
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Abstract Introduction/Objective Stillbirth is defined as fetal death that occurs at gestational age of ≥28 weeks. In our setting clinical assessment is the only method used to determine cause of stillbirths, with no reported proportion of unknown clinical diagnosis. Studies showed that unknown cause of stillbirths can be reduced by examination of placenta. Causal identification aids in the mourning process and identifying recurrence risks. The study aimed to describe pathological changes in the placentas of stillbirths which have risk to cause fetal death Methods A descriptive cross-sectional study done for the period of 6 months, it involved examination of 80 placentas of stillbirths born at gestational age of ≥ 28 weeks, placentas were fixed in 10% neutral buffered formalin for 8–12 hours. Grossing and interpretation of placenta pathology was according to Amsterdam Placental Workshop Group Consensus Statement. Results Out of 80 stillbirths, 32(40%) had unknown clinical diagnosis. Majority of stillbirth placentas 71(91%) found with either one or combined pathologies with the risk to cause stillbirth. Maternal vascular malperfusion was the commonest pathology and was significantly associated with preterm stillbirths. Maternal floor infarction, a placenta pathology with risk to cause fetal death and high risk of recurrence was among the pathologies found, was seen in 4(5%) of stillbirth placentas. Conclusion Findings in this study clearly indicated the importance of pathological examination of placenta in determining cause of stillbirth. Placenta examination in stillbirths can identify more pathology related to stillbirths than clinical assessment alone.
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Rivera-Núñez, Zorimar, J. Michael Wright, and Amy Meyer. "Exposure to disinfectant by-products and the risk of stillbirth in Massachusetts." Occupational and Environmental Medicine 75, no. 10 (July 30, 2018): 742–51. http://dx.doi.org/10.1136/oemed-2017-104861.
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ObjectivesWe examined stillbirths in relation to disinfection by-product (DBP) exposures including chloroform, bromodichloromethane (BDCM), dibromochloromethane, bromoform, trichloroacetic acid, dichloroacetic acid (DCAA), monobromoacetic acid and summary DBP measures (trihalomethanes (THM4), haloacetic acids (HAA5), THMBr (brominated trihalomethanes) and DBP9 (sum of THM4 and HAA5)).MethodsWe randomly selected 10 controls for each of the 2460 stillbirth cases with complete quarterly 1997–2004 THM4 and HAA5 town-level drinking water data. Adjusted (aORs) were calculated based on weight-averaged second-trimester DBP exposures.ResultsWe detected statistically significant associations for stillbirths and the upper DCAA quartiles (aOR range: 1.50–1.71). We also found positive associations for the upper four HAA5 quintiles and different stillbirth cause of death categories that were examined including unexplained stillbirth (aOR range: 1.24–1.72), compression of umbilical cord (aOR range: 1.08–1.94), prematurity (aOR range: 1.37–2.88), placental separation and haemorrhage (aOR range: 1.44–2.01) and asphyxia/hypoxia (aOR range: 1.52–1.97). Additionally, we found positive associations between stillbirths and chloroform exposure (aOR range: 1.29 – 1.36) and unexplained stillbirths and BDCM exposure (aOR range: 1.51 – 1.78). We saw no evidence of exposure–response relationships for any categorical DBP metrics.ConclusionsConsistent with some previous studies, we found associations between stillbirths and chloroform and unexplained stillbirth and BDCM exposures. These findings strengthen existing evidence of prenatal THM exposures increasing the risk of stillbirth. Additionally, we saw statistically significant associations between DCAA and stillbirth. Future research should examine cause-specific stillbirths in relation to narrower critical windows and additional DBP exposure metrics beyond trihalomethanes and haloacetic acids.
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Kamilova, Markhabo, Parvina Dzhonmakhmadova, and Farangis Ishan-Khodzhaeva. "ASSESSMENT OF RISK FACTORS AND DETERMINING THE LEVEL OF PREVENTABLE FETAL DEATH IN WOMEN WITH TROUBLED PREGNANCY." Avicenna Bulletin 22, no. 1 (March 1, 2020): 14–21. http://dx.doi.org/10.25005/2074-0581-2020-22-1-14-21.
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Objective: To examine the risk factors of stillbirth in the Republic of Tajikistan. Methods: Maps of individual observation of the course of pregnancy and the history of births of women with antenatal and intranatal fetal death in institutions of III and II levels have been studied. Retrospectively has been conducted the clinical audit of 187 cases of stillbirth. Results: The main causes of stillbirths were intrauterine growth retardation syndrome and fetal malformations. The most common risk factors for stillbirth were factors associated with inadequate medical care and factors related to family and women. At the same time, most of the cases of antenatal fetal death (83%) and intranatal fetal death (74%) were preventable or conditionally preventable. Conclusions: Our research confirms the need for perinatal audit, which aims to find the causes and risk factors of stillbirth with the subsequent implementation of solutions to prevent such cases of stillbirths in the future. Keywords: Stillbirths, antenatal fetal death, intranatal fetal death, classification of the ReCoDe, risk factors, levels of, levels of preventable stillbirth
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Zile, Ebela, and Rumba-Rozenfelde. "Maternal Risk Factors for Stillbirth: A Registry–Based Study." Medicina 55, no. 7 (July 1, 2019): 326. http://dx.doi.org/10.3390/medicina55070326.
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Background and Objectives: The number of stillbirths has reduced more slowly than has maternal mortality or mortality in children younger than 5 years, which were explicitly targeted in the Millennium Development Goals. Placental pathologies and infection associated with preterm birth are linked to a substantial proportion of stillbirths. Appropriate preconception care and quality antenatal care that is accessible to all women has the potential to reduce stillbirth rates. The aim of the present study was to assess potential risk factors associated with stillbirth within maternal medical diseases and obstetric complications. Materials and Methods: Retrospective cohort study (2001–2014) was used to analyse data from the Medical Birth Register on stillbirth and live births as controls. Adjusted Odds ratios (aOR) with 95% confidence intervals (CI) were estimated. Multiple regression model adjusted for maternal age, parity and gestational age. Results: The stillbirth rate was 6.2 per 1000 live and stillbirths. The presence of maternal medical diseases greatly increased the risk of stillbirth including diabetes mellitus (aOR = 2.5; p < 0.001), chronic hypertension 3.1 (aOR = 3.1; p < 0.001) and oligohydromnios/polyhydromnios (aOR = 2.4; p < 0.001). Pregnancy complications such as intrauterine growth restriction (aOR = 2.2; p < 0.001) was important risk factor for stillbirth. Abruption was associated with a 2.8 odds of stillbirth. Conclusions: Risk factors most significantly associated with stillbirth include maternal history of chronic hypertension and abruptio placenta which is a common cause of death in stillbirth. Early identification of potential risk factors and appropriate perinatal management are important issues in the prevention of adverse fetal outcomes and preventive strategies need to focus on improving antenatal detection of fetal growth restriction.
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Mensah Abrampah, Nana A., Yemisrach B. Okwaraji, Danzhen You, Lucia Hug, Salome Maswime, Caroline Pule, Hannah Blencowe, and Debra Jackson. "Global Stillbirth Policy Review – Outcomes And Implications Ahead of the 2030 Sustainable Development Goal Agenda." International Journal of Health Policy and Management 12 (August 15, 2023): 7391. http://dx.doi.org/10.34172/ijhpm.2023.7391.
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Background: Globally, data on stillbirth is limited. A call to action has been issued to governments to address the data gap by strengthening national policies and strategies to drive urgent action on stillbirth reduction. This study aims to understand the policy environment for stillbirths to advance stillbirth recording and reporting in data systems. Methods: A systematic three-step process (survey tool examination, identifying relevant study questions, and reviewing country responses to the survey and national documents) was taken to review country responses to the global 2018-2019 World Health Organization (WHO) Reproductive, Maternal, Neonatal, Child and Adolescent Health (RMNCAH) Policy Survey. Policy Survey responses were reviewed to identify if and how stillbirths were included in national documents. This paper uses descriptive analyses to identify and describe the relationship between multiple variables. Results: Responses from 155 countries to the survey were analysed, and over 800 national policy documents submitted by countries in English reviewed. Fewer than one-fifth of countries have an established stillbirth rate (SBR) target, with higher percentages reported for under-5 (71.0%) and neonatal mortality (68.5%). Two-thirds (65.8%) of countries reported a national maternal death review panel. Less than half (43.9%) of countries have a national policy that requires stillbirths to be reviewed. Two-thirds of countries have a national policy requiring review of neonatal deaths. WHO websites and national health statistics reports are the common data sources for stillbirth estimates. Countries that are signatories to global initiatives on stillbirth reduction have established national targets. Globally, nearly all countries (94.8%) have a national policy that requires every death to be registered. However, 45.5% of reviewed national policy documents made mention of registering stillbirths. Only 5 countries had national policy documents recommending training of health workers in filling out death certificates using the International Classification of Diseases (ICD)-10 for stillbirths. Conclusion: The current policy environment in countries is not supportive for identifying stillbirths and recording causes of death. This is likely to contribute to slow progress in stillbirth reduction. The paper proposes policy recommendations to make every baby count.
