Stillbirths: what difference can we make and at what cost?

Area of Science:

• Global Health
• Obstetrics and Gynecology
• Preventive Medicine

Background:

• Stillbirths represent a significant global health challenge, with 2.65 million occurring annually, predominantly in low- and middle-income countries (LMICs).
• Intrapartum stillbirths account for over 45% of the global burden, yet effective interventions, especially for resource-limited settings, are perceived as lacking.
• Addressing stillbirths is crucial for improving maternal, fetal, and neonatal health outcomes.

Purpose of the Study:

• To systematically review randomized trials and observational studies on interventions to reduce stillbirths, with a focus on LMICs.
• To identify evidence-based interventions suitable for implementation in health systems globally.
• To estimate the potential impact and cost-effectiveness of implementing these interventions.

Main Methods:

• Systematic review of randomized controlled trials and observational studies.
• Inclusion of interventions targeting stillbirth reduction, particularly in LMICs.
• Modeling using the Lives Saved Tool (LiST) to estimate averted stillbirths.

Main Results:

• Key interventions with sufficient evidence for implementation include periconceptional folic acid supplementation/fortification, malaria prevention, and syphilis detection/management in endemic areas.
• Basic and comprehensive emergency obstetric care are vital for reducing intrapartum stillbirths.
• Modeling suggests that implementing intervention packages in 68 priority countries could avert up to 45% of stillbirths.

Conclusions:

• Evidence-based interventions are available to significantly reduce the global stillbirth burden.
• Implementation of intervention packages, including emergency obstetric care, is cost-effective and can avert a substantial proportion of stillbirths.
• Focusing on these interventions in LMICs is critical for improving maternal and neonatal survival.