Stillbirth rates in low-middle income countries 2010 - 2013

A population-based, multi-country study from the Global Network

Elizabeth M. McClure, Sarah Saleem, Shivaprasad S. Goudar, Janet L. Moore, Ana Garces, Fabian Esamai, Archana Patel, Elwyn Chomba, Fernando Althabe, Omrana Pasha, Bhalachandra S. Kodkany, Carl L. Bose, Mabel Berreuta, Edward A. Liechty, K. Michael Hambidge, Nancy F. Krebs, Richard J. Derman, Patricia L. Hibberd, Pierre Buekens, Albert Manasyan & 4 others Waldemar A. Carlo, Dennis D. Wallace, Marion Koso-Thomas, Robert L. Goldenberg

Research output: Contribution to journalReview article

35 Citations (Scopus)

Abstract

Background: Stillbirth rates remain nearly ten times higher in low-middle income countries (LMIC) than high income countries. In LMIC, where nearly 98% of stillbirths worldwide occur, few population-based studies have documented characteristics or care for mothers with stillbirths. Non-macerated stillbirths, those occurring around delivery, are generally considered preventable with appropriate obstetric care. Methods: We undertook a prospective, population-based observational study of all pregnant women in defined geographic areas across 7 sites in low-resource settings (Kenya, Zambia, India, Pakistan, Guatemala and Argentina). Staff collected demographic and health care characteristics with outcomes obtained at delivery. Results: From 2010 through 2013, 269,614 enrolled women had 272,089 births, including 7,865 stillbirths. The overall stillbirth rate was 28.9/1000 births, ranging from 13.6/1000 births in Argentina to 56.5/1000 births in Pakistan. Stillbirth rates were stable or declined in 6 of the 7 sites from 2010-2013, only increasing in Pakistan. Less educated, older and women with less access to antenatal care were at increased risk of stillbirth. Furthermore, women not delivered by a skilled attendant were more likely to have a stillbirth (RR 2.8, 95% CI 2.2, 3.5). Compared to live births, stillbirths were more likely to be preterm (RR 12.4, 95% CI 11.2, 13.6). Infants with major congenital anomalies were at increased risk of stillbirth (RR 9.1, 95% CI 7.3, 11.4), as were multiple gestations (RR 2.8, 95% CI 2.4, 3.2) and breech (RR 3.0, 95% CI 2.6, 3.5). Altogether, 67.4% of the stillbirths were non-macerated. 7.6% of women with stillbirths had cesarean sections, with obstructed labor the primary indication (36.9%). Conclusions: Stillbirth rates were high, but with reductions in most sites during the study period. Disadvantaged women, those with less antenatal care and those delivered without a skilled birth attendant were at increased risk of delivering a stillbirth. More than two-thirds of all stillbirths were non-macerated, suggesting potentially preventable stillbirth. Additionally, 8% of women with stillbirths were delivered by cesarean section. The relatively high rate of cesarean section among those with stillbirths suggested that this care was too late or not of quality to prevent the stillbirth; however, further research is needed to evaluate the quality of obstetric care, including cesarean section, on stillbirth in these low resource settings. Study registration: Clinicaltrials.gov (ID# NCT01073475)

Original languageEnglish (US)
Article numbers7
JournalReproductive Health
Volume12
Issue number2
DOIs
StatePublished - Jun 8 2015

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Stillbirth
Population
Cesarean Section
Parturition
Pakistan
Prenatal Care
Argentina
Obstetrics
Guatemala
Zambia

Keywords

  • low-middle income countries
  • obstetric care
  • Stillbirth

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Reproductive Medicine

Cite this

McClure, E. M., Saleem, S., Goudar, S. S., Moore, J. L., Garces, A., Esamai, F., ... Goldenberg, R. L. (2015). Stillbirth rates in low-middle income countries 2010 - 2013: A population-based, multi-country study from the Global Network. Reproductive Health, 12(2), [s7]. https://doi.org/10.1186/1742-4755-12-S2-S7

Stillbirth rates in low-middle income countries 2010 - 2013 : A population-based, multi-country study from the Global Network. / McClure, Elizabeth M.; Saleem, Sarah; Goudar, Shivaprasad S.; Moore, Janet L.; Garces, Ana; Esamai, Fabian; Patel, Archana; Chomba, Elwyn; Althabe, Fernando; Pasha, Omrana; Kodkany, Bhalachandra S.; Bose, Carl L.; Berreuta, Mabel; Liechty, Edward A.; Michael Hambidge, K.; Krebs, Nancy F.; Derman, Richard J.; Hibberd, Patricia L.; Buekens, Pierre; Manasyan, Albert; Carlo, Waldemar A.; Wallace, Dennis D.; Koso-Thomas, Marion; Goldenberg, Robert L.

In: Reproductive Health, Vol. 12, No. 2, s7, 08.06.2015.