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Yatich, Nelly J., Ellen Funkhouser, John E. Ehiri, Tsiri Agbenyega, Jonathan K. Stiles, Julian C. Rayner, Archer Turpin, et al. "Malaria, Intestinal Helminths and Other Risk Factors for Stillbirth in Ghana." Infectious Diseases in Obstetrics and Gynecology 2010 (2010): 1–7. http://dx.doi.org/10.1155/2010/350763.
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Objective. The objective of the study was to assess Plasmodium/intestinal helminth infection in pregnancy and other risk factors for stillbirth in Ghana.Methods. A cross-sectional study of women presenting for delivery in two hospitals was conducted during November-December 2006. Data collected included sociodemographic information, medical and obstetric histories, and anthropometric measures. Laboratory investigations for the presence ofPlasmodium falciparumand intestinal helminths, and tests for hemoglobin levels were also performed.Results. The stillbirth rate was relatively high in this population (5%). Most of the stillbirths were fresh and 24% were macerated. When compared to women with no malaria, women with malaria had increased risk of stillbirth (OR=1.9, 95% CI=1.2–9.3). Other factors associated with stillbirth were severe anemia, low serum folate concentration, past induced abortion, and history of stillbirth.Conclusion. The fact that most of the stillbirths were fresh suggests that higher quality intrapartum care could reduce stillbirth rates.
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Mali, Rajshekher V., Anita Dalal, Romana Khursheed, and Aditya Gan. "Association of Stillbirths with Maternal and Fetal Risk Factors in a Tertiary Care Hospital in South India." Obstetrics and Gynecology International 2021 (July 22, 2021): 1–8. http://dx.doi.org/10.1155/2021/8033248.
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Background. Birth of a fetus with no signs of life after a predefined age of viability is a nightmare for the obstetrician. Stillbirth is a sensitive indicator of maternal care during the antepartum and intrapartum period. Though there has been a renewed global focus on stillbirth as a public health concern, the decline in stillbirth rate (SBR) has not been satisfactory across the nations, with a large number of stillbirths occurring in the low- to middle-income countries (LMICs). Hence, the study was carried out to analyze maternal and fetal risk factors and their association with stillbirths in a tertiary care center in South India. Methods. This observational prospective study included pregnant women with stillbirth beyond 20 weeks of gestation or fetal weight more than 500 grams. Stillbirths were classified according to the simplified causes of death and associated conditions (CODAC) classification. Association between the risk factor and stillbirths was calculated with chi-square test and odds ratio with 95% confidence interval. Results. There were 171 stillbirths (2.97%) among total 5755 births. The SBR was 29.71/1000 births. Risk factors such as preterm delivery (OR: 22.33, 95% CI: 15.35–32.50), anemia (OR: 21.87, 95% CI: 15.69–30.48), congenital malformation (OR: 11.24, 95% CI: 6.99–18.06), abruption (OR: 10.14, 95% CI: 6.43–15.97), oligohydramnios (OR: 4.88, 95% CI: 3.23–7.39), and hypertensive disorder (OR: 3.01, 95% CI: 2.03–4.46) were significantly associated with stillbirths. The proportion of intrapartum stillbirths was found to be 5 (3%) among the study population. Conclusion. Highest prevalent risk factors associated with stillbirth are anemia and prematurity. Intrapartum stillbirths can be reduced significantly through evidence-based clinical interventions and practices in resource-poor settings. There is a need to provide and assure access to specialized quality antenatal care to pregnant women to control the risk factors associated with stillbirths.
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Lema, Godwin, Alex Mremi, Patrick Amsi, Jeremia J. Pyuza, Julius P. Alloyce, Bariki Mchome, and Pendo Mlay. "Placental pathology and maternal factors associated with stillbirth: An institutional based case-control study in Northern Tanzania." PLOS ONE 15, no. 12 (December 31, 2020): e0243455. http://dx.doi.org/10.1371/journal.pone.0243455.
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Objective To determine the placental pathologies and maternal factors associated with stillbirth at Kilimanjaro Christian Medical Centre, a tertiary referral hospital in Northern Tanzania. Methods A 1:2 unmatched case-control study was carried out among deliveries over an 8-month period. Stillbirths were a case group and live births were the control group. Respective placentas of the newborns from both groups were histopathologically analyzed. Maternal information was collected via chart review. Mean and standard deviation were used to summarize the numerical variables while frequency and percentage were used to summarize categorical variables. Crude and adjusted logistic regressions were done to test the association between each variable and the risk of stillbirth. Results A total of 2305 women delivered during the study period. Their mean age was 30 ± 5.9 years. Of all deliveries, 2207 (95.8%) were live births while 98 (4.2%) were stillbirths. Of these, 96 stillbirths (cases) and 192 live births (controls) were enrolled. The average gestational age for the enrolled cases was 33.8 ±3.2 weeks while that of the controls was 36.3±3.6 weeks, (p-value 0.244). Of all stillbirths, nearly two thirds 61(63.5%) were males while the females were 35(36.5%). Of the stillbirth, 41were fresh stillbirths while 55 were macerated. The risk of stillbirth was significantly associated with lower maternal education [aOR (95% CI): 5.22(2.01–13.58)], history of stillbirth [aOR (95%CI): 3.17(1.20–8.36)], lower number of antenatal visits [aOR (95%CI): 6.68(2.71–16.48), pre/eclampsia [aOR (95%CI): 4.06(2.03–8.13)], and ante partum haemorrhage [OR (95%CI): 2.39(1.04–5.53)]. Placental pathology associated with stillbirth included utero-placental vascular pathology and acute chorioamnionitis. Conclusions Educating the mothers on the importance of regular antenatal clinic attendance, monitoring and managing maternal conditions during antenatal periods should be emphasized. Placentas from stillbirths should be histo-pathologically evaluated to better understand the possible aetiology of stillbirths.
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E. Hall, Ronald. "ASIAN STILLBIRTHS VIS-À-VIS BLEACHING CREAM TOXICITY: COLORISM AS CRITICAL SOCIAL WORK EXPLANATION." Asian People Journal (APJ) 5, no. 1 (April 28, 2022): 1–10. http://dx.doi.org/10.37231/apj.2022.5.1.292.
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Abstract: Colorism as suggested by social science is a veiled construct less acknowledged in the Social Work curriculum and the Social Work literature. The objective of colorism directs Asian women to engage in efforts that they may acquire by artificial means access to having light skin. Such access is facilitated by application of toxic bleaching cream ingredients which include mercury, arsenic and hydroquinone. According to empirical investigations said ingredients factor in events of stillbirth colorism. Light-skinned Asian women are less susceptible to such stillbirth events attributed to their inherent complexions. The continual use of toxic bleaching creams may be an explanation of the 33 1/3% of global stillbirths unresolved. As pertains to Asian countries in general India, Pakistan, and China significantly account for nearly 50% of all the stillbirths globally. The acknowledgement of colorism in the context of Asian women experiencing stillbirth must be addressed by unveiling the stillbirth crisis.
Keywords: Asian; Stillbirth; Dark skin; Health risks
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Popoola, Tosin, Joan Skinner, and Martin Woods. "Exploring the Social Networks of Women Bereaved by Stillbirth: A Descriptive Qualitative Study." Journal of Personalized Medicine 11, no. 11 (October 21, 2021): 1056. http://dx.doi.org/10.3390/jpm11111056.
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The loss of a baby to stillbirth is a traumatic experience and can lead to secondary losses, such as the loss of social relationships. In Nigeria, stillbirths are a common public health problem. However, limited attention has been given to the social ramifications of stillbirths. This study describes the social networks of women who have experienced a stillbirth and the factors influencing their social networks. Interviews and social network diagrams were used to collect data from 20 women about their social networks before and after stillbirth. Findings suggest that the experience of shame, unmet expectation of support, and a lack of trust led to relationship changes after stillbirth. Most participants met bereavement needs with their existing social networks before stillbirth, but many participants also experienced relationship losses (even among family networks). Information from social network analysis can reveal the risks and strengths inherent in social networks, which can be helpful for the provision of tailored/personalized bereavement care.
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Makasa, Musonda, Wilbroad Mutale, Mwansa Ketty Lubeya, Tepwanji Mpetemoya, Mukambo Chinayi, Benedictus Mangala, Musole Chipoya, and Patrick Kaonga. "Determinants of stillbirth in the Five General Hospitals of Lusaka, Zambia: A Case-Control study." Medical Journal of Zambia 50, no. 1 (December 2, 2023): 35–46. http://dx.doi.org/10.55320/mjz.50.1.395.
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Objective: We aimed to assess determinants of stillbirths among women who delivered from the five general hospitals of Lusaka city, Zambia. Methods: We conducted an unmatched case-control study. Cases were consecutively enrolled, and controls were randomly selected within 24 hours of occurrence of a case. A structured questionnaire was used to collect data, and multiple regression was used to assess determinants of stillbirths. A p-value of <0.05 was considered sufficient evidence of an association between stillbirth and independent variables. Results: A total of 58 cases and 232 controls were included in the analysis. Compared with women who delivered babies with birth weight <2500 grams, the risk of stillbirth for women who had babies with birth weight ≥2500 was higher (AOR= 4.49; 95% CI: 2.84 – 8.99); antepartum haemorrhage (AOR = 3.18; 95% CI: 1.21 – 8.09); previous experience of stillbirth (AOR=3.99; 95% CI: 1.73 – 6.73) compared with their counterparts without. Additionally, women with parity > 2 (AOR = 3.02; 95% CI: 1.07 – 7.54) had higher odds of stillbirth compared to those with parity ≤ 2. Conclusion: Birth weight ≥2.5 kg, antepartum haemorrhage, previous stillbirth were determinants of stillbirth. Program implementers should consider strategies that can mitigate these determinants to reduce stillbirth.
