Maternal and Child Health Journal

, Volume 18, Issue 1, pp 45–51 | Cite as

A Case Series Study of Perinatal Deaths at One Referral Center in Rural Post-conflict Liberia

  • Jody R. LoriEmail author
  • Sarah Rominski
  • Barbara F. Osher
  • Carol J. Boyd


The overall objective of this study was to further our understanding of the factors contributing to the high perinatal mortality rates at a busy rural, referral hospital in Liberia. The specific aims were to: (1) analyze the records of women who experienced a perinatal loss for both medical and nonmedical contributing factors; (2) describe the timing and causes of all documented stillbirths and early neonatal deaths; and (3) understand the factors surrounding stillbirth and early neonatal death in this context. This case series study was conducted through a retrospective hospital-based record review of all perinatal deaths occurring at the largest rural referral hospital in north-central Liberia during the 2010 calendar year. A record review of 1,656 deliveries identified 196 perinatal deaths; 143 classified as stillbirth and 53 were classified as early neonatal death. The majority of stillbirths (56.6 %) presented as antenatal stillbirths with no fetal heart tones documented upon admission. Thirty-one percent of cases had no maternal or obstetrical diagnosis recorded in the chart when a stillbirth occurred. Of the 53 early neonatal deaths, 47.2 % occurred on day one of the infant’s life with birth asphyxia/poor Apgar scores being the diagnosis listed most frequently. Clear and concise documentation is key to understanding the high perinatal death rates in low resource countries. Standardized, detailed documentation is needed to inform changes to clinical practice and develop feasible solutions to reduce the number of perinatal deaths worldwide.


Perinatal mortality Stillbirth Early neonatal death Post-conflict Liberia 



The authors wish to acknowledge Mary W. Tiah, RN, Nursing Supervisor and Dr. Garfee Williams, Medical Director, Phebe Hospital, Suakoko, Liberia for their support and guidance in this research. This study and the development of this article was supported in part by research grant 1 K01 TW008763-01A1 from Fogarty International, National Institutes of Health, (Dr. Jody R. Lori, PI), the University of Michigan, Center for Global Health, Ann Arbor, Michigan (Dr. Jody R. Lori, PI), and the U.S. Agency for International Development, Grant USAID-M-OOA-GH-HSR-10–40 (Drs. Jody R. Lori and Carol J. Boyd Co- PIs).


