Abstract
Introductionglobally, intrapartum stillbirth accounts for 1 million deaths of babies annually, representing approximately one-third of global stillbirth toll. Intrapartum stillbirth occurs due to causes ranging from maternal medical and obstetric conditions; access to quality obstetric care services during pregnancy; and types, timing and quality of intrapartum care. Different medical conditions including hypertensive & metabolic disorders, infections and nutritional deficiencies during pregnancy are among risk factors of stillbirth. Ethiopia remains one of the 10 high-burden stillbirth countries with estimated rate of more than 25 per 1000 births.Methodsa case-control study using primary data from chart review of medical records of women who experienced intrapartum stillbirth in 23 public health facilities of Addis Ababa during the period July 1, 2010 - June 30, 2015 was conducted. Data was collected from charts of all cases of intrapartum stillbirth meeting the inclusion criteria and randomly selected charts of controls in two to one (2:1) control to case ratio.Resultschronic medical conditions including diabetes, cardiac and renal diseases were less prevalent (1%) among the study population whereas only 6% of women experienced hypertensive disorder during the pregnancy in review. Moreover, 6.5% of the study population had HIV infection where being HIV negative was protective against intrapartum stillbirth (aOR 0.37, 95% CI 0.18-0.78). Women with non-cephalic foetal presentation during last ANC visit were three times more at risk of experiencing intrapartum stillbirth whereas singleton pregnancy had strong protective association against intrapartum stillbirth (p<0.05).Conclusionuntreated chronic medical conditions, infection, poor monitoring of foetal conditions and multiple pregnancy are among important risk factors for intrapartum stillbirth.
Highlights
Stillbirth is one of the adverse outcomes of pregnancy
Evidence shows that maternal medical conditions including hypertensive, metabolic, endocrine, respiratory, haematological disorders are associated with adverse pregnancy outcomes including stillbirth [8]
This study revealed that pregnant women with non-cephalic foetal presentations during last Antenatal Care (ANC) visits of the index pregnancy were three times more at risk of experiencing intrapartum stillbirth compared to those with cephalic foetal presentations
Summary
Stillbirth is one of the adverse outcomes of pregnancy. The definition of stillbirth can vary from country to country based on clinical and obstetric care protocols. Foetal death occurring during labour is referred as intrapartum stillbirth [3]. Nearly 2.6 million third trimester stillbirth occurred in 2015. Notwithstanding the gestational age cut-off for its definition, stillbirth can occur either during antepartum or intrapartum period. Approximately 98% of all stillbirth occur in low and middle-income countries (LMIC), nearly 10fold higher than those documented in high-resource settings [4]. Regardless of the classification challenges, intrapartum stillbirth accounts for one million deaths of babies annually, representing approximately one-third of global stillbirth toll. These estimates highlight the magnitude of loss of life just minutes and hours prior to birth with devastating social, emotional and epidemiologic consequences [6]
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