Globally, an estimated 2.1 million third trimester stillbirths (95% CI 1.8, 2.5) occurred in 2015, representing a decrease of nearly 50% since 1990. While this reduction is considerable, the overall rate of decrease in stillbirth lags well behind the rate of reductions that have occurred in under-5 mortality. Furthermore, nearly 98% of these stillbirths occur in low- and middle-income countries (LMIC), where the majority could be prevented with known interventions. We have reported on stillbirth rates from a population-based study in LMIC in the Global Network for Women’s and Children’s Health Research and found stillbirth rates ranging from 18 per 1000 births in Kenya to 44 per 1000 births in Pakistan. Another population-based study from sites in south Asia and sub-Saharan Africa, known as the Alliance for Maternal and Newborn Health Improvement (AMANHI), found similar stillbirth rates ranging from 35 per 1000 births in the Asian sites compared to 17 per 1000 births in the African sites.
In addition to challenges with complete reporting of stillbirths in resource-limited areas, the lack of reliable estimates of the medical causes of stillbirth, especially in LMIC, has been of concern. While several research efforts are currently underway to determine the causes of stillbirth, in practice, most stillbirths remain undocumented and when recorded, few characteristics of the stillbirths are available. As one step to better understand stillbirth, efforts have been made to record the timing of stillbirth. Specifically, whether a stillbirth occurred prior to labor, also known as antepartum stillbirths, or during labor (intrapartum stillbirths) has important implications. Estimates from the Global Network and AMANHI have suggested that more than half of stillbirths may occur in the intrapartum period and are generally considered preventable.
The quality of obstetric care is highly correlated with risk of stillbirth. Both the lack of access to antenatal care and the poor quality of care during labor and delivery have been associated with increased risk of stillbirth. In particular, the low population rates of Cesarean section have been correlated with increased stillbirth risk. In high-resource settings with high quality obstetric care and access to Cesarean section, intrapartum stillbirths have largely been eliminated.
With an urgent need for data to help document the rates, timing and causes of stillbirth in LMIC, we have previously reported on stillbirths in a population-based study conducted in six countries in south Asia, sub-Saharan Africa, and Guatemala. Here we seek to update our reports with estimates of stillbirth rates, timing and causes from 2010 through 2018 in a prospective study from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Global Network for Women’s and Children’s Health Research (Global Network).
By: McClure EM, Saleem S, Patel AB, Goudar SS, Garces A, Whitworth R, Esamai F et al.