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Best, Kate E., Sarah E. Seaton, Elizabeth S. Draper, David J. Field, Jennifer J. Kurinczuk, Bradley N. Manktelow, and Lucy K. Smith. "Assessing the deprivation gap in stillbirths and neonatal deaths by cause of death: a national population-based study." Archives of Disease in Childhood - Fetal and Neonatal Edition 104, no. 6 (March 6, 2019): F624—F630. http://dx.doi.org/10.1136/archdischild-2018-316124.
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ObjectiveTo investigate socioeconomic inequalities in cause-specific stillbirth and neonatal mortality to identify key areas of focus for future intervention strategies to achieve government ambitions to reduce mortality rates.DesignRetrospective cohort study.SettingEngland, Wales, Scotland and the UK Crown Dependencies.ParticipantsAll singleton births between 1 January 2014 and 31 December 2015 at ≥24 weeks’ gestation.Main outcome measureCause-specific stillbirth or neonatal death (0–27 days after birth) per 10 000 births by deprivation quintile.ResultsData on 5694 stillbirths (38.1 per 10 000 total births) and 2368 neonatal deaths (15.9 per 10 000 live births) were obtained from Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK). Women from the most deprived areas were 1.68 (95% CI 1.56 to 1.81) times more likely to experience a stillbirth and 1.67 (95% CI 1.48 to 1.87) times more likely to experience a neonatal death than those from the least deprived areas, equating to an excess of 690 stillbirths and 231 neonatal deaths per year associated with deprivation. Small for gestational age (SGA) unexplained antepartum stillbirth was the greatest contributor to excess stillbirths accounting for 33% of the deprivation gap in stillbirths. Congenital anomalies accounted for the majority (59%) of the deprivation gap in neonatal deaths, followed by preterm birth not SGA (24–27 weeks, 27%).ConclusionsCause-specific mortality rates at a national level allow identification of key areas of focus for future intervention strategies to reduce mortality. Despite a reduction in the deprivation gap for stillbirths and neonatal deaths, public health interventions should primarily focus on socioeconomic determinants of SGA stillbirth and congenital anomalies.
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Gurung, Rejina, Helena Litorp, Sara Berkelhamer, Hong Zhou, Bhim Singh Tinkari, Prajwal Paudel, Honey Malla, Srijana Sharma, and Ashish KC. "The burden of misclassification of antepartum stillbirth in Nepal." BMJ Global Health 4, no. 6 (December 2019): e001936. http://dx.doi.org/10.1136/bmjgh-2019-001936.
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BackgroundGlobally, every year 1.1 million antepartum stillbirths occur with 98% of these deaths taking place in countries where the health system is poor. In this paper we examine the burden of misclassification of antepartum stillbirth in hospitals of Nepal and factors associated with misclassification.MethodA prospective observational study was conducted in 12 hospitals of Nepal for a period of 6 months. If fetal heart sounds (FHS) were detected at admission and during the intrapartum period, the antepartum stillbirth (fetal death ≥22 weeks prior labour) recorded in patient’s case note was recategorised as misclassified antepartum stillbirth. We further compared sociodemographic, obstetric and neonatal characteristics of misclassified and correctly classified antepartum stillbirths using bivariate and multivariate analysis.ResultA total of 41 061 women were enrolled in the study and 39 562 of the participants’ FHS were taken at admission. Of the total participants whose FHS were taken at admission, 94.8% had normal FHS, 4.7% had abnormal FHS and 0.6% had no FHS at admission. Of the total 119 recorded antepartum stillbirths, 29 (24.4%) had FHS at admission and during labour and therefore categorised as misclassified antepartum stillbirths. Multivariate analysis performed to adjust the risk of association revealed that complications during pregnancy resulted in a threefold risk of misclassification (adjusted OR-3.35, 95% CI 1.95 to 5.76).ConclusionAlmost 25% of the recorded antepartum stillbirths were misclassified. Improving quality of data is crucial to improving accountability and quality of care. As the interventions to reduce antepartum stillbirth differ, accurate measurement of antepartum stillbirth is critical.Trial registration numberISRCTN30829654.
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de Mucio, Bremen, Claudio Sosa, Mercedes Colomar, Luis Mainero, Carmen M. Cruz, Luz M. Chévez, Rita Lopez, et al. "The burden of stillbirths in low resource settings in Latin America: Evidence from a network using an electronic surveillance system." PLOS ONE 18, no. 12 (December 22, 2023): e0296002. http://dx.doi.org/10.1371/journal.pone.0296002.
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Objective To determine stillbirth ratio and its association with maternal, perinatal, and delivery characteristics, as well as geographic differences in Latin American countries (LAC). Methods We analysed data from the Perinatal Information System of the Latin American Center for Perinatology and Human Development (CLAP) between January 2018 and June 2021 in 8 health facilities from five LAC countries (Bolivia, Guatemala, Honduras, Nicaragua, and the Dominican Republic). Maternal, pregnancy, and delivery characteristics, in addition to pregnancy outcomes were reported. Estimates of association were tested using chi-square tests, and P < 0.05 was regarded as significant. Bivariate analysis was conducted to estimate stillbirth risk. Prevalence ratios (PR) with their 95% confidence intervals (CI) for each predictor were reported. Results In total, 101,852 childbirths comprised the SIP database. For this analysis, we included 99,712 childbirths. There were 762 stillbirths during the study period; the Stillbirth ratio of 7.7/1,000 live births (ranged from 3.8 to 18.2/1,000 live births across the different maternities); 586 (76.9%) were antepartum stillbirths, 150 (19.7%) were intrapartum stillbirths and 26 (3.4%) with an ignored time of death. Stillbirth was significantly associated with women with diabetes (PRadj 2.36; 95%CI [1.25–4.46]), preeclampsia (PRadj 2.01; 95%CI [1.26–3.19]), maternal age (PRadj 1.04; 95%CI [1.02–1.05]), any medical condition (PRadj 1.48; 95%CI [1.24–1.76, and severe maternal outcome (PRadj 3.27; 95%CI [3.27–11.66]). Conclusions Pregnancy complications and maternal morbidity were significantly associated with stillbirths. The stillbirth ratios varied across the maternity hospitals, which highlights the importance for individual surveillance. Specialized antenatal and intrapartum care remains a priority, particularly for women who are at a higher risk of stillbirth.
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Jammeh, Abdou, Siri Vangen, and Johanne Sundby. "Stillbirths in Rural Hospitals in The Gambia: A Cross-Sectional Retrospective Study." Obstetrics and Gynecology International 2010 (2010): 1–8. http://dx.doi.org/10.1155/2010/186867.
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Objective. We determined the stillbirth rate and associated factors among women who delivered in rural hospitals in The Gambia.Method. A cross-sectional retrospective case review of all deliveries between July and December 2008 was undertaken. Maternity records were reviewed and abstracted of the mother’s demographic characteristics, obstetric complications and foetal outcome.Main Outcome Measure: The stillbirth rate was calculated as deaths per 1000 births.Results. The hospital-based stillbirth rate was high, 156 (95% CI 138–174) per 1000 births. Of the 1,519 deliveries, there were 237 stillbirths of which 137 (57.8%) were fresh. Severe obstetric complication, birth weight<2500 g, caesarean section delivery, and referral from a peripheral health facility were highly significantly associated with higher stillbirth rates, OR = 6.68 (95% CI 3.84–11.62), 4.47 (95% CI 3.04–6.59), 4.35 (95% CI 2.46–7.69), and 3.82 (95% CI 2.24–6.51), respectively. Half (50%) of the women with stillbirths had no antenatal care OR = 4. 46(95% CI 0.84–23.43).Conclusion. We observed an unacceptably high stillbirth rate in this study. As most of the stillbirths were fresh, improved intrapartum care supported by emergency transport services and skilled personnel could positively impact on perinatal outcomes in rural hospitals in The Gambia.
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Thorsten, Vanessa, Donald Dudley, Corette Parker, Matthew Koch, Carol Hogue, Barbara Stoll, Robert Silver, et al. "Stillbirth, Inflammatory Markers, and Obesity: Results from the Stillbirth Collaborative Research Network." American Journal of Perinatology 35, no. 11 (April 2, 2018): 1071–78. http://dx.doi.org/10.1055/s-0038-1639340.
