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Causes and Demographic Factors Affecting Stillbirth in a Tertiary Care Centre in India

Abstract

Introduction

Stillbirth is a global health problem having many emotional, social and economic consequences. India has the largest number of stillbirths per year in the world.

Objective

The objective of this study is to review the causes of stillbirth and classify the causes into maternal, foetal and placental causes and further classify causes by relevant condition at death (ReCoDe) classification. We intend to observe the causes of and demographic factors contributing to the burden of stillbirths. Using this data, the areas of action can be identified and measures can be formulated to reduce a significant number of perinatal mortalities.

Methodology

This is an observational study of data collected over one year (January 2019–December 2019) from a tertiary care centre in Mumbai, India. The maternal demographic characteristics and causes of stillbirth were studied. The causes of stillbirths were classified into maternal, foetal and placental causes and relevant condition at death (ReCoDe) classification [1].

Results

A total of 9074 babies were delivered during this period. There were 275 stillbirths in this year (SBR 30.3 per 1000 total births). Majority of the mothers were in the age group of 26–30 years (32.7%). Almost all the mothers (98.5%) were from urban areas. As per the modified Kuppuswamy classification for urban India, 195 (71.79%) belonged to the upper lower class. 31.2% were primigravidae, and 54.8% had 3 or more antenatal visits. Maternal conditions (pre-eclampsia, diabetes, pre-existing medical disorders) as a group were the cause of maximum number (42%) of stillbirths either directly or as a contributory risk factor. 78% of the stillbirths occurred in the antepartum period. Ours being a referral centre, 65% subjects in the study were referred to us from other peripheral hospitals. 53.8% of the stillborn babies were male. 58.9% were macerated stillbirths. According to the ReCoDe classification, hypertensive disease in pregnancy was the most common cause of stillbirths (76) followed by foetal growth restriction (30).

Conclusion

Most of the stillbirths in this study were due to maternal medical conditions. Out of these conditions, hypertensive disorders of pregnancy and its consequences were the most common (66.08%). Better regulation of the private healthcare sector, provision of healthcare providers and better equipments in peripheral health centres and a well-chalked out referral system will contribute to reduction in the number of preventable stillbirths. Regular facility-based stillbirth review meetings and healthcare provider accountability would also help to reduce the burden of this silent epidemic as well as reach the goal of a “single-digit” stillbirth rate by the year 2030.

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Authors and Affiliations

Authors

Contributions

All authors have contributed to the design, data collection, data analysis, writing and proofreading of manuscript.

Corresponding author

Correspondence to Pradnya Changede.

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Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval

Taken from institutional ethics committee.

Human Rights

Study has been approved by institutional ethics board, and all procedures performed in study involving human participants were in accordance with the ethical standards of the institution and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent has been obtained from all participants of this study.

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Pradnya Changede is an Assistant Professor, Department of Obstetrics and Gynecology, Lokmanya Tilak, Municipal Medical College and General Hospital, Sion, Mumbai, India; Sneha Venkateswaran is a Speciality Medical Officer, Department of Obstetrics and Gynecology, Lokmanya Tilak, Municipal Medical College and General Hospital, Sion, Mumbai, India; Arun Nayak is a Professor and Head of Department, Department of Obstetrics and Gynecology, Lokmanya Tilak, Municipal Medical College and General Hospital, Sion, Mumbai, India; Dinesh Wade is a Senior Registrar, Department of Obstetrics and Gynecology, Lokmanya Tilak, Municipal Medical College and General Hospital, Sion, Mumbai, India; Priyanka Sonawane is a Speciality Medical Officer, Department of Obstetrics and Gynecology, Lokmanya Tilak, Municipal Medical College and General Hospital, Sion, Mumbai, India; Ruchita Patel is a Resident, Department of Obstetrics and Gynecology, Lokmanya Tilak, Municipal Medical College and General Hospital, Sion, Mumbai, India; Hitendra Rajput is a Resident, Department of Obstetrics and Gynecology, Lokmanya Tilak, Municipal Medical College and General Hospital, Sion, Mumbai, India.

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Changede, P., Venkateswaran, S., Nayak, A. et al. Causes and Demographic Factors Affecting Stillbirth in a Tertiary Care Centre in India. J Obstet Gynecol India 72, 225–235 (2022). https://doi.org/10.1007/s13224-021-01571-1

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  • DOI: https://doi.org/10.1007/s13224-021-01571-1

Keywords

  • Stillbirth
  • Classification of stillbirth
  • ReCoDe classification