for stillbirth and its possible causes and recommend remedial
measures to be adopted in an attempt to reduce stillbirth rate in
our facility.
Materials and Methods:
This is a retrospective study over a period of five years from
January 2004 to December 2009 on stillbirth.
To find out possible causes of stillbirth, maternal details like
age, parity, socioeconomic status, antenatal check up, gestation-
al age, associated medical disorders, and presence of any ob-
stetric complications were noted.
Changing trends of still births for last five years were also eval-
uated. Pregnant women having at least three antenatal check
ups in our hospital were considered as booked cases. The gesta-
tional age was assessed from LMP and clinical examination of
the baby. The cut off point of gestational age for still birth was
taken as 28 weeks. All relevant investigations e.g. Hb%, ultra-
sound and other antenatal investigations available were also
noted. The modes of delivery, sex and birth weight of fetuses
were recorded. The babies were examined for any congenital
anomalies and placentae were examined for any retroplacental
clots and any other abnormalities. Autopsy was performed
where consent was given by parents. If an obvious cause of
death was not found, then by way of exclusion, stillbirth was
usually considered unexplained.
Results:
During the study period, the total number of deliveries were
27541 and stillbirths were 1646, including 17 sets of twins. The
stillbirth rate was 59.76/1000 (Fresh 59.72% and macerated
40.27%). The perinatal mortality was 98.65/1000 (Table 1).
|
Table 1: Stillbirth rate and Perinatal mortality rate | |
|
Total deliveries________________ |
___________27,541___________ |
|
Total no of stillbirths___________ |
____________1646____________ |
|
Stillbirth rate____________________ |
_________59.76/1000_________ |
|
Fresh stillbirth__________________ |
_______983(59.72%)_______ |
|
Macerated stillbirth____________ |
_______663(40.27%)_______ |
|
Perinatal death_________________ |
___________2717___________ |
|
Perinatal mortality rate________ |
_________98.65/1000_________ |
Table 2 shows that there was a decreasing trend of Still Birth
Rate from 74.43 in 2004-2005 to 44.36 in 2008-2009. The Peri-
natal Mortality Rate (PMR) also showed a decreasing trend
from 120.16 in 2004-2005 to 80.38 in 2008-2009.
|
Table 2: Year wise distribution of stillbirth and PMR | ||||||
|
Year |
No of Deliveries |
No. of stillbirths |
No. of neonatal |
No. of perinatal |
Stillbirth rate |
PMR* |
|
2004-2005 |
4702 |
350 |
215 |
565 |
74.43 |
120.16 |
|
2005-2006 |
4507 |
331 |
195 |
526 |
73.44 |
116.70 |
|
2006-2007 |
5853 |
357 |
214 |
571 |
60.99 |
97.55 |
|
2007-2008 |
6371 |
337 |
227 |
564 |
52.89 |
88.52 |
|
2008-2009 |
6108 |
271 |
220 |
491 |
44.36 |
80.38 |
|
*Perinatal Mortality Rate________________________________________________________________________________________________________ | ||||||
Table 3 shows that 70.28% cases were unbooked and only
29.71% were booked cases. Maximum cases were from low so-
cio economic status (61.93%). In 66.23% cases age of the
mothers were between 20-30 years, primigravida constitutes
56.72% and multigravida 43.27% cases. In 47.26% cases, gest-
ational age was between 28-37 weeks and vaginal delivery con-
stituted 72.98% among stillbirths.
|
Table 3: Profile of women. n=1629 (17 sets of twins) | ||
|
No of women Percentage | ||
|
1) Antenatal check-up | ||
|
Unbooked________________ |
1145 |
70.28% |
|
Booked__________________ |
484 |
29.71% |
|
2) Age______________________ | ||
|
<20 years___________________ |
198 ~~ |
12.15% ~ |
|
20-30 years___________________ |
1079 |
66.23% |
|
>30 years |
352 |
20.60% |
|
3) Socio-economic status | ||
|
Low___________________ |
1009 |
61.93% |
|
Middle_____________________ |
504 |
30.93% |
|
High |
146 |
8.96% |
|
4) Parity | ||
|
Primi_________________________ |
924 |
56.72% |
|
Multi |
705 |
43.27% |
|
5) Gestational age | ||
|
Preterm (28-37wks)__________ |
770 |
47.26% |
|
Term (37-42wks)___________ |
556 |
34.13% |
|
Post term (>42wks)__________ |
81 |
4.97% |
|
Undetermined |
222 |
13.62% |
|
6) Mode of delivery | ||
|
V aginal delivery______________ |
1189 |
72.98% |
|
Caesarean Section____________ |
264 |
16.20% |
|
Instrumental vaginal delivery |
120 |
7.36% |
|
Destructive operation_________ |
56 |
3.43% |
of stillbirths of which prematurity (21.20%), malpresentation
(17.48%), preeclampsia and eclampsia (10.66%) were the lead-
ing causes. However, in 23% cases no definite cause could be
found. Table 6 shows that amongst the stillbirths, 59.72%
( n=983) were fresh and 40.27% (n=663) were macerated.
|
Table 4: Birth Weight amongst stillbirth babies (n=1646) | |||||
|
Wt in grams_____ |
___Number___ |
Percentage | |||
|
1000-1499________ |
_______203_______ |
12.33% | |||
|
1500-2500________ |
1172 |
71.20% | |||
|
>2500 |
271 |
16.46% | |||
|
Table 5: Causes of stillbirth (n=1646) | |||||
|
Causes_________________________ |
Number |
Percentage | |||
|
Unexplained______________________ |
381 |
23.14% | |||
|
Prematurity_________________________ |
348 |
21.20% | |||
|
Malpresentation_____________________ |
287 |
17.48% | |||
|
Preeclampsia & Eclampsia__________ |
175 |
10.66% | |||
|
Obstructed labor____________________ |
149 |
9.07% | |||
|
IUGR_____________________ |
66 |
4.02% | |||
|
Medical disorders of Pregnancy_____ |
57 |
3.47% | |||
|
Peripartum hypoxia________________ |
49 |
2.98% | |||
|
APH_____________________ |
44 |
2.68% | |||
|
Uterine rupture______________________ |
38 |
2.31% | |||
|
Congenital malformation___________ |
21 |
1.27% | |||
|
Infections_____________________________ |
18 |
1.09% | |||
|
Post maturity_______________________ |
13 |
0.79% | |||
|
Table 6: Classification of stillbirth (n=1646) | |||||
|
Fresh stillbirth 983 (59.72%)__________ |
Registered: 292(29.70%)____________ | ||||
|
Unregistered: 691(70.29%)__________ | |||||
|
Macerated stillbirth |
Registered: 197(29.71%)____________ | ||||
|
Unregistered:466(70.28%)__________ | |||||
Table 4 shows that amongst the stillbirth babies, 71.20% were
between 1500gm to 2500gm and in 16.46% cases birth weights
were more than 2500 gm. Table 5 depicts the different causes