Abstract

Research Article

Prospective Community-based Study of Still Births in Remote Villages with Low Resources

Shakuntala Chhabra*, Naman Chhabda, Afreen S and Rathod M

Published: 13 June, 2024 | Volume 7 - Issue 2 | Pages: 072-077

Background: Stillbirth (SB), either because of intrauterine or intrapartum fetal death, is amongst the most devastating pregnancy complications, hardest to predict, real challenge for health systems. India probably accounts for the highest SB numbers in the world.
Objectives: A community-based prospective study was carried out to know the burden, and causes of SBs in rural women of remote region.
Material methods: After approval of the ethics committee of the Institute in Maharashtra for broader research, which was service-oriented, the present study was conducted in 100 villages around the village with health facilities. These villages were included keeping in mind future services. After obtaining the consent of women, information was prospectively recorded on their predesigned tool (which was for broader work), by asking women and seeing their records of antenatal and intranatal care on a regular basis. The study subjects were selected after obtaining information from nurse midwives, Accredited Social Health Activists (ASHAs), and Aaganwadi workers. As the plan was to serve, there was excellent cooperation. The tool was made for broader work. Villages were visited 5 days a week. Study was community-based in villages in remote, hilly region with various local issues so any information the women gave conclusion and was in the record was used.
Results: A total of 3905 births occurred over two years, 3635 (93%) term, and 270 (7%) preterm. Amongst 3635 term births, 3474 (95.6%) were live births, 161 (4.4%) SBs, amongst 270 preterm births, 239 (88.5%) were live births, 31 (11.5%) SBs. Of 192 SBs, 48 (7.2%) SBs were amongst 2690 women with anaemia, (16 (2.4%) SBs amongst women with very severe anaemia, 12 (1.8%) SBs were amongst 667 women with severe anaemia, 12 (1.8%) SBs were amongst 664 women with moderate anaemia, 8 (1.2%) SBs were amongst 680 women with mild anaemia). Overall of 192 (4.9%) SBs, 31 (18.1%) SBs were among 517 women with hypertensive disorders of pregnancy (HDsP) 8 (4.4%) SBs amongst 280 women with moderate HDsP, 12 (6.9%) SBs amongst 175 women with severe HDsP, 11 (6.8%) SBs in 62 women with eclampsia. Overall of 192 SBs, 6 (3.1%) babies had weight 
< 1 kg, 8 (4.1%) of ≥ 1 to < 1.5 kg, 50 (26.0%) ≥ 1.5 to < 2 kg, 64 (33.3%) ≥ 2 to < 2.5 kg, 64 (33.3%) 2.5 kg and more, obviously fewer babies more deaths in birth weight less than 1. 5 kg, more so less than 1 kg.
Conclusion: Overall SBs were in women with disorders but 4.5% SBs did occur in women with no disorder. SBs were significantly higher amongst babies weighing less than 1 kg, beyond this weight, numbers were similar.

Read Full Article HTML DOI: 10.29328/journal.cjog.1001168 Cite this Article Read Full Article PDF

Keywords:

