Tracking stillbirths by referral pattern and causes in a rural tertiary hospital in Southern Nigeria.

Abstract

The burden of stillbirth is disproportionately more in rural areas of developing countries where unskilled birth attendants contribute a large quota in the management of pregnant women. Tracking stillbirth should include the pattern of referral from the primary institutions that take care of these women. This study evaluated the causes and determinants of stillbirth by the referral pattern in a rural area in southern Nigeria. This was a retrospective case-controlled study of stillbirth at the Madonna University Teaching Hospital, Elele, from 2010 to 2014. The lying-in, delivery and theatre registers were used to extract the relevant information. For each stillbirth, two controls were selected which were live births. Data analysis was performed using SPSS version 20. The confidence interval was 95% set at value of P = 0.05. During the study, a total of 1243 neonates were delivered at the hospital, the number of live births and stillbirths were 1025 and 218, respectively. This gives a stillbirth rate of 175/1000 deliveries. Only 179 neonates whose case files were retrieved were used in the analysis. There were 87 fresh and 92 macerated stillbirths. Intrapartum complications contributed 91 (51.40%) of the stillbirths with traditional birth attendants and maternity homes contributing 72%. Determinants include booking status, educational level, abruptio placentae, preeclampsia, ruptured uterus, prolonged labor and low birthweight. The study showed an unacceptably high rate of stillbirth in rural Nigeria. Early recognition of complications and prompt referral may reduce stillbirth rate.