Global Network for Women's and Children's Health Research: Probable causes of stillbirth in low- and middle-income countries using a prospectively defined classification system

E. M. Mcclure, A. Garces, S. Saleem, J. L. Moore, C. L. Bose, F. Esamai, S. S. Goudar, E. Chomba, M. Mwenechanya, O. Pasha, A. Tshefu, A. Patel, S. M. Dhaded, C. Tenge, I. Marete, M. Bauserman, S. Sunder, B. S. Kodkany, W. A. Carlo, R. J. DermanP. L. Hibberd, E. A. Liechty, K. M. Hambidge, N. F. Krebs, M. Koso-Thomas, M. Miodovnik, D. D. Wallace, R. L. Goldenberg

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Objective: We sought to classify causes of stillbirth for six low-middle-income countries using a prospectively defined algorithm. Design: Prospective, observational study. Setting: Communities in India, Pakistan, Guatemala, Democratic Republic of Congo, Zambia and Kenya. Population: Pregnant women residing in defined study regions. Methods: Basic data regarding conditions present during pregnancy and delivery were collected. Using these data, a computer-based hierarchal algorithm assigned cause of stillbirth. Causes included birth trauma, congenital anomaly, infection, asphyxia, and preterm birth, based on existing cause of death classifications and included contributing maternal conditions. Main outcome measures: Primary cause of stillbirth. Results: Of 109 911 women who were enrolled and delivered (99% of those screened in pregnancy), 2847 had a stillbirth (a rate of 27.2 per 1000 births). Asphyxia was the cause of 46.6% of the stillbirths, followed by infection (20.8%), congenital anomalies (8.4%) and prematurity (6.6%). Among those caused by asphyxia, 38% had prolonged or obstructed labour, 19% antepartum haemorrhage and 18% pre-eclampsia/eclampsia. About two-thirds (67.4%) of the stillbirths did not have signs of maceration. Conclusions: Our algorithm determined cause of stillbirth from basic data obtained from lay-health providers. The major cause of stillbirth was fetal asphyxia associated with prolonged or obstructed labour, pre-eclampsia and antepartum haemorrhage. In the African sites, infection also was an important contributor to stillbirth. Using this algorithm, we documented cause of stillbirth and its trends to inform public health programs, using consistency, transparency, and comparability across time or regions with minimal burden on the healthcare system. Tweetable abstract: Major causes of stillbirth are asphyxia, pre-eclampsia and haemorrhage. Infections are important in Africa.

Original languageEnglish (US)
JournalBJOG: An International Journal of Obstetrics and Gynaecology
DOIs
StateAccepted/In press - 2017

Fingerprint

Stillbirth
Women's Health
Asphyxia
Research
Pre-Eclampsia
Hemorrhage
Infection
Child Health
Parturition
Guatemala
Zambia
Democratic Republic of the Congo
Pregnancy
Eclampsia
Kenya
Pakistan
Premature Birth
Observational Studies
Pregnant Women
India

Keywords

  • Cause of death classification system
  • Low-income countries
  • Stillbirth

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Global Network for Women's and Children's Health Research : Probable causes of stillbirth in low- and middle-income countries using a prospectively defined classification system. / Mcclure, E. M.; Garces, A.; Saleem, S.; Moore, J. L.; Bose, C. L.; Esamai, F.; Goudar, S. S.; Chomba, E.; Mwenechanya, M.; Pasha, O.; Tshefu, A.; Patel, A.; Dhaded, S. M.; Tenge, C.; Marete, I.; Bauserman, M.; Sunder, S.; Kodkany, B. S.; Carlo, W. A.; Derman, R. J.; Hibberd, P. L.; Liechty, E. A.; Hambidge, K. M.; Krebs, N. F.; Koso-Thomas, M.; Miodovnik, M.; Wallace, D. D.; Goldenberg, R. L.

In: BJOG: An International Journal of Obstetrics and Gynaecology, 2017.

