Abstract
Objective:To determine the stillbirth rate in 2017 at Christian Medical College, a tertiary care perinatal center in South India, and to identify causes for the various stillbirths that occurred using the Relevant Condition at Death (ReCoDe) classification.Material and Methods:Medical records of the women with stillbirths between January 1st, to December 31st, 2017, were retrieved and analyzed using the SPSS software (IBM, version 23). The study was approved by the institutional review board (minute no: 11273, retro dated: 28/3/2018).Results:Of the total 14696 deliveries between January 1st, 2017, to December 31st, 2017, there were 247 stillbirths, a rate of 16.8 per 1000 births. Maternal factors: 156 (64.2%) women were booked and the rest were un-booked. Hypertensive disorders of pregnancy were detected in 27.5% (n=67). A greater number of un-booked women had gestational hypertension as compared with booked women (41% vs 24%, p=0.005). Fetal characteristics: still births secondary to lethal congenital anomalies were seen in 18.2% (n=45). Lethal congenital anomalies were diagnosed 10 times more in the booked patients than un-booked ones (24.7% vs 2.3%, p=0.001). Obstetric factors: one or two previous miscarriages were seen in 29.5% cases. Seventeen women (6.9%) had a prior stillbirth. ReCoDe Classification: we were able to successfully classify 84.2% of the stillbirths, leaving 15.78% unclassified. Fetal growth restriction secondary to uteroplacental insufficiency was found in 25.9% cases. Of the placental causes, abruption accounted for 10.9% of cases. Medical co-morbidities were seen in 46.5% pregnancies.Conclusion:The ReCoDe method of classifying stillbirths is useful in the developing world. It helped to elucidate the cause for stillbirths in 84.2% of cases. The majority of cases in our set were due to fetal growth restriction, hypertensive disorders of pregnancy, and uteroplacental insufficiency. Stillbirths can be prevented by a comprehensive antenatal care system, early recognition, and close monitoring of high-risk pregnancies.
Highlights
The World Health Organization (WHO) defines stillbirth as the delivery of a fetus after 22 completed weeks of gestation, weighing 500 grams or more, with the newborn showing no signs of life at delivery (1)
The stillbirth rate in our country has declined by 10%, with an annual reduction rate of 2% between 2000-2015
Of the total 14696 deliveries between January 1st, 2017, to December 31st, 2017, there were 243 deliveries, which resulted in 247 stillbirths, a stillbirth rate of 16.8 per 1000 births
Summary
The World Health Organization (WHO) defines stillbirth as the delivery of a fetus after 22 completed weeks of gestation, weighing 500 grams or more, with the newborn showing no signs of life at delivery (1). According to the WHO, there were 2.6 million stillbirths in 2015. The stillbirth rate in India was 23/1000 births in 2015, compared to a worldwide rate of 18.4/1000 births (2). The stillbirth rate in our country has declined by 10%, with an annual reduction rate of 2% between 2000-2015. This decline, is slow in comparison to the annual reduction in maternal mortality rate and under 5 infant mortality rate at 3% and 3.9%, respectively, during the same period (2). The WHO targets reducing the stillbirth rate to 12/1000 by 2030 by adopting the “Every newborn action plan” (2)
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