Factors associated with stillbirths among women delivering at a resource limited tertiary hospital in Malawi

Abstract

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.