Research output: Contribution to journalReview article

McClure, EM, Saleem, S, Goudar, SS, Moore, JL, Garces, A, Esamai, F, Patel, A, Chomba, E, Althabe, F, Pasha, O, Kodkany, BS, Bose, CL, Berreuta, M, Liechty, EA, Michael Hambidge, K, Krebs, NF, Derman, RJ, Hibberd, PL, Buekens, P, Manasyan, A, Carlo, WA, Wallace, DD, Koso-Thomas, M & Goldenberg, RL 2015, 'Stillbirth rates in low-middle income countries 2010 - 2013: A population-based, multi-country study from the Global Network', Reproductive Health, vol. 12, no. 2, s7. https://doi.org/10.1186/1742-4755-12-S2-S7
McClure, Elizabeth M. ; Saleem, Sarah ; Goudar, Shivaprasad S. ; Moore, Janet L. ; Garces, Ana ; Esamai, Fabian ; Patel, Archana ; Chomba, Elwyn ; Althabe, Fernando ; Pasha, Omrana ; Kodkany, Bhalachandra S. ; Bose, Carl L. ; Berreuta, Mabel ; Liechty, Edward A. ; Michael Hambidge, K. ; Krebs, Nancy F. ; Derman, Richard J. ; Hibberd, Patricia L. ; Buekens, Pierre ; Manasyan, Albert ; Carlo, Waldemar A. ; Wallace, Dennis D. ; Koso-Thomas, Marion ; Goldenberg, Robert L. / Stillbirth rates in low-middle income countries 2010 - 2013 : A population-based, multi-country study from the Global Network. In: Reproductive Health. 2015 ; Vol. 12, No. 2.
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abstract = "Background: Stillbirth rates remain nearly ten times higher in low-middle income countries (LMIC) than high income countries. In LMIC, where nearly 98{\%} of stillbirths worldwide occur, few population-based studies have documented characteristics or care for mothers with stillbirths. Non-macerated stillbirths, those occurring around delivery, are generally considered preventable with appropriate obstetric care. Methods: We undertook a prospective, population-based observational study of all pregnant women in defined geographic areas across 7 sites in low-resource settings (Kenya, Zambia, India, Pakistan, Guatemala and Argentina). Staff collected demographic and health care characteristics with outcomes obtained at delivery. Results: From 2010 through 2013, 269,614 enrolled women had 272,089 births, including 7,865 stillbirths. The overall stillbirth rate was 28.9/1000 births, ranging from 13.6/1000 births in Argentina to 56.5/1000 births in Pakistan. Stillbirth rates were stable or declined in 6 of the 7 sites from 2010-2013, only increasing in Pakistan. Less educated, older and women with less access to antenatal care were at increased risk of stillbirth. Furthermore, women not delivered by a skilled attendant were more likely to have a stillbirth (RR 2.8, 95{\%} CI 2.2, 3.5). Compared to live births, stillbirths were more likely to be preterm (RR 12.4, 95{\%} CI 11.2, 13.6). Infants with major congenital anomalies were at increased risk of stillbirth (RR 9.1, 95{\%} CI 7.3, 11.4), as were multiple gestations (RR 2.8, 95{\%} CI 2.4, 3.2) and breech (RR 3.0, 95{\%} CI 2.6, 3.5). Altogether, 67.4{\%} of the stillbirths were non-macerated. 7.6{\%} of women with stillbirths had cesarean sections, with obstructed labor the primary indication (36.9{\%}). Conclusions: Stillbirth rates were high, but with reductions in most sites during the study period. Disadvantaged women, those with less antenatal care and those delivered without a skilled birth attendant were at increased risk of delivering a stillbirth. More than two-thirds of all stillbirths were non-macerated, suggesting potentially preventable stillbirth. Additionally, 8{\%} of women with stillbirths were delivered by cesarean section. The relatively high rate of cesarean section among those with stillbirths suggested that this care was too late or not of quality to prevent the stillbirth; however, further research is needed to evaluate the quality of obstetric care, including cesarean section, on stillbirth in these low resource settings. Study registration: Clinicaltrials.gov (ID# NCT01073475)",
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TY - JOUR

T1 - Stillbirth rates in low-middle income countries 2010 - 2013

T2 - A population-based, multi-country study from the Global Network

AU - McClure, Elizabeth M.

AU - Saleem, Sarah

AU - Goudar, Shivaprasad S.

AU - Moore, Janet L.

AU - Garces, Ana

AU - Esamai, Fabian

AU - Patel, Archana

AU - Chomba, Elwyn

AU - Althabe, Fernando

AU - Pasha, Omrana

AU - Kodkany, Bhalachandra S.

AU - Bose, Carl L.

AU - Berreuta, Mabel

AU - Liechty, Edward A.

AU - Michael Hambidge, K.

AU - Krebs, Nancy F.

AU - Derman, Richard J.

AU - Hibberd, Patricia L.

AU - Buekens, Pierre

AU - Manasyan, Albert

AU - Carlo, Waldemar A.

AU - Wallace, Dennis D.

