Related Experiment Video
Updated: Nov 11, 2025
14:40
Instrumentation of Near-term Fetal Sheep for Multivariate Chronic Non-anesthetized Recordings
Published on: October 25, 2015
9.7K
Stillbirths including intrapartum timing: EN-BIRTH multi-country validation study
Kimberly Peven1,2, Louise T Day1, Harriet Ruysen1
1Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
BMC Pregnancy and Childbirth
|March 26, 2021
Summary
Routine hospital registers accurately capture stillbirth data, crucial for improving maternal and child health outcomes in low-resource settings. Enhanced data collection and supervision are key enablers for precise stillbirth counting.
Area of Science:
- Perinatal epidemiology
- Public health surveillance
- Reproductive health research
Background:
- Millions of annual stillbirths globally, particularly in low- and middle-income countries, remain undercounted due to limited data.
- Most births occur in healthcare facilities, presenting an opportunity to improve stillbirth surveillance through routine recording.
- Research on the accuracy of register-recorded stillbirths is limited, highlighting a need for evaluation.
Purpose of the Study:
- To evaluate the accuracy of hospital stillbirth recording in routine registers.
- To assess the classification accuracy of stillbirths and misclassification with neonatal deaths.
- To identify barriers and enablers for accurate routine stillbirth recording.
Main Methods:
- A mixed-methods observational study (EN-BIRTH) was conducted in five hospitals in Bangladesh, Nepal, and Tanzania (2017-2018).
- Clinical observers collected gold-standard data, which was compared against routine labour ward register entries.
- Metrics included absolute rate differences, sensitivity, specificity, and percent agreement; stillbirth appearance was assessed as a proxy for timing of death.
Main Results:
- Register completeness for birth outcomes exceeded 90%, with high overall agreement (> 98%) between observer data and register records.
- Register-recorded stillbirth rates underestimated observed rates, but specificity was high (> 99%) while sensitivity varied (77.7-86.1%).
- Stillbirth appearance was a poor proxy for death timing; neonatal deaths were disproportionately misclassified as stillbirths (58.3% vs 4.0%).
Conclusions:
- Routine hospital registers demonstrate accuracy in recording stillbirths, offering a viable surveillance tool.
- Focusing on fetal heart rate monitoring is crucial for accurate classification and reduction of preventable intrapartum stillbirths.
- Supervision and data utilization emerged as key enablers for improving the accuracy of birth outcome recording.