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Background Obesity is associated with increased risk of stillbirth, although the mechanisms are unknown. Obesity is also associated with inflammation. Serum ferritin, C-reactive protein, white blood cell count, and histologic chorioamnionitis are all markers of inflammation. Objective This article determines if inflammatory markers are associated with stillbirth and body mass index (BMI). Additionally, we determined whether inflammatory markers help to explain the known relationship between obesity and stillbirth. Study Design White blood cell count was assessed at admission to labor and delivery, maternal serum for assessment of various biomarkers was collected after study enrollment, and histologic chorioamnionitis was based on placental histology. These markers were compared for stillbirths and live births overall and within categories of BMI using analysis of variance on logarithmic-transformed markers and logistic regression for dichotomous variables. The impact of inflammatory markers on the association of BMI categories with stillbirth status was assessed using crude and adjusted odds ratios (COR and AOR, respectively) from logistic regression models. The interaction of inflammatory markers and BMI categories on stillbirth status was also assessed through logistic regression. Additional logistic regression models were used to determine if the association of maternal serum ferritin with stillbirth is different for preterm versus term births. Analyses were weighted for the overall population from which this sample was derived. Results A total of 497 women with singleton stillbirths and 1,414 women with live births were studied with prepregnancy BMI (kg/m2) categorized as normal (18.5–24.9), overweight (25.0–29.9), or obese (30.0 + ). Overweight (COR, 1.48; 95% confidence interval [CI]: 1.14–1.94) and obese women (COR, 1.60; 95% CI: 1.23–2.08) were more likely than normal weight women to experience stillbirth. Serum ferritin levels were higher (geometric mean: 37.4 ng/mL vs. 23.3, p < 0.0001) and C-reactive protein levels lower (geometric mean: 2.9 mg/dL vs. 3.3, p = 0.0279), among women with stillbirth compared with live birth. Elevated white blood cell count (15.0 uL × 103 or greater) was associated with stillbirth (21.2% SB vs. 10.0% live birth, p < 0.0001). Histologic chorioamnionitis was more common (33.2% vs. 15.7%, p < 0.0001) among women with stillbirth compared with those with live birth. Serum ferritin, C-reactive protein, and chorioamnionitis had little impact on the ORs associating stillbirth with overweight or obesity. Adjustment for elevated white blood cell count did not meaningfully change the OR for stillbirth in overweight versus normal weight women. However, the stillbirth OR for obese versus normal BMI changed by more than 10% when adjusting for histologic chorioamnionitis (AOR, 1.38; 95% CI: 1.02–1.88), indicating confounding. BMI by inflammatory marker interaction terms were not significant. The association of serum ferritin levels with stillbirth was stronger among preterm births (p = 0.0066). Conclusion Maternal serum ferritin levels, elevated white blood cell count, and histologic chorioamnionitis were positively and C-reactive protein levels negatively associated with stillbirth. Elevated BMIs, both overweight and obese, were associated with stillbirth when compared with women with normal BMI. None of the inflammatory markers fully accounted for the relationship between obesity and stillbirth. The association of maternal serum ferritin with stillbirth was stronger in preterm than term stillbirths.
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Tsanova, Dima K., and Toni Y. Vekov. "Regional Variations in Stillbirth and Relation Between Extramarital Birth and Stillbirth in Bulgaria." Journal of Biomedical and Clinical Research 11, no. 1 (July 1, 2018): 30–35. http://dx.doi.org/10.2478/jbcr-2018-0005.
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Summary Stillbirth rate is an essential indicator of population health and is much more common than presumed. In 2014, it was 7.34‰ in Bulgaria. These trends are seen against the background of a continuous process of increasing proportion of births to unmarried women. This report aims to investigateand conduct a comparative analysis of indicators of stillbirth and extramarital births in Bulgaria for a 15-year period. The data was derived from the National Statistical Institute (NSI) and Eurostat and statistically processed with Statistical Package for Social Science version 24.0 (SPSS v.24.0). The correlation coefficient of Pearson was used to establish the relationship between stillbirth rates and extramarital births. Despite the technological progress of contemporary medicine, the stillbirth rate in Bulgaria during the last 15 years remained almost the same – from 7.48‰ in 2000 to 7.34‰ in 2014. One of the factors that may increase the risk for stillbirth is the marital status of the mother. The proportion of extramarital stillbirths for the country was 74.70% of all stillbirths for 2014, but in several districts, this proportion was 100%. Extramarital births and stillbirth rate in Bulgaria seem to be related. There are persisting regional differences in Bulgaria. A potential explanation includes health inequalities and welfare differences.
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Awoleke, Jacob Olumuyiwa, and Abiodun Idowu Adanikin. "Baird-Pattinson Aetiological Classification and Phases of Delay Contributing to Stillbirths in a Nigerian Tertiary Hospital." Journal of Pregnancy 2016 (2016): 1–5. http://dx.doi.org/10.1155/2016/1703809.
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Purpose. This study aims to identify triggers of stillbirth in the study setting and to make suggestions to reduce the prevalence.Method. A three-year retrospective case-control study of stillbirths at Ekiti State University Teaching Hospital.Results. The stillbirth rate was 33 per 1000 births. Based on Baird-Pattinson classification of the primary obstetric causes of stillbirth, adverse intrapartum events, hypertensive diseases, and unexplained intrapartum fetal deaths were topmost causes of stillbirths. In comparison with the controls, other identified predictors of SB were grand multiparity (p=0.016), delays in seeking medical care and/or in receiving treatment (p=0.001), wrong initial diagnosis (p=0.001), inadequate intrapartum monitoring (p=0.001), and inappropriate clinical management (p=0.001).Conclusion. Stillbirth rate remains high in our setting. Elimination of obstacles to accessing care, effective management of hypertensive disorders in pregnancy, updated health facilities, improved dedication to duty, and retraining of health workers will reduce the prevalence.
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Quincer, Elizabeth, Rebecca Philipsborn, Diane Morof, Navit T. Salzberg, Pio Vitorino, Sara Ajanovic, Dickens Onyango, et al. "Insights on the differentiation of stillbirths and early neonatal deaths: A study from the Child Health and Mortality Prevention Surveillance (CHAMPS) network." PLOS ONE 17, no. 7 (July 21, 2022): e0271662. http://dx.doi.org/10.1371/journal.pone.0271662.
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Introduction The high burden of stillbirths and neonatal deaths is driving global initiatives to improve birth outcomes. Discerning stillbirths from neonatal deaths can be difficult in some settings, yet this distinction is critical for understanding causes of perinatal deaths and improving resuscitation practices for live born babies. Methods We evaluated data from the Child Health and Mortality Prevention Surveillance (CHAMPS) network to compare the accuracy of determining stillbirths versus neonatal deaths from different data sources and to evaluate evidence of resuscitation at delivery in accordance with World Health Organization (WHO) guidelines. CHAMPS works to identify causes of stillbirth and death in children <5 years of age in Bangladesh and 6 countries in sub-Saharan Africa. Using CHAMPS data, we compared the final classification of a case as a stillbirth or neonatal death as certified by the CHAMPS Determining Cause of Death (DeCoDe) panel to both the initial report of the case by the family member or healthcare worker at CHAMPS enrollment and the birth outcome as stillbirth or livebirth documented in the maternal health record. Results Of 1967 deaths ultimately classified as stillbirth, only 28 (1.4%) were initially reported as livebirths. Of 845 cases classified as very early neonatal death, 33 (4%) were initially reported as stillbirth. Of 367 cases with post-mortem examination showing delivery weight >1000g and no maceration, the maternal clinical record documented that resuscitation was not performed in 161 cases (44%), performed in 14 (3%), and unknown or data missing for 192 (52%). Conclusion This analysis found that CHAMPS cases assigned as stillbirth or neonatal death after DeCoDe expert panel review were generally consistent with the initial report of the case as a stillbirth or neonatal death. Our findings suggest that more frequent use of resuscitation at delivery and improvements in documentation around events at birth could help improve perinatal outcomes.
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Christou, Aliki, Camille Raynes-Greenow, Adela Mubasher, Sayed Murtaza Sadat Hofiani, Mohammad Hafiz Rasooly, Mohammad Khakerah Rashidi, and Neeloy Ashraful Alam. "Explanatory models of stillbirth among bereaved parents in Afghanistan: Implications for stillbirth prevention." PLOS Global Public Health 3, no. 6 (June 21, 2023): e0001420. http://dx.doi.org/10.1371/journal.pgph.0001420.
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Local perceptions and understanding of the causes of ill health and death can influence health-seeking behaviour and practices in pregnancy. We aimed to understand individual explanatory models for stillbirth in Afghanistan to inform future stillbirth prevention. This was an exploratory qualitative study of 42 semi-structured interviews with women and men whose child was stillborn, community elders, and healthcare providers in Kabul province, Afghanistan between October-November 2017. We used thematic data analysis framing the findings around Kleinman’s explanatory framework. Perceived causes of stillbirth were broadly classified into four categories–biomedical, spiritual and supernatural, extrinsic factors, and mental wellbeing. Most respondents attributed stillbirths to multiple categories, and many believed that stillbirths could be prevented. Prevention practices in pregnancy aligned with perceived causes and included engaging self-care, religious rituals, superstitious practices and imposing social restrictions. Symptoms preceding the stillbirth included both physical and non-physical symptoms or no symptoms at all. The impacts of stillbirth concerned psychological effects and grief, the physical effect on women’s health, and social implications for women and how their communities perceive them. Our findings show that local explanations for stillbirth vary and need to be taken into consideration when developing health education messages for stillbirth prevention. The overarching belief that stillbirth was preventable is encouraging and offers opportunities for health education. Such messages should emphasise the importance of care-seeking for problems and should be delivered at all levels in the community. Community engagement will be important to dispel misinformation around pregnancy loss and reduce social stigma.
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Ogunbode, Olayinka Oladunjoye, Mobolaji P. Oyeyiola, and Ayodele O. Arowojo. "Clinical Audit of Stillbirths at a Faith-Based Secondary Health Centre in Ibadan, Nigeria: A Six-Year Review." Medical Journal of Zambia 49, no. 2 (November 21, 2022): 157–62. http://dx.doi.org/10.55320/mjz.49.2.9.
