Still-birth--a tragic journey: a critical analysis

Area of Science:

• Obstetrics and Gynecology
• Perinatal Medicine
• Public Health

Background:

• Late intrauterine fetal death (stillbirth) at or after 28 weeks gestation remains a significant challenge in obstetric care, particularly in developing countries.
• Stillbirths constitute a substantial proportion of perinatal mortality, with Nepal reporting over 50% of perinatal deaths attributed to this outcome.

Purpose of the Study:

• To determine the prevalence rate of late intrauterine fetal death in Nepal.
• To identify the causes and contributing factors of stillbirths.
• To propose preventive measures for reducing stillbirths and perinatal mortality.

Main Methods:

• A retrospective review of medical records was conducted for 89 women with singleton pregnancies delivering stillborn infants at or after 28 weeks gestation.
• Data were collected from April 1998 to April 2007 at Nepal Medical College Teaching Hospital.
• Causes of stillbirth were analyzed, categorizing them by maternal conditions (e.g., pre-eclampsia) and fetal/placental factors.

Main Results:

• Major malformations were found in 5.6% of stillborn infants, including neural tube abnormalities.
• Pre-eclampsia was identified as a potential indirect cause in 19.0% of cases with normal fetal formations.
• In non-pre-eclamptic women, causes were often unclear (45.6%), with other identified factors including breech delivery complications (16.0%), abruptio placentae (7.3%), intrauterine growth restriction (14.7%), infection (8.8%), and cord accidents (7.3%).

Conclusions:

• The causes of stillbirth are diverse, with a significant proportion remaining unexplained in this study.
• Improved monitoring of pre-eclampsia and prompt management of abruptio placentae are crucial for reducing stillbirths.
• Enhanced community-focused antenatal care, increased institutional deliveries, and accessible emergency obstetric care are vital for decreasing stillbirths and perinatal mortality in Nepal.