Research output: Contribution to journalArticle

Mcclure, EM, Garces, A, Saleem, S, Moore, JL, Bose, CL, Esamai, F, Goudar, SS, Chomba, E, Mwenechanya, M, Pasha, O, Tshefu, A, Patel, A, Dhaded, SM, Tenge, C, Marete, I, Bauserman, M, Sunder, S, Kodkany, BS, Carlo, WA, Derman, RJ, Hibberd, PL, Liechty, EA, Hambidge, KM, Krebs, NF, Koso-Thomas, M, Miodovnik, M, Wallace, DD & Goldenberg, RL 2017, 'Global Network for Women's and Children's Health Research: Probable causes of stillbirth in low- and middle-income countries using a prospectively defined classification system', BJOG: An International Journal of Obstetrics and Gynaecology. https://doi.org/10.1111/1471-0528.14493
Mcclure, E. M. ; Garces, A. ; Saleem, S. ; Moore, J. L. ; Bose, C. L. ; Esamai, F. ; Goudar, S. S. ; Chomba, E. ; Mwenechanya, M. ; Pasha, O. ; Tshefu, A. ; Patel, A. ; Dhaded, S. M. ; Tenge, C. ; Marete, I. ; Bauserman, M. ; Sunder, S. ; Kodkany, B. S. ; Carlo, W. A. ; Derman, R. J. ; Hibberd, P. L. ; Liechty, E. A. ; Hambidge, K. M. ; Krebs, N. F. ; Koso-Thomas, M. ; Miodovnik, M. ; Wallace, D. D. ; Goldenberg, R. L. / Global Network for Women's and Children's Health Research : Probable causes of stillbirth in low- and middle-income countries using a prospectively defined classification system. In: BJOG: An International Journal of Obstetrics and Gynaecology. 2017.
@article{781a4ac3f32540d1a9b22480487a20d7,
title = "Global Network for Women's and Children's Health Research: Probable causes of stillbirth in low- and middle-income countries using a prospectively defined classification system",
abstract = "Objective: We sought to classify causes of stillbirth for six low-middle-income countries using a prospectively defined algorithm. Design: Prospective, observational study. Setting: Communities in India, Pakistan, Guatemala, Democratic Republic of Congo, Zambia and Kenya. Population: Pregnant women residing in defined study regions. Methods: Basic data regarding conditions present during pregnancy and delivery were collected. Using these data, a computer-based hierarchal algorithm assigned cause of stillbirth. Causes included birth trauma, congenital anomaly, infection, asphyxia, and preterm birth, based on existing cause of death classifications and included contributing maternal conditions. Main outcome measures: Primary cause of stillbirth. Results: Of 109 911 women who were enrolled and delivered (99{\%} of those screened in pregnancy), 2847 had a stillbirth (a rate of 27.2 per 1000 births). Asphyxia was the cause of 46.6{\%} of the stillbirths, followed by infection (20.8{\%}), congenital anomalies (8.4{\%}) and prematurity (6.6{\%}). Among those caused by asphyxia, 38{\%} had prolonged or obstructed labour, 19{\%} antepartum haemorrhage and 18{\%} pre-eclampsia/eclampsia. About two-thirds (67.4{\%}) of the stillbirths did not have signs of maceration. Conclusions: Our algorithm determined cause of stillbirth from basic data obtained from lay-health providers. The major cause of stillbirth was fetal asphyxia associated with prolonged or obstructed labour, pre-eclampsia and antepartum haemorrhage. In the African sites, infection also was an important contributor to stillbirth. Using this algorithm, we documented cause of stillbirth and its trends to inform public health programs, using consistency, transparency, and comparability across time or regions with minimal burden on the healthcare system. Tweetable abstract: Major causes of stillbirth are asphyxia, pre-eclampsia and haemorrhage. Infections are important in Africa.",
keywords = "Cause of death classification system, Low-income countries, Stillbirth",
author = "Mcclure, {E. M.} and A. Garces and S. Saleem and Moore, {J. L.} and Bose, {C. L.} and F. Esamai and Goudar, {S. S.} and E. Chomba and M. Mwenechanya and O. Pasha and A. Tshefu and A. Patel and Dhaded, {S. M.} and C. Tenge and I. Marete and M. Bauserman and S. Sunder and Kodkany, {B. S.} and Carlo, {W. A.} and Derman, {R. J.} and Hibberd, {P. L.} and Liechty, {E. A.} and Hambidge, {K. M.} and Krebs, {N. F.} and M. Koso-Thomas and M. Miodovnik and Wallace, {D. D.} and Goldenberg, {R. L.}",
year = "2017",
doi = "10.1111/1471-0528.14493",
language = "English (US)",
journal = "BJOG: An International Journal of Obstetrics and Gynaecology",
issn = "1470-0328",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Global Network for Women's and Children's Health Research

T2 - Probable causes of stillbirth in low- and middle-income countries using a prospectively defined classification system

AU - Mcclure, E. M.

AU - Garces, A.

AU - Saleem, S.

AU - Moore, J. L.

AU - Bose, C. L.

AU - Esamai, F.

AU - Goudar, S. S.

AU - Chomba, E.

AU - Mwenechanya, M.

AU - Pasha, O.

AU - Tshefu, A.

AU - Patel, A.

