PT  - JOURNAL ARTICLE
AU  - Gurung, Rejina
AU  - Litorp, Helena
AU  - Berkelhamer, Sara
AU  - Zhou, Hong
AU  - Tinkari, Bhim Singh
AU  - Paudel, Prajwal
AU  - Malla, Honey
AU  - Sharma, Srijana
AU  - KC, Ashish
TI  - The burden of misclassification of antepartum stillbirth in Nepal
AID  - 10.1136/bmjgh-2019-001936
DP  - 2019 Dec 01
TA  - BMJ Global Health
PG  - e001936
VI  - 4
IP  - 6
4099  - http://gh.bmj.com/content/4/6/e001936.short
4100  - http://gh.bmj.com/content/4/6/e001936.full
SO  - BMJ Global Health2019 Dec 01; 4
AB  - Background Globally, every year 1.1 million antepartum stillbirths occur with 98% of these deaths taking place in countries where the health system is poor. In this paper we examine the burden of misclassification of antepartum stillbirth in hospitals of Nepal and factors associated with misclassification.Method A prospective observational study was conducted in 12 hospitals of Nepal for a period of 6 months. If fetal heart sounds (FHS) were detected at admission and during the intrapartum period, the antepartum stillbirth (fetal death ≥22 weeks prior labour) recorded in patient’s case note was recategorised as misclassified antepartum stillbirth. We further compared sociodemographic, obstetric and neonatal characteristics of misclassified and correctly classified antepartum stillbirths using bivariate and multivariate analysis.Result A total of 41 061 women were enrolled in the study and 39 562 of the participants’ FHS were taken at admission. Of the total participants whose FHS were taken at admission, 94.8% had normal FHS, 4.7% had abnormal FHS and 0.6% had no FHS at admission. Of the total 119 recorded antepartum stillbirths, 29 (24.4%) had FHS at admission and during labour and therefore categorised as misclassified antepartum stillbirths. Multivariate analysis performed to adjust the risk of association revealed that complications during pregnancy resulted in a threefold risk of misclassification (adjusted OR-3.35, 95% CI 1.95 to 5.76).Conclusion Almost 25% of the recorded antepartum stillbirths were misclassified. Improving quality of data is crucial to improving accountability and quality of care. As the interventions to reduce antepartum stillbirth differ, accurate measurement of antepartum stillbirth is critical.Trial registration number ISRCTN30829654.