Provided by Cognitive Sciences ePrint Archive
Online Journal of Health and Allied Sciences
Peer Reviewed, Open Access, Free Online Journal
Published Quarterly : Mangalore, South India : ISSN 0972-5997
Volume 9, Issue 4; Oct-Dec 2010
This work is licensed under a
Creative Commons Attribution-
No Derivative Works 2.5 India License
Original Article:
Stillbirth in a Tertiary Care Referral Hospital in North Bengal - A Review of Causes, Risk Factors
and Prevention Strategies
Shritanu Bhattacharya, Associate Professor,
Gautam Mukhopadhyay, Associate Professor,
Pallab Kumar Mistry, Assistant Professor,
Shyamapada Pati, Professor and Head,
Shyama Prasad Saha, Associate Professor,
Department of Gynaecology and Obstetrics, North Bengal Medical College.
Address For Correspondence:
Dr. Shritanu Bhattacharya,
Behind Ranikutir,
No. 2 Airport Gate, Dum Dum,
Kolkata - 700081,
West Bengal, India
E-mail: [email protected]
Citation: Bhattacharya S, Mukhopadhyay G, Mistry PK, Pati S, Saha SP. Stillbirth in a Tertiary Care Referral Hospital in North
Bengal - A Review of Causes, Risk Factors and Prevention Strategies. Online J Health Allied Scs. 2010;9(4):4
URL: http://www.ojhas.org/issue36/2010-4-4.htm
Open Access Archives: http://cogprints.org/view/subjects/OJHAS.html and http://openmed.nic.in/view/subjects/ojhas.html
Submitted: Aug 31, 2010; Accepted: Sep 27, 2010; Published: Jan 20, 2010
Abstract:
Background and Aims: Stillbirth is one of the most common
adverse outcomes of pregnancy, accounting for half of all
perinatal mortality. Each year approximately 4 million
stillbirths are reported, with 97% occurring in developing
countries. The objective of the present study was to evaluate the
stillbirth rate, exploring the risk factors and causes of stillbirth
and suggest policies to reduce it. Settings and Design: A
retrospective study of stillbirth among all deliveries over 5
years at North Bengal Medical College, a referral tertiary care
teaching hospital in a rural background. The stillbirth rate and
its trend were defined and the probable causes and risk factors
were identified. Results: Stillbirth rate is 59.76/1000 live
births, and Perinatal Mortality 98.65/1000 births. Of the still
births, 59.72% were fresh and 40.27% were macerated. Among
the causes of stillbirths, poor antenatal attendance and low
socioeconomic status were important; other risk factors
included prematurity, PIH, birth asphyxia, poor intrapartum
care including prolonged and obstructed labour. In 23% cases,
the cause remained unexplained. Conclusion: In addition to
poor antenatal care, low socioeconomic condition, poor referral
service, suboptimal intrapartum care in health facilities
including tertiary centre were mainly responsible for majority
of still births which could have been prevented. We speculate
that upgrading the existing health system performance,
particularly high quality intrapartum care by skilled health
personnel, will reduce stillbirths substantially in our institute.
Key Words: Still birth; Intrapartum stillbirth; Perinatal
Mortality
Introduction:
Stillbirth generally accounts for half of all perinatal mortality,
with an estimated 4 million occurring worldwide each year.
More than 97% of these stillbirths take place in developing
countries.1 For many reasons, stillbirths have been understud-
ied, underreported and rarely have been considered in attempts
to improve adverse pregnancy outcome in developing coun-
tries.2 Perinatal mortality reflects one of the important health in-
dex of a country and it is one of the sensitive indicators of ma-
ternal and child health (MCH) care. Nearly 60% of perinatal
deaths in our country are stillbirths and are preventable.3
In developed countries, stillbirth has generally been defined as
fetal loss beyond 20 weeks of gestation, however, some de-
veloped countries such as Sweden still use 28 weeks as the
lower cut off for still birth. In less developed countries, a gesta-
tional age of 28 weeks or a birth weight of 1000gm is often the
lower cut off used.4 There exists no standard international clas-
sification system that defines causes of fetal death, nor is there
any agreement about the lower limits of birth weight or gesta-
tional age that define stillbirth, making comparisons of causes
of stillbirth or rates over time or between sites problematic.5
Stillbirths that occur more than 12-24 hours prior to delivery
result in maceration of skin, while those occurring in the intra-
partum period or immediately prior to delivery are generally
normal in appearance and are often called fresh stillbirth. 2 Still-
birth can be sub classified according to the gestational age at
birth, typically into early stillbirth (20-28 weeks) and late still-
birth (after 28weeks). 6 Stillbirths are also sub classified by
whether death occurred before or after the onset of labour -
termed antepartum or intrapartum respectively. However the
primary method of classification of still birth is according to the
presumed causes or associated obstetric disorders.
In general, the study of specific causes of stillbirth has been af-
fected by scarcity of uniform protocols for assessment and clas-
sification of stillbirths and falling autopsy rates. In most cases,
death certificates are filled out before the results of postnatal in-
vestigations are available.
Aims and Objectives
We have analyzed the still birth over a period of five years
from 2004 to 2009 in North Bengal Medical college which is a
referral tertiary care teaching hospital of West Bengal, India at
the foothills of Himalayas in a rural back ground. Our goal in
this study was to determine the stillbirth rate and thereby as-
sessing the magnitude of the problem, exploring the risk factors