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Objective: The determine the prevalence of stillbirth and identify associated factors among pregnant women.
Method: This was a retrospective audit of two hundred and twenty-five stillbirth deliveries at Our lady of Apostle, Catholic Hospital, Oluyoro, Oke-Offa, Ibadan, Nigeria, between January 1, 2013, and December 31, 2018. Data was extracted from hospital records for socio-demographic characteristics, obstetric factors, complications, and outcomes of pregnancy. Data analysis was done using SPSS version 20 and the level of statistical significance was set at p < 0.05.
Results: The stillbirth rate was 27.75 per 1000 births. More than half (129; 57.4%) were macerated. The ratio of stillbirth rate among the booked and unbooked parturients was 1:21. The common causes of stillbirths were hypertensive disorders in pregnancy (24.9%) and anaemia in pregnancy (20.4%) while the least were congenital anomalies (1.0%) and gestational diabetes mellitus (1.0%).
Conclusion: This study confirmed that most of the stillbirths were due to unsupervised or poorly supervised pregnancies. There is need to ensure quality antenatal care services for the early detection and management of risk factors in order to reduce the burden of stillbirths.
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Ogunbode, Olayinka Oladunjoye, Mobolaji Philip Oyeyiola, and Ayodele Olatunji Arowojolu. "Clinical Audit of Stillbirths at a Faith-Based Secondary Health Centre in Ibadan, Nigeria: A Six-Year Review." Medical Journal of Zambia 49, no. 2 (November 21, 2022): 157–62. http://dx.doi.org/10.55320/mjz.49.2.1067.
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Objective: The determine the prevalence of stillbirth and identify associated factors among pregnant women.
Method: This was a retrospective audit of two hundred and twenty-five stillbirth deliveries at Our lady of Apostle, Catholic Hospital, Oluyoro, Oke-Offa, Ibadan, Nigeria, between January 1, 2013, and December 31, 2018. Data was extracted from hospital records for socio-demographic characteristics, obstetric factors, complications, and outcomes of pregnancy. Data analysis was done using SPSS version 20 and the level of statistical significance was set at p < 0.05.
Results: The stillbirth rate was 27.75 per 1000 births. More than half (129; 57.4%) were macerated. The ratio of stillbirth rate among the booked and unbooked parturients was 1:21. The common causes of stillbirths were hypertensive disorders in pregnancy (24.9%) and anaemia in pregnancy (20.4%) while the least were congenital anomalies (1.0%) and gestational diabetes mellitus (1.0%).
Conclusion: This study confirmed that most of the stillbirths were due to unsupervised or poorly supervised pregnancies. There is need to ensure quality antenatal care services for the early detection and management of risk factors in order to reduce the burden of stillbirths.
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Merc, Maja Dolanc, Borut Peterlin, and Luca Lovrecic. "The Genetic Approach to Stillbirth: A Systematic Review." Obstetrical & Gynecological Survey 79, no. 3 (March 2024): 139–41. http://dx.doi.org/10.1097/ogx.0000000000001259.
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ABSTRACT Stillbirth represents a significant burden to individuals and families and has a great variety of causes, but much is still unknown about the underlying etiologies. The overall contribution of genetic abnormalities to stillbirth is not well known; this study was designed to evaluate known genetic causes of unexplained stillbirths, as well as understand the current position and future direction for using genetic and genomic testing in this field. This study was a systematic review of literature published between 1953 and 2020 on genetic testing and stillbirth. Inclusion criteria for studies were human cases, details and specific data on cohorts that included proportion of unexplained fetal deaths, and data on genetic testing and the subsequent results. Exclusion criteria were pregnancy loss before 22 weeks of gestation, focus on known causes of stillbirth, focus on fetal pathology or abnormalities, investigating neonatal death, genetic testing in populations with congenital anomalies or suspected specific syndromes, and those without details on genetic testing. The final review included 9 studies, 1 comparing karyotyping and chromosomal microarray analysis (CMA); 1 comparing karyotyping, CMA, and quantitative fluorescence–polymerase chain reaction; 2 with CMA only; and 5 with exome sequencing data. The studies that examined only CMA found 1 case of copy number variants (CNVs) in 24 cases and 31 CNVs in 96 cases. The largest study included here analyzed 532 stillbirths and compared CMA and karyotyping. Chromosomal microarray analysis showed a higher rate of detection of CNVs, increasing from 5.8% to 8.3% (P = 0.007) when compared with karyotype analysis. One challenge presented by this topic is that some disorders that could contribute to unexplained stillbirth are typically diagnosed when symptoms appear later in life and so are not usually associated with stillbirth or the risk of stillbirth. One example of this could be cardiac rhythm anomalies or other rare genetic variants that lead to stillbirth when appearing in a particular variation. One study included a cohort of unexplained stillbirth after postmortem examination that excluded obvious causes. Genetic analysis showed that several cases carried a variant that was functionally disruptive that may have contributed to stillbirth, but several additional cases that were functionally normal. Genetic variations relating to unexplained stillbirth are a broad and largely unexplored topic. Genetics play a vital role in clinical exploration and treatment of many disorders and in diagnosing causes of fetal mortality and morbidity. This review shows that genetic testing for stillbirth varies greatly according to test availability and guidelines of use, with some tests showing greater diagnostic yield than others. Although these studies incorporated large cohorts of unexplained stillbirths, genetic analysis identified potential causes for only a small percentage. Future research is needed to explain potential genetic causes for stillbirth.
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Jindal, Aditi, Rama Thakur, and Santosh Minhas. "Causes of stillbirth according to different gestational ages." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 7, no. 3 (February 27, 2018): 1029. http://dx.doi.org/10.18203/2320-1770.ijrcog20180886.
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Background: Stillbirth is one of the most common yet the most poorly studied adverse outcome of pregnancy. Objective of present study was to determine the risk factors and prevalence of stillbirth at Department of Obstetrics and Gynecology, Kamla Nehru State Hospital, for Mother and Child, Indira Gandhi Medical College, Shimla, Himachal Pradesh.Methods: A prospective non-interventional study was conducted with effect from 1st August 2015 to 31st July 2016, during which all the intrapartum and antepartum stillbirths were enrolled.Results: During the study period total number of stillbirth were 94 and the total number of live births were 6412, giving a stillbirth rate of 14.66/1000 live births. The perinatal mortality was 22.1/1000 births. The most common cause of stillbirth as revealed in the study was hypertensive disorder.Conclusions: The stillbirth rate in the study was higher than the stillbirth rate of developed countries. Improvement of socioeconomic conditions, literacy and health education among women will definitely be important to curb the staggeringly high stillbirth rate, but the need of the hour is to deploy adequate number of dedicated skilled providers.
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Åmark, Hanna, Magnus Westgren, Meeli Sirotkina, Ingela Hulthén Varli, Martina Persson, and Nikos Papadogiannakis. "Maternal obesity and stillbirth at term; placental pathology—A case control study." PLOS ONE 16, no. 4 (April 30, 2021): e0250983. http://dx.doi.org/10.1371/journal.pone.0250983.
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Objective The aim was to explore the potential role of the placenta for the risk of stillbirth at term in pregnancies of obese women. Methods This was a case-control study comparing placental findings from term stillbirths with placental findings from live born infants. Cases were singleton term stillbirths to normal weight or obese women, identified in the Stockholm stillbirth database, n = 264 and n = 87, respectively. Controls were term singletons born alive to normal weight or obese women, delivered between 2002–2005 and between 2018–2019. Placentas were compared between women with stillborn and live-born infants, using logistic regression analyses. Results A long and hyper coiled cord, cord thrombosis and velamentous cord insertion were stronger risk factors for stillbirth in obese women compared to normal weight women. When these variables were adjusted for in the logistic regression analysis, also adjusted for potential confounders, the odds ratio for stillbirth in obese women decreased from 1.89 (CI 1.24–2.89) to 1.63 (CI 1.04–2.56). Conclusion Approximately one fourth of the effect of obesity on the risk of stillbirth in term pregnancies is explained by umbilical cord associated pathology.
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Jawad, Ariana Khalis, Shahla Kareem Alalaf, Mahabad Salih Ali, and AbdulKader Ahmad Bawadikji. "Bemiparin as a Prophylaxis After an Unexplained Stillbirth: Open-Label Interventional Prospective Study." Clinical and Applied Thrombosis/Hemostasis 25 (January 1, 2019): 107602961989662. http://dx.doi.org/10.1177/1076029619896629.
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Stillbirth is a devastating event to the parents, relatives, friends, and families. The role of anticoagulants in the prevention of unexplained stillbirths is uncertain. An open-label interventional prospective cohort study was conducted on 144 women with a history of unexplained stillbirths. The intervention group had a high umbilical artery resistance index (RI) and received bemiparin. The nonintervention group had a normal RI and did not receive any intervention. We measured the adjusted odds ratio (OR) and 95% confidence interval (CI) of the main outcome for these variables using logistic regression analysis. Fresh stillbirth and early neonatal death rates were lower ( P = .005, OR = 11.949 and 95% CI = 2.099-68.014) and newborn weight was higher ( P = .015, OR = 0.048, 95% CI = 0.004-0.549) in the group that received bemiparin. Bemiparin is effective in decreasing the rate of stillbirth in women with a history of previous unexplained stillbirths.
