Stillbirths at the Jos University Teaching Hospital: incidence, risk, and etiological factors

Death of a fetus in-utero or intrapartum is both devastating to the couple and of concern to the clinician. Identifying the etiological and risk factors of stillbirths will help in the prevention or reduction of its occurrence.

This was a prospective observational study of all stillbirths over a 16-month period (from January 2006 to April 2007) at the maternity Unit of Jos University Teaching Hospital. Information on maternal socio-demographic details, history of antenatal complications of the index pregnancy, and maternal medical history were obtained by personal interview of all mothers who had a stillbirth. For each stillbirth, information was obtained on the type of stillbirth, estimated gestational age at delivery, sex of baby, and the mode of delivery. These characteristics were subjected to analysis. Etiological causes were assessed using the clinico-pathological approach advocated by Baird-Pattinson.

There were a total of 3,904 deliveries with 158 stillbirths during the study period, giving a stillbirth rate of 40.5 per 1,000 total births. There were 84 (53.2%) macerated and 74 (46.8%) fresh stillbirths. Of the 3,904 total deliveries, there were 2,022 (51.8%) males and 1,882 (48.2%) females. There were 84 male and 74 female stillbirths, giving stillbirth rates of 41.5 per 1,000 and 39.3 per 1,000 total deliveries for male and female deliveries, respectively, which was not statistically significant (X2 = 4.6865, P < 0.3564). The major causes were abruptio placentae (17.7%), hypertensive disorders of pregnancy (12.7%) and maternal HIV infection 10.7% of stillbirths. Other causes were cord accidents (7.0%), placenta praevia (3.8%), and anemia in pregnancy (3.8%). Forty-six (29.1%) of the stillbirths were unexplained. The main risk factors identified were lack of antenatal care, poor antenatal clinic attendance, home delivery, and late presentation of complicated labor to the facility.

The stillbirth rate in our centre is high, major causes being abruptio placenta and maternal medical conditions. Maternal HIV infection has emerged as a major contributor to stillbirths in this study.