Stillbirths; Causes; Weight; Variables; Disorders

References

  1. Ghumare JP, Morey AP. Epidemiology of Stillbirth: A study in a tertiary care hospital located at a rural area of Northern Maharashtra, India. Indian Journal of Obstetrics and Gynecology Research. 2016; 3(4):326-9.
  2. Blencowe H, Cousens S, Jassir FB, Say L, Chou D, Mathers C, Hogan D, Shiekh S, Qureshi ZU, You D, Lawn JE; Lancet Stillbirth Epidemiology Investigator Group. National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis. Lancet Glob Health. 2016 Feb; 4(2):e98-e108. doi: 10.1016/S2214-109X(15)00275-2. Epub 2016 Jan 19. Erratum in: Lancet Glob Health. 2016 Mar; 4(3):e164. PMID: 26795602.
  3. Sergi CM, Spencer D, Al-Jishi T. Stillbirth Investigations: An Iconographic and Concise Diagnostic Workup in Perinatal Pathology. J Lab Physicians. 2023 Apr 18; 15(4):475-487. doi: 10.1055/s-0043-1764485. PMID: 37780873; PMCID: PMC10539070.
  4. Skytte TB, Holm-Hansen CC, Ali SM, Ame S, Molenaar J, Greisen G, Poulsen A, Sorensen JL, Lund S. Risk factors of stillbirths in four district hospitals on Pemba Island, Tanzania: a prospective cohort study. BMC Pregnancy Childbirth. 2023 Apr 26; 23(1):288. doi: 10.1186/s12884-023-05613-6. PMID: 37101264; PMCID: PMC10131471.
  5. Kingdom JC, Audette MC, Hobson SR, Windrim RC, Morgen E. A placenta clinic approach to the diagnosis and management of fetal growth restriction. Am J Obstet Gynecol. 2018 Feb; 218(2S):S803-S817. doi: 10.1016/j.ajog.2017.11.575. Epub 2017 Dec 15. PMID: 29254754.
  6. Hanson C, Annerstedt KS, Alsina MDR, Abeid M, Kidanto HL, Alvesson HM, Pembe AB, Waiswa P, Dossou JP, Chipeta E, Straneo M, Benova L; ALERT team. Stillbirth mortality by Robson ten-group classification system: A cross-sectional registry of 80 663 births from 16 hospital in sub-Saharan Africa. BJOG. 2024 May 10. doi: 10.1111/1471-0528.17833. Epub ahead of print. PMID: 38725396.
  7. Pujades-Rodriguez M, Morgan AW, Cubbon RM, Wu J. Dose-dependent oral glucocorticoid cardiovascular risks in people with immune-mediated inflammatory diseases: A population-based cohort study. PLoS Med. 2020 Dec 3; 17(12):e1003432. doi: 10.1371/journal.pmed.1003432. PMID: 33270649; PMCID: PMC7714202.
  8. Lawn JE, Blencowe H, Waiswa P, Amouzou A, Mathers C, Hogan D, Flenady V, Frøen JF, Qureshi ZU, Calderwood C, Shiekh S, Jassir FB, You D, McClure EM, Mathai M, Cousens S; Lancet Ending Preventable Stillbirths Series study group; Lancet Stillbirth Epidemiology investigator group. Stillbirths: rates, risk factors, and acceleration towards 2030. Lancet. 2016 Feb 6; 387(10018):587-603. doi: 10.1016/S0140-6736(15)00837-5. Epub 2016 Jan 19. PMID: 26794078.
  9. McClure EM, Wright LL, Goldenberg RL, Goudar SS, Parida SN, Jehan I, Tshefu A, Chomba E, Althabe F, Garces A, Harris H, Derman RJ, Panigrahi P, Engmann C, Buekens P, Hambidge M, Carlo WA; NICHD FIRST BREATH Study Group. The global network: a prospective study of stillbirths in developing countries. Am J Obstet Gynecol. 2007 Sep; 197(3):247.e1-5. doi: 10.1016/j.ajog.2007.07.004. PMID: 17826406; PMCID: PMC2150563.
  10. Townsend R, Sileo FG, Allotey J, Dodds J, Heazell A, Jorgensen L, Kim VB, Magee L, Mol B, Sandall J, Smith G, Thilaganathan B, von Dadelszen P, Thangaratinam S, Khalil A. Prediction of stillbirth: an umbrella review of evaluation of prognostic variables. BJOG. 2021 Jan; 128(2):238-250. doi: 10.1111/1471-0528.16510. Epub 2020 Oct 13. PMID: 32931648.
  11. Yakoob MY, Lawn JE, Darmstadt GL, Bhutta ZA. Stillbirths: epidemiology, evidence, and priorities for action. Semin Perinatol. 2010 Dec; 34(6):387-94. doi: 10.1053/j.semperi.2010.09.010. PMID: 21094413.
