Reducing stillbirths in low-income countries

Area of Science:

• Perinatal health
• Global public health
• Obstetrics

Background:

• Stillbirth rates are ten times higher in low-income countries (LIC) compared to high-income countries (HIC).
• In LIC, stillbirths predominantly occur at term and during labor, unlike in HIC where most are prenatal.
• Key causes include maternal conditions (e.g., obstructed labor, preeclampsia, infection) and fetal factors (e.g., growth restriction, asphyxia).

Purpose of the Study:

• To highlight the disparities in stillbirth rates and timing between LIC and HIC.
• To identify the primary causes of stillbirth in LIC, particularly fetal asphyxia.
• To emphasize the need for improved obstetric care interventions in LIC.

Main Methods:

• Comparative analysis of stillbirth occurrence and timing in LIC versus HIC.
• Review of maternal and fetal conditions contributing to stillbirth.
• Assessment of current prevention strategies and their limitations.

Main Results:

• 98% of stillbirths occur in LIC, with rates ten times higher than in HIC.
• Fetal asphyxia is a major cause of stillbirth in LIC, often occurring during labor.
• Only a few causes, like syphilis and malaria, are manageable prenatally.

Conclusions:

• Reducing stillbirths in LIC requires comprehensive modern antepartum and intrapartum care.
• Effective interventions include fetal monitoring and timely cesarean sections (CS).
• Targeting single causes is insufficient; systemic improvements in obstetric care are necessary.