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Khare, Smriti, Sushma Dahal, Ruiyan Luo, Richard Rothenberg, Kenji Mizumoto, and Gerardo Chowell. "Stillbirth Risk during the 1918 Influenza Pandemic in Arizona, USA." Epidemiologia 1, no. 1 (November 11, 2020): 23–30. http://dx.doi.org/10.3390/epidemiologia1010005.
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The 1918 influenza pandemic, the deadliest pandemic on record, affected approximately 1/3rd of the population worldwide. The impact of this pandemic on stillbirth risk has not been studied in depth. In this study, we assessed the stillbirth risk during the 1918 influenza pandemic in Arizona, USA. We carried out a retrospective study using 21,334 birth records for Maricopa County, Arizona, for the period 1915–1925. We conducted logistic regression analyses to assess the effect of that pandemic on stillbirth risk. Though we did not find a statistically significant impact on stillbirth risk during the pandemic, there was a higher risk of stillbirth in July 1919 (42 stillbirths/1000 births), 9 months after the peak pandemic mortality, and a stillbirth risk of 1.42 (95% CI: 1.17, 1.72) in women ≥35 years compared to the women aged <35 years. The risk of stillbirth was lowest if the mother’s age was approximately 26 years at the time of birth. We also report peaks in stillbirth risk 9–10 months after the peak pandemic mortality. Our findings add to our current understanding of the link between pandemic influenza and stillbirth risk.
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R., Vinolia, and Dattatreya D. Bant. "A study on the major risk factors of stillbirth in the rural areas of Dharwad district: a prospective study." International Journal Of Community Medicine And Public Health 5, no. 6 (May 22, 2018): 2232. http://dx.doi.org/10.18203/2394-6040.ijcmph20182061.
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Background: As per the WHO recommendation for international comparison, stillbirth is defined as a baby born with no signs of life at or after 28 weeks of gestation. It is estimated that 2.6 million stillbirths occur annually in the world with more than 7300 stillbirths happening every day. More than 2/3rd of these stillbirths are identified to be from the South-east Asian countries and Africa. This study is aimed at obtaining key learning points for future implications. The objectives of the study were to study the risk factors associated with stillbirth and to assess the most common and preventable risk factor(s).Methods: The study was conducted in randomly selected villages of Dharwad district chosen equally from all the taluks of the district. 378 of the registered pregnant women with period of gestation <12 weeks from the selected villages, aged 18 to 35 years were studied.Results: Women with <1 year of birth spacing had higher risk of stillbirth with (X2=242.096 and p<0.05). Women with medical conditions like severe anaemia and hypertension had higher risk of stillbirth (p<0.05).Conclusions: The findings in the study suggest that marital and obstetric factors such as early pregnancies and lack of adequate spacing between pregnancies can have an impact on the normal course of pregnancy leading to adverse events like stillbirth but general factors such as women’s education status do not affect the birth outcome.
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Jadhav, Balaji, Shweta Avinash Khade, Ganesh Shinde, and Shilpa Chandan. "Factors affecting stillbirth: prospective study." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 10, no. 3 (February 24, 2021): 939. http://dx.doi.org/10.18203/2320-1770.ijrcog20210712.
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Background: Stillbirth is defined by WHO as the birth of a baby with a birth weight of 500 gm or more, 22 or more completed weeks of gestation or a body length of 25 cm or more, who died before or during labour and birth.Methods: This was prospective observational study of factors affecting stillbirth was conducted in tertiary hospital for a period of 1 year from 1st June 2014 to 31st May 2015. During the study period, 200 parturient of gestational age 28 weeks or more and fetal weight 1000 gm or more with or without medical disorders were included.Results: The total number of births during study period was 11,951. Stillbirth rate in the present study was 16.73 per 1000 births. Most of stillbirths were seen in the antepartum period (76%) when compared to intrapartum period (24%). Maximum stillbirths occurred in gestational age of 36 weeks and above (52%) and fetal weight between 2001-2500 gm (27.50%). Patients with inadequate antenatal care, less than three visits had 86% stillbirths.Conclusions: Proper antenatal care, prompt referral services and availability of emergency obstetric care will provide a pivotal role for reduction of stillbirths.
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Saidi, Friday, Grace Chiudzu, Maganizo Chagomerana, Beteniko Milala, and Jennifer H. Tang. "Factors associated with stillbirths among women delivering at a resource limited tertiary hospital in Malawi." Obstetrics & Gynecology International Journal 12, no. 5 (September 16, 2021): 289–95. http://dx.doi.org/10.15406/ogij.2021.12.00594.
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Background: Stillbirths remain a major public health issue worldwide with an estimated 3 million deaths per year globally. We investigated the factors associated with stillbirths in fetuses of at least 28 weeks’ gestation or 1000 grams at birth. Methods: We performed a hospital-based, cross-sectional study among women who delivered stillbirths at Kamuzu Central Hospital (KCH) in Lilongwe, Malawi from May-November 2017. Eligible women were enrolled after obtaining informed consent, and their demographic and reproductive health information was collected. Blood samples were collected for full blood count, malaria, blood glucose, syphilis, and HIV testing, and the probable risk factors associated with stillbirths were assessed. Results: A total of 1,687 deliveries with 126 stillbirths occurred during the 6-month period, representing a stillbirth rate of 79 per 1,000 births. Seventy percent of these stillbirths were diagnosed on admission at KCH, and about 49% were fresh stillbirths. Half of the stillbirths had a birthweight of at least 2,500g, and the majority of these stillbirths were fresh (60%). The following factors were associated with stillbirth: uterine rupture (15.1%), placental abruption (14.3%), Hypertension (10.3%), obstructed/prolonged labor (5.8%), syphilis (7.1%), malaria (2.4%), congenital anomalies (2.4%), and diabetes (1.5%). Conclusions: The stillbirth rate at KCH is high, and most fetal deaths occurred prior to arrival at KCH. Although most of the stillbirths were unexplained, uterine rupture and abruption placenta emerged as major factors associated with stillbirths and these are largely preventable even in resource limited settings.
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Volkov, V. G., and M. V. Kastor. "Stillbirth and fetal growth restriction." Obstetrics, Gynecology and Reproduction 17, no. 1 (March 6, 2023): 104–14. http://dx.doi.org/10.17749/2313-7347/ob.gyn.rep.2023.357.
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Aim: to estimate the rate of early-onset and late-onset fetal growth restriction (FGR) in stillbirth, identify features of placentaassociated complications and determine respective risk factors of stillbirth (especially at early gestational age).Materials and Methods. There were retrospectively studied 61 stillbirth cases in 2016–2019 that occurred in the III level obstetric hospitals: 32 early (23–31 weeks of gestation) and late (32–39 weeks) cases; 156 live births with 8–10 Apgar scores delivered at 36–41 weeks of gestation used as controls. Quantitative parameters were compared using the mean values and standard deviation; nominal parameters were analyzed using odds ratio (OR) and adjusted OR (aOR) with 95 % confidence interval (CI).Results. More than half of stillbirths are associated with FGR with almost 60 % of early-onset phenotype of this pathology. Both in stillbirths and live births, 2/3 of FGR have extremely low weight (OR = 1.8; 95 % CI = 0.6–6.9); 1/3 of growth restricted fetuses were detected shortly before delivery (OR = 1.3; 95 % CI = 0.7–2.4); 1/4 of pregnancies complicated by placental insufficiency are not associated with FGR (OR = 1.4; 95 % CI = 0.7–2.7). Risk factors of stillbirth in pregnancy complicated by FGR are the early-onset growth restriction phenotype (aOR = 3.2; 95 % CI = 1.0–10.3), maternal age over 28 years (aOR = 6.0; 95 % CI = 1.2–29.4), miscarriages and multiple induced abortions (aOR = 3.6; 95 % CI = 1.1–11.2), non-compliance in regular clinics visiting and correction of threatening conditions (aOR = 10.9; 95 % CI = 1.3–91.6), toxoplasma infection (aOR = 6.0; 95 % CI = 1.5–24.5). Early stillbirth with FGR is associated with an older mother's age (aOR = 5.8; 95 % CI = 1.0–34.4), greater parity (aOR = 3.3; 95 % CI = 1.0–10.4), uterine diseases including endometrial polyps, endometriosis, cervix cervicitis, cervix dysplasia (aOR = 4.0; 95 % CI = 0.9–17.2), diabetes mellitus (aOR = 3.1; 95 % CI = 0.8–13.2) and preeclampsia.Conclusion. The rate of early-onset FGR in stillbirth comprises almost 60 % that is twice higher than in live birth, with the rate of late-onset phenotype being less than 30 %. In late stillbirths the early-onset phenotype also prevails. There are no prominent features for stillbirths with FGR compared to previously known risk factors regardless of hypotrophy. Early vs. late stillbirth with FGR is more associated with gynecological pathologies as well as with diabetes mellitus and preeclampsia.
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Forsberg, Kaitlin, Robert Silver, and Lauren Christiansen-Lindquist. "Factors Associated with Stillbirth Autopsy in Georgia and Utah, 2010–2014: The Importance of Delivery Location." American Journal of Perinatology 35, no. 13 (May 3, 2018): 1271–80. http://dx.doi.org/10.1055/s-0038-1648234.
