Stillbirths: Epidemiology, Evidence, and Priorities for Action
Section snippets
Definition of Stillbirths
ICD-10 defines early fetal death as death of a fetus weighing 500 to 1000 g or 22 to 28 weeks' gestation and late fetal death as death of a fetus weighing at least 1000 g (or a gestational age of 28 completed weeks or a crown-heel length of 35 cm or more).6 The term “stillbirth” in this article refers to both early and late fetal deaths, as described in Panel 1.
Epidemiology of Stillbirths
In LMICs, the stillbirth rate (20-32 per 1000 births) is manifold higher than the rate in high-income countries (HICs; 4.2-6.8 per 1000 births), according to estimates for the year 2000.2 The highest rates are in sub-Saharan Africa (32.2 per 1000 births) and South Asia (31.9 per 1000 births; Fig. 1). Reductions in stillbirth rates that have occurred during the last few decades in HICs have been primarily as the result of a reduction in stillbirths that occur during labor (ie, intrapartum
Timing of Stillbirths
Stillbirths are mainly categorized as antepartum or intrapartum, with antepartum referring to deaths occurring before the onset of labor. The other way of classification of stillbirths, particularly in LMICs in whim ultrasound or fetal monitors are largely not available, is fresh and macerated. This classification is also used in verbal autopsy data. In fresh stillbirths, the skin is intact, and there are no signs of maceration because death occurs <12 hours before delivery (equivalent to
Risk Factors and Causes of Stillbirths
Risk factors are characteristics associated with stillbirths, without an obvious direct or underlying causal relationship for stillbirth. These include previous stillbirth, short interpregnancy interval, minority status, low socioeconomic status, low level of maternal education, maternal thinness, advanced maternal age, single marital status, nulliparity, smoking, alcohol, and drug use.7, 13 An additional risk factor that is particularly pertinent in developing countries is lack of maternal
Evidence for Impact of Key Interventions
The death of an infant during the last trimester of pregnancy is a source of grief and pain for families and communities. Moreover, social taboos associated with open grieving for a stillbirth tend to make grief reactions more protracted than for early neonatal deaths.2 Appropriate interventions and intervention strategies are needed to prevent stillbirths, based on evidence of benefit, especially in the world's poorest countries.1, 4 There are very few systematic reviews that have studied the
Implications of Evidence for Interventions on Program Priorities
For many interventions that are potentially effective for reducing stillbirths, data on impact on stillbirths is not available, and an alternative indicator, perinatal mortality (stillbirths plus early neonatal deaths), must be used. None of the available reviews have segregated stillbirths according to “antepartum” or “intrapartum.” This is of great significance because knowledge of the percentage of stillbirths in each category that could be averted with various interventions would greatly
Conclusions
In conclusion, this review summarizes major priorities in programs and data action to reduce stillbirths (Panel 2). More efforts need to focus on the etiology of stillbirths, whether antepartum or intrapartum, and the role of specific interventions in averting each of these 2 categories of stillbirths. The top priority for reducing stillbirths globally includes increasing and improving the coverage of skilled birth attendance and emergency obstetrical care, as these interventions have been
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2016, International Journal of Gynecology and ObstetricsCitation Excerpt :However, the effect of its routine use on perinatal and maternal morbidity and mortality is controversial [29]. Aside from use of the partograph, health systems-related factors have rarely been investigated in studies on the determinants of stillbirths compared with medical conditions and sociodemographic factors [17,30–32]. Knowledge that utilization of the partograph can significantly reduce the burden of stillbirths is of great importance in this setting because it is easy to use at any level of the health system.
Global Burden, Epidemiologic Trends, and Prevention of Intrapartum-Related Deaths in Low-Resource Settings
2016, Clinics in PerinatologyCitation Excerpt :Stillbirths may be miscounted in retrospective surveys by a margin of 20%.12 These surveys mostly rely on live birth histories and simple questions regarding stillbirths.27 In developed countries, cause-specific data related to stillbirths are available through national perinatal surveillance systems.
Epidemiology of stillbirths based on different gestational thresholds at a tertiary hospital
2022, Singapore Medical Journal