  12. Seaton SE, Field DJ, Draper ES, Manktelow BN, Smith GC, Springett A, Smith LK. Socioeconomic inequalities in the rate of stillbirths by cause: a population-based study. BMJ Open. 2012 Jun 25; 2(3):e001100. doi: 10.1136/bmjopen-2012-001100. PMID: 22735165; PMCID: PMC3383980.
  13. Flenady V, Boyle FM. Towards respectful supportive care after stillbirth for every woman. BJOG. 2021 Jan; 128(1):110. doi: 10.1111/1471-0528.16455. Epub 2020 Sep 2. PMID: 32770785.
  14. Andreasen LA, Tabor A, Nørgaard LN, Taksøe-Vester CA, Krebs L, Jørgensen FS, Jepsen IE, Sharif H, Zingenberg H, Rosthøj S, Sørensen AL, Tolsgaard MG. Why we succeed and fail in detecting fetal growth restriction: A population-based study. Acta Obstet Gynecol Scand. 2021 May; 100(5):893-899. doi: 10.1111/aogs.14048. Epub 2021 Jan 12. PMID: 33220065.
  15. Mozooni M, Preen DB, Pennell CE. The influence of acculturation on the risk of stillbirth in migrant women residing in Western Australia. PLoS One. 2020 Apr 2; 15(4):e0231106. doi: 10.1371/journal.pone.0231106. PMID: 32240255; PMCID: PMC7117748.
  16. Ellis M, Azad K, Banerjee B, Shaha SK, Prost A, Rego AR, Barua S, Costello A, Barnett S. Intrapartum-related stillbirths and neonatal deaths in rural bangladesh: a prospective, community-based cohort study. Pediatrics. 2011 May; 127(5):e1182-90. doi: 10.1542/peds.2010-0842. Epub 2011 Apr 18. PMID: 21502233.
  17. Boyle FM, Horey D, Siassakos D, Burden C, Bakhbakhi D, Silver RM, Flenady V. Parent engagement in perinatal mortality reviews: an online survey of clinicians from six high-income countries. BJOG. 2021 Mar; 128(4):696-703. doi: 10.1111/1471-0528.16529. Epub 2020 Oct 19. PMID: 32959539.
  18. Flenady V, Koopmans L, Middleton P, Frøen JF, Smith GC, Gibbons K, Coory M, Gordon A, Ellwood D, McIntyre HD, Fretts R, Ezzati M. Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis. Lancet. 2011 Apr 16; 377(9774):1331-40. doi: 10.1016/S0140-6736(10)62233-7. PMID: 21496916.
  19. Rowe R, Draper ES, Kenyon S, Bevan C, Dickens J, Forrester M, Scanlan R, Tuffnell D, Kurinczuk JJ. Intrapartum-related perinatal deaths in births planned in midwifery-led settings in Great Britain: findings and recommendations from the ESMiE confidential enquiry. BJOG. 2020 Dec; 127(13):1665-1675. doi: 10.1111/1471-0528.16327. Epub 2020 Jun 10. PMID: 32437088.
  20. Sexton J, Ellwood D, Flenady V. Challenges in developing prediction models for stillbirth. BJOG. 2021 Jan; 128(2):251. doi: 10.1111/1471-0528.16525. Epub 2020 Oct 14. PMID: 32970392.
  21. Elison H, Butler E, Hugh O Gardosi J Near Miss of SGAbabies not detected during antenatal surveillance. BJOG. 2023 Jun 1; 130(S2):209-10.
  22. Mukherjee A, Di Stefano L, Blencowe H, Mee P. Determinants of stillbirths in sub-Saharan Africa: A systematic review. BJOG. 2024 Jan; 131(2):140-150. doi: 10.1111/1471-0528.17562. Epub 2023 Jun 4. PMID: 37272228.
  23. Altijani N, Carson C, Choudhury SS, Rani A, Sarma UC, Knight M, Nair M. Stillbirth among women in nine states in India: rate and risk factors in study of 886,505 women from the annual health survey. BMJ Open. 2018 Nov 8; 8(11):e022583. doi: 10.1136/bmjopen-2018-022583. PMID: 30413502; PMCID: PMC6231551.
  24. Wastnedge E, Waters D, Murray SR, McGowan B, Chipeta E, Nyondo-Mipando AL, Gadama L, Gadama G, Masamba M, Malata M, Taulo F, Dube Q, Kawaza K, Khomani PM, Whyte S, Crampin M, Freyne B, Norman JE, Reynolds RM; DIPLOMATIC Collaboration. Interventions to reduce preterm birth and stillbirth, and improve outcomes for babies born preterm in low- and middle-income countries: A systematic review. J Glob Health. 2021 Dec 30; 11:04050. doi: 10.7189/jogh.11.04050. PMID: 35003711; PMCID: PMC8709903.

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