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Objective This article determines whether demographic, delivery, and medical factors are associated with stillbirth autopsy performance in Georgia and Utah. Study Design This study used fetal death certificates from 2010 to 2014 to determine which factors are associated with stillbirth autopsy performance in Georgia and Utah. Analyses were conducted using logistic regression with a predicted margins approach. Results The stillbirth autopsy rate was low in both states: 11.9% in Georgia (N = 5,610) and 23.9% in Utah (N = 1,425). In Utah, the autopsy rate significantly declined during the study period (p = 0.01). Stillbirths delivered outside of large metropolitan areas were less likely to receive an autopsy (medium/small metropolitans: prevalence ratioGA [PR] = 0.57, 95% confidence interval [CI]: 0.48–0.68 and PRUT = 0.48, CI: 0.38–0.59; nonmetropolitans: PRGA = 0.57, CI: 0.43–0.75 and PRUT = 0.37, CI: 0.21–0.63). In Georgia, autopsies were less common among stillbirths of Hispanic (vs. white) women (PR = 0.57, CI: 0.41–0.79), at earlier (vs. later) gestational ages (PR = 0.59, CI: 0.51–0.69), and of multiple birth pregnancies (PR = 0.71, CI: 0.53–0.96). Conclusion Despite strong evidence supporting the value of stillbirth autopsies, autopsy rates were low, especially outside metropolitan areas, where approximately half of stillbirths were delivered.
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Kunjachen Maducolil, Mariam, Hafsa Abid, Rachael Marian Lobo, Ambreen Qayyum Chughtai, Arjumand Muhammad Afzal, Huda Abdullah Hussain Saleh, and Stephen W. Lindow. "Risk factors and classification of stillbirth in a Middle Eastern population: a retrospective study." Journal of Perinatal Medicine 46, no. 9 (November 27, 2018): 1022–27. http://dx.doi.org/10.1515/jpm-2017-0274.
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AbstractObjective:To estimate the incidence of stillbirth, explore the associated maternal and fetal factors and to evaluate the most appropriate classification of stillbirth for a multiethnic population.Methods:This is a retrospective population-based study of stillbirth in a large tertiary unit. Data of each stillbirth with a gestational age >/=24 weeks in the year 2015 were collected from electronic medical records and analyzed.Results:The stillbirth rate for our multiethnic population is 7.81 per 1000 births. Maternal medical factors comprised 52.4% in which the rates of hypertensive disorders, diabetes and other medical disorders were 22.5%, 20.8% and 8.3%, respectively. The most common fetal factor was intrauterine growth restriction (IUGR) (22.5%) followed by congenital anomalies (21.6%). All cases were categorized using the Wigglesworth, Aberdeen, Tulip, ReCoDe and International Classification of Diseases-perinatal mortality (ICD-PM) classifications and the rates of unclassified stillbirths were 59.2%, 46.6%, 16.6%, 11.6% and 7.5%, respectively. An autopsy was performed in 9.1% of cases reflecting local religious and cultural sensitivities.Conclusion:This study highlighted the modifiable risk factors among the Middle Eastern population. The most appropriate classification was the ICD-PM. The low rates of autopsy prevented a detailed evaluation of stillbirths, therefore it is suggested that a minimally invasive autopsy [postmortem magnetic resonance imaging (MRI)] may improve the quality of care.
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Imaizumi, Y., and K. Nonaka. "Yearly Changes in Stillbirth Rates of Zygotic Twins in Japan, 1975-1994." Acta geneticae medicae et gemellologiae: twin research 47, no. 1 (January 1998): 19–30. http://dx.doi.org/10.1017/s0001566000000349.
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AbstractThe stillbirth rates decreased to 2/3 for MZ male twins, 1/2 for MZ female twins, and under 1/2 for DZ twins for both sexes during the 19-year period from 1975 in Japan. The stillbirth rate was significantly higher in MZ males than MZ females in each year, whereas stillbirth rates of DZ twins for both sexes indicated similar values during that period. After 1986, stillbirth rates were more than 2 times higher in MZ twins than in singletons and in DZ twins. The higher stillbirth rate of MZ twins as opposed to DZ twins could be related to monochorionic twin pairs in MZ twins. The stillbirth rate decreased more drastically in twins for both zygosities than in singleton births during the 34-year period from 1960. However, declining rates of stillbirths may be attributed to medical care during twin pregnancies. Recommendation of an optimum day to give birth for twin pregnancy is 37-38 weeks for Japanese women.
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Kajdy, Anna, Dorota Sys, Jan Modzelewski, Joanna Bogusławska, Aneta Cymbaluk-Płoska, Ewa Kwiatkowska, Magdalena Bednarek-Jędrzejek, et al. "Evidence of Placental Aging in Late SGA, Fetal Growth Restriction and Stillbirth—A Systematic Review." Biomedicines 11, no. 7 (June 21, 2023): 1785. http://dx.doi.org/10.3390/biomedicines11071785.
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During pregnancy, the placenta undergoes a natural aging process, which is considered normal. However, it has been hypothesized that an abnormally accelerated and premature aging of the placenta may contribute to placenta-related health issues. Placental senescence has been linked to several obstetric complications, including abnormal fetal growth, preeclampsia, preterm birth, and stillbirth, with stillbirth being the most challenging. A systematic search was conducted on Pubmed, Embase, and Scopus databases. Twenty-two full-text articles were identified for the final synthesis. Of these, 15 presented original research and 7 presented narrative reviews. There is a paucity of evidence in the literature on the role of placental aging in late small for gestational age (SGA), fetal growth restriction (FGR), and stillbirth. For future research, guidelines for both planning and reporting research must be implemented. The inclusion criteria should include clear differentiation between early and late SGA and FGR. As for stillbirths, only those with no other known cause of stillbirth should be included in the studies. This means excluding stillbirths due to congenital defects, infections, placental abruption, and maternal conditions affecting feto-maternal hemodynamics.
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Das, Rituparna, Nalini Sharma, Bifica S. Lyngdoh, Subrat Panda, Anusmita Saha, Wansalan K. Shullai, and Biswajit De. "Analysis of the prevalence, etiology, and risk factors of stillbirth from a teaching institute of North Eastern India- a retrospective study." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 11, no. 4 (March 25, 2022): 1191. http://dx.doi.org/10.18203/2320-1770.ijrcog20220903.
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Background: Stillbirth rate is considered a health index. The worldwide stillbirth rate is 18.4/1000 total birth. This study was aimed to evaluate the prevalence and risk factors of intrauterine fetal death in pregnant women in one of the teaching centers in Northeastern India.Methods: This was a retrospective study. All cases of intrauterine fetal death admitted in the department of obstetrics gynecology of our institute were included over two and half years. Information was gathered from the medical records of the patients and data were analyzed.Results: During two and half year’s period, the total number of deliveries was 2696 and the total numbers of stillbirths were 96, hence the stillbirth rate was 35.6/1000. 93 (96.87%) were antenatal stillbirths and 3 (3.12%) were intrapartum stillbirths. 82 (85.41%) women were unbooked. 85 (90.4%) belonged to low socioeconomic status. 67 (69.79%) were preterm. Maximum 39 (40.62%) belonged to 28-35 weeks of gestational age. The most common cause of Intrauterine death (IUD) was antepartum hemorrhage (17.7%). 14 (14.5%) were abruption and 3 were placenta previa. The second most common cause (14.5%) was the hypertensive disorder of pregnancy.Conclusions: The stillbirth rate in our institute is higher than the national average. The most common causes of IUD were antepartum hemorrhage, preeclampsia, prematurity, and malpresentation which can be diagnosed and managed by increasing uptake of antenatal care which will lead to timely identification and proper management of maternal and fetal complications eventually reducing the preventable stillbirths.
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Mira, Ana Rita, João Pedro Pereira, Catrine Dahlstedt-Ferreira, Margarida Enes, Hélder Oliveira Coelho, and Ana Beatriz Godinho. "Fetal Deaths in SARS-CoV-2-Infected Pregnant Women: A Portuguese Case Series." Case Reports in Obstetrics and Gynecology 2022 (August 3, 2022): 1–7. http://dx.doi.org/10.1155/2022/8423733.
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Introduction. Stillbirth has been documented as an outcome of SARS-CoV-2 infection in pregnancy. Placental hypoperfusion and inflammation secondary to maternal immune response seem to play a role in the cascade of events that contribute to fetal death. The aim of our study is to report a perinatal outcome of SARS-CoV-2 infection in pregnancy adding information to the pool of data on COVID-19 pregnancy outcomes. Case Presentation. This is the first stillbirth case series occurring in pregnant women infected with SARS-CoV-2 in a Portuguese cohort. Between April 2020 and March 2021, we had 2680 births in our centre, of which 130 (4.95%) involved mothers infected with SARS-CoV-2. Of total births, there were 14 stillbirths (0.52%), accounting for the highest stillbirth rate we have had in the last 5 years. Among these 14 stillbirths, 5 (35.71%) occurred in SARS-CoV-2-infected mothers. We report the clinical features and placental histopathologic findings of 4 stillbirth cases that occurred in our hospital. Discussion. The stillbirth rate among SARS-CoV-2-infected pregnant women (5/130; 3.84%) was significantly increased compared to noninfected patients (9/2550; 0.35%). Most women (3/4) were asymptomatic for COVID-19, a surprising outcome, given the current literature. All cases had histologic exams showing placental signs of vascular malperfusion, although we acknowledge that 3/5 had obstetric conditions related to placental vascular impairment such as preeclampsia and HELLP syndrome. Conclusion. Stillbirth can be a perinatal consequence of SARS-CoV-2 infection in pregnancy, even in asymptomatic patients. We urge more studies to explore the association between SARS-CoV-2 infection and the risk of stillbirth.