  1. 1.
    Mullan, Z., & Horton, R. (2011). Bringing stillbirths out of the shadows. Lancet, 377(9775), 1291–1292.CrossRefGoogle Scholar
  2. 2.
    Lawn, J. E., Blencowe, H., Pattinson, R., Cousens, S., Kumar, R., Ibiebele, I., et al. (2011). Stillbirths: Where? When? Why? How to make the data count? Lancet, 377(9775), 1448–1463.CrossRefGoogle Scholar
  3. 3.
    Goldenberg, R. L., McClure, E. M., & Belizan, J. M. (2009). Commentary: Reducing the world’s stillbirths. BMC Pregnancy and Childbirth, 9(Suppl 1), S1.CrossRefGoogle Scholar
  4. 4.
    Spector, J. M., & Daga, S. (2008). Preventing those so-called stillbirths. Bulletin of the World Health Organization, 86(4), 315–316.CrossRefGoogle Scholar
  5. 5.
    Lawn, J. E., Kinney, M. (2011, April 14) Stillbirths: An executive summary for the lancet’s series. Lancet. Available from Cited February 4, 2013.
  6. 6.
    Engmann, C., Matendo, R., Kinoshita, R., Ditekemena, J., Moore, J., Goldenberg, R. L., et al. (2009). Stillbirth and early neonatal mortality in rural Central Africa. International Journal of Gynaecology and Obstetrics, 105, 112–117.CrossRefGoogle Scholar
  7. 7.
    Bhattacharyya, R., & Pal, A. (2011). Stillbirths in a referral medical college hospital, West Bengal, India: A ten year review. Obstetrics & Gynaecology Research,. doi: 10/1111/j.1447-0756.2011.01670.x.Google Scholar
  8. 8.
    McClure, E. M, Wright, L. L, Goldenberg, R. L, Goudar, S. S., Parida, S. N., Jehan, I., et al. (2007). The global network: A prospective study of still births in developing countries. American Journal of Obstetrics and Gynecology, 197, 247.e1–247.e5.CrossRefGoogle Scholar
  9. 9.
    Edmond, K. M., Quigley, M. A., Zandoh, C., Danso, S., Hurt, C., Agyei, S. O., et al. (2008). Aetiology of stillbirths and neonatal deaths in rural Ghana: Implications for health programming in developing countries. Paediatric and Perinatal Epidemiology, 22, 430–437. doi: 10.1111/j.1365-3016.2008.00961.x.CrossRefGoogle Scholar
  10. 10.
    Cousens, S., Blencowe, H., Stanton, C., Chou, D., Ahmed, S., Steinhardt, L., et al. (2011). National, regional, and worldwide estimates of stillbirth rates in 2009 with trends since 1995: A systematic analysis. Lancet, 377(9775), 1319–1330.CrossRefGoogle Scholar
  11. 11.
    World Health Organization. Measuring health systems strengthening and trends: A toolkit for countries, Geneva. 2008. Available from Cited December 1, 2012.
  12. 12.
    Lori, J. R., & Boyle, J. S. (2011). Maternal health, illness and death in post-conflict Liberia. Health Care for Women International, 32(6), 454–473.CrossRefGoogle Scholar
  13. 13.
    Lori, J. R., & Starke, A. (2011). A critical analysis of maternal morbidity and mortality in Liberia, West Africa. Midwifery, 28, 67–72. doi: 10.1016/j.midw.2010.12.001.CrossRefGoogle Scholar
  14. 14.
    Mittal, M. Perinatal periods of risk (PPOR): a useful tool for analyzing fetal and infant mortality. 2005. Statistical Brief No. 28, State Center for Health Statistics, North Carolina, Department of Health and Human Services, Division of Public Health.Google Scholar
  15. 15.
    Lee, P. T., Kruse, G. R., Chan, B. T., Massaquoi, M. B. F., Panjabi, R. R., Dahn, B. T., et al. (2011). An analysis of Liberia’s 2007 National Health Policy: Lessons for health systems strengthening and chronic disease care in poor, post-conflict countries. BMC Globalization and Health, 7, 37. doi: 10.1186/1744-8603-7-37.CrossRefGoogle Scholar
  16. 16.
    World Health Organization. Neonatal and perinatal mortality: Country, regional and global estimates. 2006. Available from Cited August 26, 2012.
  17. 17.
    Liberia Institute of Statistics and Geo-Information Services (LISGIS) [Liberia], Ministry of Health and Social Welfare [Liberia], National AIDS Control Program [Liberia], and Macro International, Inc. (2008). Liberia demographic and health survey, 2007. Monrovia, Liberia: Liberia Institute of Statistics and Geo-Information Services (LISGIS) and Macro International.Google Scholar
  18. 18.
    Republic of Liberia. (2008). National population and housing census final results. Monrovia, Liberia: Liberia Institute of Statistics and Geo-Information Services, May 2009. Available from Cited August 26, 2012.
  19. 19.
    Ministry of Health and Social Welfare (MOHSW. The basic package of health services accreditation final results report.), 2010. Monrovia, Liberia.Google Scholar
  20. 20.
    Kruk, M. E., Rockers, P. C., Williams, E. H., Varpilah, S. T., Mccauley, R., Sadee, G., et al. (2010). Availability of essential health services in post-conflict Liberia. Bulletin of the World Health Organization, 88(7), 527–534.CrossRefGoogle Scholar
  21. 21.
    Chibuike, C. O., Okezie, O. A., & Odugu, B. U. (2009). Intrapartum stillbirth in a Nigerian tertiary hospital setting. International Journal of Gynaecology and Obstetrics, 104, 18–21.CrossRefGoogle Scholar
  22. 22.
    Feresu, S. A., Harlow, S. D., Welch, K., Gillespie, B. W. (2005). Incidence of stillbirth and perinatal mortality and their associated factors among women delivering at Harare Maternity Hospital, Zimbabwe: A cross-sectional retrospective analysis. BMC: Pregnancy and Childbirth, 5, 9. doi: 10.1186/1471-2393-5-9.
  23. 23.
    World Health Organization. (2004). Priority interventions for strengthening national health information systems, AFR/RC54/12. Geneva.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Jody R. Lori
    • 1
    Email author
  • Sarah Rominski
    • 2
  • Barbara F. Osher
    • 3
  • Carol J. Boyd
    • 4
  1. 1.School of Nursing, WHO Collaborating CenterUniversity of MichiganAnn ArborUSA
  2. 2.Global REACHUniversity of Michigan Medical SchoolAnn ArborUSA
  3. 3.School of NursingAdjunct Faculty, University of MichiganAnn ArborUSA
  4. 4.School of Nursing & Women’s StudiesUniversity of MichiganLane Hall, Ann ArborUSA

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