AU - Koso-Thomas, Marion

AU - Goldenberg, Robert L.

PY - 2015/6/8

Y1 - 2015/6/8

N2 - Background: Stillbirth rates remain nearly ten times higher in low-middle income countries (LMIC) than high income countries. In LMIC, where nearly 98% of stillbirths worldwide occur, few population-based studies have documented characteristics or care for mothers with stillbirths. Non-macerated stillbirths, those occurring around delivery, are generally considered preventable with appropriate obstetric care. Methods: We undertook a prospective, population-based observational study of all pregnant women in defined geographic areas across 7 sites in low-resource settings (Kenya, Zambia, India, Pakistan, Guatemala and Argentina). Staff collected demographic and health care characteristics with outcomes obtained at delivery. Results: From 2010 through 2013, 269,614 enrolled women had 272,089 births, including 7,865 stillbirths. The overall stillbirth rate was 28.9/1000 births, ranging from 13.6/1000 births in Argentina to 56.5/1000 births in Pakistan. Stillbirth rates were stable or declined in 6 of the 7 sites from 2010-2013, only increasing in Pakistan. Less educated, older and women with less access to antenatal care were at increased risk of stillbirth. Furthermore, women not delivered by a skilled attendant were more likely to have a stillbirth (RR 2.8, 95% CI 2.2, 3.5). Compared to live births, stillbirths were more likely to be preterm (RR 12.4, 95% CI 11.2, 13.6). Infants with major congenital anomalies were at increased risk of stillbirth (RR 9.1, 95% CI 7.3, 11.4), as were multiple gestations (RR 2.8, 95% CI 2.4, 3.2) and breech (RR 3.0, 95% CI 2.6, 3.5). Altogether, 67.4% of the stillbirths were non-macerated. 7.6% of women with stillbirths had cesarean sections, with obstructed labor the primary indication (36.9%). Conclusions: Stillbirth rates were high, but with reductions in most sites during the study period. Disadvantaged women, those with less antenatal care and those delivered without a skilled birth attendant were at increased risk of delivering a stillbirth. More than two-thirds of all stillbirths were non-macerated, suggesting potentially preventable stillbirth. Additionally, 8% of women with stillbirths were delivered by cesarean section. The relatively high rate of cesarean section among those with stillbirths suggested that this care was too late or not of quality to prevent the stillbirth; however, further research is needed to evaluate the quality of obstetric care, including cesarean section, on stillbirth in these low resource settings. Study registration: Clinicaltrials.gov (ID# NCT01073475)

AB - Background: Stillbirth rates remain nearly ten times higher in low-middle income countries (LMIC) than high income countries. In LMIC, where nearly 98% of stillbirths worldwide occur, few population-based studies have documented characteristics or care for mothers with stillbirths. Non-macerated stillbirths, those occurring around delivery, are generally considered preventable with appropriate obstetric care. Methods: We undertook a prospective, population-based observational study of all pregnant women in defined geographic areas across 7 sites in low-resource settings (Kenya, Zambia, India, Pakistan, Guatemala and Argentina). Staff collected demographic and health care characteristics with outcomes obtained at delivery. Results: From 2010 through 2013, 269,614 enrolled women had 272,089 births, including 7,865 stillbirths. The overall stillbirth rate was 28.9/1000 births, ranging from 13.6/1000 births in Argentina to 56.5/1000 births in Pakistan. Stillbirth rates were stable or declined in 6 of the 7 sites from 2010-2013, only increasing in Pakistan. Less educated, older and women with less access to antenatal care were at increased risk of stillbirth. Furthermore, women not delivered by a skilled attendant were more likely to have a stillbirth (RR 2.8, 95% CI 2.2, 3.5). Compared to live births, stillbirths were more likely to be preterm (RR 12.4, 95% CI 11.2, 13.6). Infants with major congenital anomalies were at increased risk of stillbirth (RR 9.1, 95% CI 7.3, 11.4), as were multiple gestations (RR 2.8, 95% CI 2.4, 3.2) and breech (RR 3.0, 95% CI 2.6, 3.5). Altogether, 67.4% of the stillbirths were non-macerated. 7.6% of women with stillbirths had cesarean sections, with obstructed labor the primary indication (36.9%). Conclusions: Stillbirth rates were high, but with reductions in most sites during the study period. Disadvantaged women, those with less antenatal care and those delivered without a skilled birth attendant were at increased risk of delivering a stillbirth. More than two-thirds of all stillbirths were non-macerated, suggesting potentially preventable stillbirth. Additionally, 8% of women with stillbirths were delivered by cesarean section. The relatively high rate of cesarean section among those with stillbirths suggested that this care was too late or not of quality to prevent the stillbirth; however, further research is needed to evaluate the quality of obstetric care, including cesarean section, on stillbirth in these low resource settings. Study registration: Clinicaltrials.gov (ID# NCT01073475)

KW - low-middle income countries

KW - obstetric care

KW - Stillbirth

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