Determining the cause of stillbirth in Kumasi, Ghana

Stillbirth incidence and determinants in a tertiary health facility in the Volta Region of Ghana

BACKGROUND

Stillbirths are indicators of the quality of obstetrics care in health systems. Stillbirth rates and their associating factors vary by socio-economic and geographical settings. Published data on stillbirths and their associating factors in the Volta Region of Ghana are limited. This limits understanding of local factors that must be considered in designing appropriate interventions to mitigate the occurrence of stillbirths. This study determined the incidence of stillbirths and associated factors among deliveries at Ho Teaching Hospital (HTH) and contributes to understanding the consistent high stillbirths in the country and potentially in other low-resourced settings in sub-Saharan Africa.

METHOD

This was a prospective cohort study involving pregnant women admitted for delivery at HTH between October 2019 and March 2020. Data on socio-demographic characteristics such as age and employment, obstetric factors including gestational age at delivery and delivery outcomes like birthweight were collected using a pretested structured questionnaire. The primary outcome was the incidence of stillbirths at the facility. Summary statistics were reported as frequencies, percentages and means. Logistic regression methods were used to assess for association between stillbirths and independent variables including age and birthweight. Odds ratios were reported with 95% confidence intervals and associations with p-values < 0.05 were considered statistically significant.

RESULTS

A total of 687 women and their 702 newborns contributed data for analysis. The mean age (SD) was 29.3 (6.3) years and close to two-thirds had had at least one delivery previously. Overall stillbirth incidence was 31.3 per 1000 births. Of the 22 stillbirths, 17 were antepartum. Pre-eclampsia was the most common hypertensive disorder of pregnancy observed (49.3%, 33/67). Among others, less than 3 antenatal visits and low birthweight increased the odds of stillbirths in the bivariate analysis. In the final multivariate model, pregnancy and delivery at 28-34 weeks gestation [AOR 9.37(95% CI 1.18-74.53); p = 0.034] and induction of labour [AOR 11.06 (95% CI 3.10-39.42); p < 0.001] remained significantly associated with stillbirths.

CONCLUSION

Stillbirth incidence was 31.3 per 1000 births with more than half being antepartum stillbirths. Pregnancy/delivery at 28-34 weeks' gestation increased the odds of a stillbirth. Improving the quality of antenatal services, ensuring adherence to evidence-based protocols, accurate and prompt diagnosis and timely interventions of medical conditions in pregnancy particularly at 28-34 weeks' gestation could reduce incidence of stillbirths.

The prevalence of and risk factors for stillbirths in women with severe preeclampsia in a high-burden setting at Mpilo Central Hospital, Bulawayo, Zimbabwe

OBJECTIVES

Stillbirth remains a global public health issue; in low-resource settings stillbirth rates remain high (>12 per 1,000 births target of Every Newborn Action Plan). Preeclampsia is major risk factor for stillbirths. This study aimed to determine the prevalence and risk factors for stillbirth amongst women with severe preeclampsia at Mpilo Central Hospital.

METHODS

A retrospective cross-sectional study was conducted of women with severe preeclampsia from 01/01/2016 to 31/12/2018 at Mpilo Central Hospital, Bulawayo, Zimbabwe. Multivariable logistic regression was used to determine risk factors that were independently associated with stillbirths.

RESULTS

Of 469 women that met the inclusion criteria, 46 had a stillbirth giving a stillbirth prevalence of 9.8%. The risk factors for stillbirths in women with severe preeclampsia were: unbooked status (adjusted odds ratio (aOR) 3.01, 95% (confidence interval) CI 2.20-9.10), frontal headaches (aOR 2.33, 95% CI 0.14-5.78), vaginal bleeding with abdominal pain (aOR 4.71, 95% CI 1.12-19.94), diastolic blood pressure ≥150 mmHg (aOR 15.04, 95% CI 1.78-126.79), platelet count 0-49 × 10⁹/L (aOR 2.80, 95% CI 1.26-6.21), platelet count 50-99 × 10⁹/L (aOR 2.48, 95% CI 0.99-6.18), antepartum haemorrhage (aOR 12.71, 95% CI 4.15-38.96), haemolysis elevated liver enzymes syndrome (HELLP) (aOR 6.02, 95% CI 2.22-16.33) and fetal sex (aOR 2.75, 95% CI 1.37-5.53).

CONCLUSIONS

Women with severe preeclampsia are at significantly increased risk of stillbirth. This study has identified risk factors for stillbirth in this high-risk population; which we hope could be used by clinicians to reduce the burden of stillbirths in women with severe preeclampsia.

Beyond counting induced abortions, miscarriages and stillbirths to understanding their risk factors: analysis of the 2017 Ghana maternal health survey

Background

Inasmuch as induced abortions, miscarriages and stillbirths constitute common adverse pregnancy outcomes contributing to poor maternal health, there is paucity of literature about these in Ghana. We investigated the factors associated with induced abortions, miscarriages and stillbirths in Ghana.

Methods

Data derived from the 2017 Ghana Maternal Health Survey was used in this study. Women aged 15–49 constituted the target for the study. This study examined the relationship between socio-demographic characteristics and induced abortions, stillbirths and miscarriages. Subsequently, multivariable binary logistic regression models were fitted to investigate the factors associated with induced abortions, stillbirths and miscarriages at 95 % confidence interval (CI).

Results

The prevalence of miscarriages, induced abortions and stillbirths in Ghana in 2017 were 10.8 %, 10.4 % and 2 % respectively. Induced abortions (12.9 %) and miscarriages (11.1 %) were found to be higher among urban residents whiles rural residents had more of stillbirths (2.1 %). Compared to women aged 15–24, those in all age categories had lower odds of experiencing induced abortions, with the lowest odds occurring among women aged 35–49 (AOR = 0.26, 95 % CI = 0.21-32). Conversely, women of all age categories had higher odds of experiencing miscarriages compared to those aged 15–24 with the highest odds among those aged 25–34 (AOR = 1.62, 95 % CI = 1.39–1.89). Women with at least primary education were more likely to experience miscarriages than those with no formal education, with those with higher level of education having the highest odds (AOR = 1.42, 95 % CI = 1.13–1.78). While the likelihood of induced abortions was lower among Muslims, compared to Christians (AOR = 0.65, 95 % CI = 0.52–0.82), the odds of miscarriages were higher among Muslims, compared to Christians (AOR = 1.31, 95 % CI = 1.13–1.52). Women with parity 1 or more were less likely to experience induced abortions, miscarriages and stillbirths compared to those with parity 0.

Conclusions

Our study indicates that efforts to limit induced abortions, miscarriages and stillbirths in Ghana need to focus on the disparities in socio-demographic characteristics of women. Synergy between government health institutions and the private sector cannot be left out if much success can be achieved in efforts to subside the current prevalence of induced abortions, stillbirths and miscarriages confronting the country.