Level, causes, and risk factors of stillbirth: a population-based case control study from Chandigarh, India

Ariarathinam Newtonraj,Manmeet Kaur,Rajesh Kumar,Madhu Gupta

doi:10.1186/s12884-017-1557-4

Ariarathinam Newtonraj, Manmeet Kaur + Show 2 more

Open Access

https://doi.org/10.1186/s12884-017-1557-4

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Abstract

BackgroundGlobally, India ranks first in the absolute number of stillbirths. Hence, the level, causes, and risk factors of stillbirths were estimated to facilitate designing of prevention strategy.MethodsCapture and recapture method was used to identify 301 stillbirths from 1st July 2013 to 31st August 2014 in Chandigarh Union Territory of India. Verbal autopsies (n = 181) were done at household level to identify causes of stillbirths. Risk factors were determined using case-control approach. Women who had a stillbirth in the past 3 months were enrolled as cases (n = 181) and those who had live-birth in same neighbourhood were included as controls (n = 181). Statistical differences in the distribution of characteristics of cases and controls were tested by t test and chi square test respectively for quantitative and categorical variables. In logistic regression models adjusted odds ratios (aOR) and 95% confidence intervals (CIs) were estimated for various risk factors.ResultsStillbirth rate was estimated to be 16/1000 birth. Antepartum causes were more common (68%) than intrapartum causes (32%). Among maternal conditions, hypertension (18.2%) and chorio-amnionitis (13.8%), and among foetal conditions, growth restriction (19.9%) and congenital anomalies (18.8%) were the leading causes. In about half of the stillbirths foetal (48%) and maternal (44.7%) causes were unidentifiable. Risk factors of stillbirths were: higher maternal age (aOR 1.1, 95%CI 1.0–1.2), vaginal delivery (aOR 8.1, 95%CI 2.6–26), induced labour (aOR 2.6, 95%CI 1.5–4.5), green or light brown liquor (aOR 2.0, 95%CI 1.1–3.8), preterm delivery (aOR 6.4, 95%CI 3.7–11) and smaller household size (aOR 1.2, 95% CI 1.1–1.3).ConclusionsStillbirth rate was high in Chandigarh Union Territory of India. Major causes and risk factors amenable to interventions were infections, hypertension, congenital malformations, foetal growth restriction, pre-maturity and household size. Therefore, better maternity ante-natal and intra-natal care is required to achieve a single digit stillbirth rate.

Highlights

India ranks first in the absolute number of stillbirths
Stillbirth rate During the study period, 301 stillbirths were recorded in Chandigarh Union Territory (UT)
Causes of stillbirths On the basis of verbal autopsy and available health records, 124 (68%) stillbirths were classified as antepartum and 57 (32%) as intra-partum (Table 1)

Summary

Introduction

India ranks first in the absolute number of stillbirths. The level, causes, and risk factors of stillbirths were estimated to facilitate designing of prevention strategy. Worldwide about 2.65 million babies were born as stillbirth in 2008. Out of these about 98% of the third-trimester stillbirths occurred in low-income and middle-income countries. Most of the high quality epidemiological studies have been conducted in high income countries [1], leading to a worldwide 10/90 gap in health research; Globally, India has been ranked first in the absolute number of stillbirths [4, 5]. The sample registration system (SRS) of India has estimated stillbirth rate to be only 5 per 1000 births in 2013 [6]. Government of India has set a target for bringing down the stillbirth rate to single digit by 2025 [12]

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