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Mohan, Manoj, Kwabena Appiah-Sakyi, Ashok Oliparambil, Abdul Kareem Pullattayil, Stephen W. Lindow, Badreldeen Ahmed, and Justin C. Konje. "A Meta-Analysis of the Global Stillbirth Rates during the COVID-19 Pandemic." Journal of Clinical Medicine 12, no. 23 (November 21, 2023): 7219. http://dx.doi.org/10.3390/jcm12237219.
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COVID-19 has been shown to have variable adverse effects on pregnancy. Reported data on stillbirth rates during the pandemic have, however, been inconsistent—some reporting a rise and others no change. Knowing the precise impact of COVID-19 on stillbirths should help with the planning and delivery of antenatal care. Our aim was, therefore, to undertake a meta-analysis to determine the impact of COVID-19 on the stillbirth rate. Databases searched included PubMed, Embase, Cochrane Library, ClinicalTrials.gov, and Web of Science, with no language restriction. Publications with stillbirth data on women with COVID-19, comparing stillbirth rates in COVID-19 and non-COVID-19 women, as well as comparisons before and during the pandemic, were included. Two independent reviewers extracted data separately and then compared them to ensure the accuracy of extraction and synthesis. Where data were incomplete, authors were contacted for additional information, which was included if provided. The main outcome measures were (1) stillbirth (SB) rate in pregnant women with COVID-19, (2) stillbirth rates in pregnant women with and without COVID-19 during the same period, and (3) population stillbirth rates in pre-pandemic and pandemic periods. A total of 29 studies were included in the meta-analysis; from 17 of these, the SB rate was 7 per 1000 in women with COVID-19. This rate was much higher (34/1000) in low- and middle-income countries. The odds ratio of stillbirth in COVID-19 compared to non-COVID-19 pregnant women was 1.89. However, there was no significant difference in population SB between the pre-pandemic and pandemic periods. Stillbirths are an ongoing global concern, and there is evidence that the rate has increased during the COVID-19 pandemic, but mostly in low- and middle-income countries. A major factor for this is possibly access to healthcare during the pandemic. Attention should be focused on education and the provision of high-quality maternity care, such as face-to-face consultation (taking all the preventative precautions) or remote appointments where appropriate.
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Fellman, Johan, and Aldur W. Eriksson. "Stillbirths in Multiple Births: Test of Independence." Twin Research and Human Genetics 9, no. 5 (October 1, 2006): 677–84. http://dx.doi.org/10.1375/twin.9.5.677.
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AbstractThe stillbirth rate in twins is a more sensitive indicator of environmental hazards than the stillbirth rate in singletons. Medical care or other socioeconomic factors may be more influential for perinatal survival in twin than in single deliveries. Studies have indicated that stillbirths among children in a set of multiple maternities are not independent. Models were considered assuming independent outcomes within a set of multiple maternities. Analyses of the stillbirth rates confirm that the risk of stillbirth among males is almost constantly higher than among females. Any model introduced should assume different stillbirth rates for males and females. The models were tested with both maximum likelihood and minimum χ2 methods. Data was analyzed from Sweden, the Åland Islands, Saxony, England and Wales, and significant discrepancies obtained from the independence models. The same-sexed twin data contain both monozygotic and dizygotic twin sets with apparently different stillbirth rates. Consequently, for same-sexed twins the proposed model could be considered too simple. After improvement by splitting the same-sexed data into monozygotic and dizygotic twin sets, the dependence still remains. The proportion of both same-sexed and opposite-sexed twin pairs that contain two stillborn is greater than what the stillbirth rates and the independence should indicate. Consequently, stillbirth rate estimates based on the relative frequency of twin sets with two stillborn children have a positive bias. When the stillbirth rate decreases, the number of sets with two stillborn children decreases more slowly than would be indicated by independence.
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Al Khalaf, Sukainah, Karolina Kublickiene, Marius Kublickas, Ali S. Khashan, and Alexander E. P. Heazell. "Risk of stillbirth and adverse pregnancy outcomes in a third pregnancy when an earlier pregnancy has ended in stillbirth." Acta Obstetricia et Gynecologica Scandinavica, October 27, 2023. http://dx.doi.org/10.1111/aogs.14705.
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AbstractIntroductionOur study evaluated how a history of stillbirth in either of the first two pregnancies affects the risk of having a stillbirth or other adverse pregnancy outcomes in the third subsequent pregnancy.Material and MethodsWe used the Swedish Medical Birth Register to define a population‐based cohort of women who had at least three singleton births from 1973 to 2012. The exposure of interest was a history of stillbirth in either of the first two pregnancies. The primary outcome was subsequent stillbirth in the third pregnancy. Secondary outcomes included: preterm birth, preeclampsia, placental abruption and small‐for‐gestational‐age infant. Adjusted logistic regression was performed including maternal age, body mass index, smoking, diabetes and hypertension. A sensitivity analysis was performed excluding stillbirths associated with congenital anomalies, pregestational and gestational diabetes, hypertension and preterm stillbirths.ResultsThe study contained data on 1 316 175 births, including 8911 stillbirths. Compared with women who had two live births, the highest odds of stillbirth in the third pregnancy were observed in women who had two stillbirths (adjusted odds ratio [aOR] 11.40, 95% confidence interval [95% CI] 2.75–47.70), followed by those who had stillbirth in the second birth (live birth–stillbirth) (aOR 3.59, 95% CI 2.58–4.98), but the odds were still elevated in those whose first birth ended in stillbirth (stillbirth–live birth) (aOR 2.35, 1.68, 3.28). Preterm birth, pre‐eclampsia and placental abruption followed a similar pattern. The odds of having a small‐for‐gestational‐age infant were highest in women whose first birth ended in stillbirth (aOR 1.93, 95% CI 1.66–2.24). The increased odds of having a stillbirth in a third pregnancy when either of the earlier births ended in stillbirth remained when stillbirths associated with congenital anomalies, pregestational and gestational diabetes, hypertension or preterm stillbirths were excluded. However, when preterm stillbirths were excluded, the strength of the association was reduced.ConclusionsEven when they have had a live‐born infant, women with a history of stillbirth have an increased risk of adverse pregnancy outcomes; this cannot be solely accounted for by the recurrence of congenital anomalies or maternal medical disorders. This suggests that women with a history of stillbirth should be offered additional surveillance for subsequent pregnancies.
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McClure, Elizabeth M., Sarah Saleem, Shivaprasad S. Goudar, Ana Garces, Ryan Whitworth, Fabian Esamai, Archana B. Patel, et al. "Stillbirth 2010–2018: a prospective, population-based, multi-country study from the Global Network." Reproductive Health 17, S2 (November 2020). http://dx.doi.org/10.1186/s12978-020-00991-y.
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Abstract Background Stillbirth rates are high and represent a substantial proportion of the under-5 mortality in low and middle-income countries (LMIC). In LMIC, where nearly 98% of stillbirths worldwide occur, few population-based studies have documented cause of stillbirths or the trends in rate of stillbirth over time. Methods We undertook a prospective, population-based multi-country research study of all pregnant women in defined geographic areas across 7 sites in low-resource settings (Kenya, Zambia, Democratic Republic of Congo, India, Pakistan, and Guatemala). Staff collected demographic and health care characteristics with outcomes obtained at delivery. Cause of stillbirth was assigned by algorithm. Results From 2010 through 2018, 573,148 women were enrolled with delivery data obtained. Of the 552,547 births that reached 500 g or 20 weeks gestation, 15,604 were stillbirths; a rate of 28.2 stillbirths per 1000 births. The stillbirth rates were 19.3 in the Guatemala site, 23.8 in the African sites, and 33.3 in the Asian sites. Specifically, stillbirth rates were highest in the Pakistan site, which also documented a substantial decrease in stillbirth rates over the study period, from 56.0 per 1000 (95% CI 51.0, 61.0) in 2010 to 44.4 per 1000 (95% CI 39.1, 49.7) in 2018. The Nagpur, India site also documented a substantial decrease in stillbirths from 32.5 (95% CI 29.0, 36.1) to 16.9 (95% CI 13.9, 19.9) per 1000 in 2018; however, other sites had only small declines in stillbirth over the same period. Women who were less educated and older as well as those with less access to antenatal care and with vaginal assisted delivery were at increased risk of stillbirth. The major fetal causes of stillbirth were birth asphyxia (44.0% of stillbirths) and infectious causes (22.2%). The maternal conditions that were observed among those with stillbirth were obstructed or prolonged labor, antepartum hemorrhage and maternal infections. Conclusions Over the study period, stillbirth rates have remained relatively high across all sites. With the exceptions of the Pakistan and Nagpur sites, Global Network sites did not observe substantial changes in their stillbirth rates. Women who were less educated and had less access to antenatal and obstetric care remained at the highest burden of stillbirth. Study registration Clinicaltrials.gov (ID# NCT01073475).