Preventable stillbirths in India and Pakistan: A prospective, observational study

Document Type

Article

Department

Community Health Sciences

Abstract

Objective: Stillbirths occur 10 to 20 times more frequently in low-income settings compared to high-income settings. We created a methodology to define the proportion of stillbirths that are potentially preventable in low-income settings and applied it to stillbirths in sites in India and Pakistan.
Design: Prospective observational study SETTING: Three maternity hospitals in Davangere, India and a large public hospital in Karachi, Pakistan POPULATION: All stillbirth cases ≥ 20 weeks gestational age (GA) occurring from July 2018 to February 2020 were screened for participation. 872 stillbirth cases were included in this analysis.
Methods: We prospectively defined the conditions and GAs that defined the stillbirth cases considered potentially preventable. Informed consent was sought from the parent(s) once the stillbirth was identified, either before or soon after delivery. All information available including obstetric and medical history, clinical course, fetal heart sounds on admission, the presence of maceration as well as examination of the stillbirth after delivery, histology, and PCR for infectious pathogens of the placenta and various fetal tissues was used to assess whether a stillbirth was potentially preventable.
Main outcome measures: Whether a stillbirth was determined to be potentially preventable and the criteria for assignment to those categories RESULTS: Of 984 enrolled, 872 stillbirths at ≥20 weeks' GA met inclusion criteria and were included; of these, 55.5% were deemed to be potentially preventable. Of the 649 stillbirths at ≥28 weeks' GA and ≥1000g, 73.5% were considered potentially preventable. The most common conditions associated with a potentially preventable stillbirth at GA ≥28 weeks and ≥1000g were small for gestational age (SGA) (52.8%), maternal hypertension (50.2%), antepartum hemorrhage (31.4%) and death that occurred after hospital admission (15.7%).
Conclusions: Most stillbirths in these sites were deemed preventable and were often associated with maternal hypertension, antepartum hemorrhage, SGA and intrapartum demise.

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Publication (Name of Journal)

BJOG: An International Journal of Obstetrics and Gynaecology

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