Factors contributing to intrapartum stillbirth: a criteria-based audit to support midwifery practice in Zambia

Abstract

Background: Stillbirth is a poor pregnancy outcome and one that is common worldwide. It mostly occurs during the intrapartum period, which accounts for more than 50% of cases. Estimates suggest that 55% of stillbirths occur in low-to middle-income countries ( Lawn et al, 2011 ). Objective: To establish factors contributing to intrapartum stillbirth in Mansa General Hospital, Lupala Province, Zambia. Methods: In this retrospective audit, the files of 115 women were purposively reviewed in an initial baseline clinical audit and strategies introduced to change practice. A further 31 files were reviewed in a subsequent re-audit. Data were entered and analysed using SPSS version 16.0. Results: The study found that only 36 (33.3%) labouring women in the initial audit and 20 (65%) in the re-audit were managed using a partograph. Obstructed labour was the main cause of intrapartum stillbirths, which was the case for 65 women (55.7%) at baseline and 12 (38.7%) in the re-audit. Antepartum haemorrhage was the cause for 27 (23.5%) stillbirths in the baseline audit and 5 (16.1%) in the re-audit. Suboptimal care was observed in the initial audit, but thanks to intervention strategies, care improved in the subsequent audit. Conclusions: Improving intrapartum care in labour wards by skilled birth attendants and an improved referral system is critical if stillbirths are to be averted.