Abstract
About 2.6 million third-trimester stillbirths occur annually worldwide, mostly in low- and middle-income countries. However, the causes of stillbirths are rarely investigated. We performed a retrospective, hospital-based study in Zhejiang Province, southern China, of the causes of third-trimester stillbirths. Causes of stillbirths were classified using the Relevant Condition at Death classification system. From January 1, 2013, to December 31, 2018, we enrolled 341 stillbirths (born to 338 women) from 111,275 perinatal fetuses (born to 107,142 women), as well as 293 control cases (born to 291 women). The total incidence of third-trimester stillbirths was 3.06/1000 (341/111,275). There were higher proportions of women with a high body mass index, twins, pregnancy-induced hypertension, assisted reproduction and other risk factors among the antepartum than the control cases. The antepartum stillbirth fetuses were of lower median birth weight and gestational age and had a smaller portion of translucent amniotic fluid than the control cases. The antepartum stillbirth fetuses had a higher frequency of abnormalities detected prenatally and of fetal growth restriction than the control cases. Of 341 cases (born to 338 mothers), the most common causes of stillbirth were fetal conditions [117 (34.3%) cases], umbilical cord [88 (25.8%)], maternal conditions [34 (10.0%)], placental conditions [31 (9.1%)], and intrapartum [28 (8.2%)]. Only eight (2.3%), three (0.9%), and two (0.6%) stillbirths were attributed to amniotic fluid, trauma, and uterus, respectively. In 30 (8.8%) cases, the cause of death was unclassified. In conclusion, targeted investigation can ascertain the causes of most cases of third-trimester stillbirths.
Highlights
About 2.6 million third-trimester stillbirths occur annually worldwide, mostly in low- and middleincome countries
The stillbirth rate decreased from 2000 to 2015, there were 4.8 million perinatal deaths worldwide in 2015, of which 2.6 million were third-trimester stillbirths and 98% occurred in low- and middle-income countries (LMICs)
A systematic review of stillbirths from 2009 to 2016 in LMICs and high-income countries highlighted the poor quality of the d ata[10], which hampers the development of strategies to reduce the incidence of stillbirths
Summary
About 2.6 million third-trimester stillbirths occur annually worldwide, mostly in low- and middleincome countries. The stillbirth rate decreased from 2000 to 2015, there were 4.8 million perinatal deaths worldwide in 2015, of which 2.6 million were third-trimester stillbirths and 98% occurred in low- and middle-income countries (LMICs). The most effective means of reducing the incidence of stillbirths is to identify risk factors and provide targeted treatment. Pregnancy complications, such as pre-eclampsia and placental abruption, can lead to stillbirth, as can maternal infection[7]. Few highquality biological investigations of the risk factors for stillbirths in LMICs have been performed The aim of this retrospective study was to investigate the incidence of third-trimester stillbirths and the risk factors thereof among women who attended the Women’s Hospital, Zhejiang University School of Medicine, Scientific Reports | (2021) 11:12701. We wish to provide reliable data that will enable the incidence of preventable stillbirths to be reduced, in LMICs
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