AU - Dhaded, S. M.

AU - Tenge, C.

AU - Marete, I.

AU - Bauserman, M.

AU - Sunder, S.

AU - Kodkany, B. S.

AU - Carlo, W. A.

AU - Derman, R. J.

AU - Hibberd, P. L.

AU - Liechty, E. A.

AU - Hambidge, K. M.

AU - Krebs, N. F.

AU - Koso-Thomas, M.

AU - Miodovnik, M.

AU - Wallace, D. D.

AU - Goldenberg, R. L.

PY - 2017

Y1 - 2017

N2 - Objective: We sought to classify causes of stillbirth for six low-middle-income countries using a prospectively defined algorithm. Design: Prospective, observational study. Setting: Communities in India, Pakistan, Guatemala, Democratic Republic of Congo, Zambia and Kenya. Population: Pregnant women residing in defined study regions. Methods: Basic data regarding conditions present during pregnancy and delivery were collected. Using these data, a computer-based hierarchal algorithm assigned cause of stillbirth. Causes included birth trauma, congenital anomaly, infection, asphyxia, and preterm birth, based on existing cause of death classifications and included contributing maternal conditions. Main outcome measures: Primary cause of stillbirth. Results: Of 109 911 women who were enrolled and delivered (99% of those screened in pregnancy), 2847 had a stillbirth (a rate of 27.2 per 1000 births). Asphyxia was the cause of 46.6% of the stillbirths, followed by infection (20.8%), congenital anomalies (8.4%) and prematurity (6.6%). Among those caused by asphyxia, 38% had prolonged or obstructed labour, 19% antepartum haemorrhage and 18% pre-eclampsia/eclampsia. About two-thirds (67.4%) of the stillbirths did not have signs of maceration. Conclusions: Our algorithm determined cause of stillbirth from basic data obtained from lay-health providers. The major cause of stillbirth was fetal asphyxia associated with prolonged or obstructed labour, pre-eclampsia and antepartum haemorrhage. In the African sites, infection also was an important contributor to stillbirth. Using this algorithm, we documented cause of stillbirth and its trends to inform public health programs, using consistency, transparency, and comparability across time or regions with minimal burden on the healthcare system. Tweetable abstract: Major causes of stillbirth are asphyxia, pre-eclampsia and haemorrhage. Infections are important in Africa.

AB - Objective: We sought to classify causes of stillbirth for six low-middle-income countries using a prospectively defined algorithm. Design: Prospective, observational study. Setting: Communities in India, Pakistan, Guatemala, Democratic Republic of Congo, Zambia and Kenya. Population: Pregnant women residing in defined study regions. Methods: Basic data regarding conditions present during pregnancy and delivery were collected. Using these data, a computer-based hierarchal algorithm assigned cause of stillbirth. Causes included birth trauma, congenital anomaly, infection, asphyxia, and preterm birth, based on existing cause of death classifications and included contributing maternal conditions. Main outcome measures: Primary cause of stillbirth. Results: Of 109 911 women who were enrolled and delivered (99% of those screened in pregnancy), 2847 had a stillbirth (a rate of 27.2 per 1000 births). Asphyxia was the cause of 46.6% of the stillbirths, followed by infection (20.8%), congenital anomalies (8.4%) and prematurity (6.6%). Among those caused by asphyxia, 38% had prolonged or obstructed labour, 19% antepartum haemorrhage and 18% pre-eclampsia/eclampsia. About two-thirds (67.4%) of the stillbirths did not have signs of maceration. Conclusions: Our algorithm determined cause of stillbirth from basic data obtained from lay-health providers. The major cause of stillbirth was fetal asphyxia associated with prolonged or obstructed labour, pre-eclampsia and antepartum haemorrhage. In the African sites, infection also was an important contributor to stillbirth. Using this algorithm, we documented cause of stillbirth and its trends to inform public health programs, using consistency, transparency, and comparability across time or regions with minimal burden on the healthcare system. Tweetable abstract: Major causes of stillbirth are asphyxia, pre-eclampsia and haemorrhage. Infections are important in Africa.

KW - Cause of death classification system

KW - Low-income countries

KW - Stillbirth

UR - http://www.scopus.com/inward/record.url?scp=85011298706&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85011298706&partnerID=8YFLogxK

U2 - 10.1111/1471-0528.14493

DO - 10.1111/1471-0528.14493

M3 - Article

AN - SCOPUS:85011298706

JO - BJOG: An International Journal of Obstetrics and Gynaecology

JF - BJOG: An International Journal of Obstetrics and Gynaecology

SN - 1470-0328

ER -