Abstract
BackgroundAnnually, 2.6 million stillbirths occur around the world, with approximately 98% occurring in low- and middle-income countries. The stillbirth rates in these countries are 10 times higher than the rates in high-income countries.MethodsAn electronic stillbirths and neonatal deaths surveillance system (JSANDS) was established in five large hospitals located in three of the largest cities in Jordan in August 2019. JSANDS was developed as a secure on-line data entry system to collect, organize, analyze, and disseminate data on stillbirths, neonatal deaths, and their contributing conditions. Data on births, stillbirths and their contributing conditions, and other demographic and clinical characteristics in the period between August 2019 – January 2020 were extracted and analyzed.ResultsA total of 10,328 births were registered during the reporting period. Of the total births, 102 were born dead (88 antepartum stillbirths and 14 intrapartum stillbirths), with a rate of 9.9 per 1000 total births. The main contributing fetal conditions of antepartum stillbirths were antepartum death of unspecified cause (33.7%), acute antepartum event (hypoxia) (33.7%), congenital malformations and chromosomal abnormalities (13.3%), and disorders related to the length of gestation and fetal growth (10.8%). The main contributing maternal conditions of antepartum stillbirths included complications of the placental cord and membranes (48.7%), maternal complications of pregnancy (23.1%), and maternal medical and surgical conditions (23.1%). Contributing fetal conditions of intrapartum stillbirths included congenital malformations, deformations and chromosomal abnormalities, other specified intrapartum disorders, and intrapartum death of unspecified cause (33.3% each). Contributing maternal conditions of intrapartum stillbirths included complications of the placental cord and membranes. In the multivariate analysis, small for gestational age (SGA) pregnancies were associated with a significant 3-fold increased risk of stillbirth compared to appropriate for gestational age (AGA) pregnancies.ConclusionsAlthough the rate of stillbirth is lower than that in other countries in the region, there is an opportunity to prevent such deaths. While the majority of stillbirths occurred during the antepartum period, care should be taken for the early identification of high-risk pregnancies, including the early detection of SGA pregnancies, and ensuring adequate antenatal obstetric interventions.
Highlights
2.6 million stillbirths occur around the world, with approximately 98% occurring in low- and middle-income countries
The stillbirth rate did not vary significantly according to health sector and mother’s age, educational level, income, and working status
The stillbirth rate was much higher among small for gestational age (SGA) deliveries compared to appropriate for gestational age (AGA) deliveries
Summary
2.6 million stillbirths occur around the world, with approximately 98% occurring in low- and middle-income countries. The global burden of disease study reported a 47.0% decline in stillbirth rates between 1990 and 2015 [1]. Data extracted from registration systems from 157 countries reported that an estimate of 2.6 million stillbirths occurred annually and showed a reduction of 25.5% in stillbirth rates for the period 2000 until 2015 [2]. 98% of these stillbirths occurred in low- and middle-income countries [3]. A retrospective population-based study of stillbirth in a multi-ethnic Middle-Eastern population reported a stillbirth rate of 7.81 per 1000 total births [4]. Maducolil et al reported that maternal factors comprised a 52.4% of total stillbirths in the Middle-Eastern population and included maternal hypertension, diabetes, and other medical disorders. The main fetal factors reported in the same study were intrauterine growth restriction followed by congenital anomalies [4]
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