1
|
Christou A, Mbishi J, Matsui M, Beňová L, Kim R, Numazawa A, Iwamoto A, Sokhan S, Ieng N, Delvaux T. Stillbirth rates and their determinants in a national maternity hospital in Phnom Penh, Cambodia in 2017-2020: a cross-sectional assessment with a nested case-control study. Reprod Health 2023; 20:157. [PMID: 37865789 PMCID: PMC10590507 DOI: 10.1186/s12978-023-01703-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 10/15/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND In Cambodia, stillbirths and their underlying factors have not been systematically studied. This study aimed to assess the proportion and trends in stillbirths between 2017 and 2020 in a large maternity referral hospital in the country and identify their key determinants to inform future prevention efforts. METHODS This was a retrospective cross-sectional analysis with a nested case-control study of women giving birth at the National Maternal and Child Health Centre (NMCHC) in Phnom Penh, 2017-2020. We calculated percentages of singleton births at ≥ 22 weeks' gestation resulting in stillbirth and annual stillbirth rates by timing: intrapartum (fresh) or antepartum (macerated). Multivariable logistic regression was used to explore factors associated with stillbirth, where cases were all women who gave birth to a singleton stillborn baby in the 4-year period. One singleton live birth immediately following each case served as an unmatched control. Multiple imputation was used to handle missing data for gestational age. RESULTS Between 2017 and 2020, 3.2% of singleton births ended in stillbirth (938/29,742). The stillbirth rate increased from 24.8 per 1000 births in 2017 to 38.1 per 1000 births in 2020, largely due to an increase in intrapartum stillbirth rates which rose from 18.8 to 27.4 per 1000 births in the same period. The case-control study included 938 cases (stillbirth) and 938 controls (livebirths). Factors independently associated with stillbirth were maternal age ≥ 35 years compared to < 20 years (aOR: 1.82, 95%CI: 1.39, 2.38), extreme (aOR: 3.29, 95%CI: 2.37, 4.55) or moderate (aOR: 2.45, 95%CI: 1.74, 3.46) prematurity compared with full term, and small-for-gestational age (SGA) (aOR: 2.32, 1.71, 3.14) compared to average size-for-age. Breech/transverse births had nearly four times greater odds of stillbirth (aOR: 3.84, 95%CI: 2.78, 5.29), while caesarean section reduced the odds by half compared with vaginal birth (aOR: 0.50, 95%CI: 0.39, 0.64). A history of abnormal vaginal discharge increased odds of stillbirth (aOR: 1.42, 95%CI: 1.11, 1.81) as did a history of stillbirth (aOR: 3.08, 95%CI: 1.5, 6.5). CONCLUSIONS Stillbirth prevention in this maternity referral hospital in Cambodia requires strengthening preterm birth detection and management of SGA, intrapartum care, monitoring women with stillbirth history, management of breech births, and further investigation of high-risk referral cases.
Collapse
Affiliation(s)
- Aliki Christou
- Department of Public Health, Sexual and Reproductive Health Unit, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium.
| | | | - Mitsuaki Matsui
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
- Nagasaki University School of Tropical Medicine and Global Health, Nagasaki, Japan
| | - Lenka Beňová
- Department of Public Health, Sexual and Reproductive Health Unit, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Rattana Kim
- National Maternal and Child Health Center, Phnom Penh, Cambodia
| | - Ayako Numazawa
- Nagasaki University School of Tropical Medicine and Global Health, Nagasaki, Japan
| | - Azusa Iwamoto
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Sophearith Sokhan
- Nagasaki University School of Tropical Medicine and Global Health, Nagasaki, Japan
| | - Nary Ieng
- Nagasaki University School of Tropical Medicine and Global Health, Nagasaki, Japan
| | - Thérèse Delvaux
- Department of Public Health, Sexual and Reproductive Health Unit, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| |
Collapse
|
2
|
Torre Monmany N, Astete JA, Ramaiah D, Suchitra J, Krauel X, Fillol M, Balasubbaiah Y, Alarcón A, Bassat Q. Extended Perinatal Mortality Audit in a Rural Hospital in India. Am J Perinatol 2023; 40:375-386. [PMID: 33902133 DOI: 10.1055/s-0041-1727220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of the study is to describe the status of perinatal mortality (PM) in an Indian rural hospital. STUDY DESIGN Retrospective analysis of data was compiled from PM meetings (April 2017 to December 2018) following "Making Every Baby Count: audit and review of stillbirths and neonatal deaths (ENAP or Every Newborn Action Plan)." RESULTS The study includes 8,801 livebirths, 105 stillbirths (SBs); 74 antepartum stillbirths [ASBs], 22 intrapartum stillbirths [ISBs], and nine unknown timing stillbirths [USBs]), 39 neonatal deaths or NDs (perinatal death or PDs 144). The higher risks for ASBs were maternal age >34 years, previous history of death, and/or SBs. Almost half of the PDs could be related with antepartum complications. More than half of the ASB were related with preeclampsia/eclampsia and abruptio placentae; one-third of the ISB were related with preeclampsia/eclampsia and gestational hypertension, fetal growth restriction, and placental dysfunction. The main maternal conditions differed between PDs (p = 0.005). The main causes of the ND were infections, congenital malformations, complications of prematurity, intrapartum complications, and unknown. The stillbirth rate was 11.8/1,000 births, neonatal mortality rate 4.4/1,000 livebirths, and perinatal mortality rate 15.8/1,000 births. CONCLUSION This is the first study of its kind in Andhra Pradesh being the first step for the analysis and prevention of PM. KEY POINTS · Many conditions that lead to stillbirths are linked to neonatal deaths and PM has been outside of the global parameters from the last decades.. · This is the first study following International Classification of Disease perinatal mortality codes and the audit of ENAP in Andhra Pradesh.. · Extended PM and mortality are mainly caused by similar preventable and treatable conditions..
Collapse
Affiliation(s)
- Núria Torre Monmany
- Department of Paediatrics, Rural Development Trust Children's Hospital, Bathalapalli, Andhra Pradesh, India
- Department of Paediatric Emergency Transport, Sant Joan de Déu Hospital, Barcelona, Spain
| | - Joaquín Américo Astete
- Department of Paediatrics, Rural Development Trust Children's Hospital, Bathalapalli, Andhra Pradesh, India
- Department of Paediatrics, Pediatria dels pirineus, la Seu d'Urgell, Spain
| | - Dasarath Ramaiah
- Department of Paediatrics, Rural Development Trust Children's Hospital, Bathalapalli, Andhra Pradesh, India
| | - Jyothi Suchitra
- Department of Gynecology and Obstetrics, Rural Development Trust Children's Hospital, Bathalapalli, Andhra Pradesh, India
| | - Xavier Krauel
- Department of Paediatrics, Rural Development Trust Children's Hospital, Bathalapalli, Andhra Pradesh, India
- Department of Neonatology, Sant Joan de déu Hospital, Barcelona, Spain
| | - Manolo Fillol
- Department of Gynecology and Obstetrics, Rural Development Trust Children's Hospital, Bathalapalli, Andhra Pradesh, India
- Department of Gynecology, Hospital de la plana, Castellón, Spain
| | - Yadamala Balasubbaiah
- Department of Gynecology and Obstetrics, Rural Development Trust Children's Hospital, Bathalapalli, Andhra Pradesh, India
| | - Ana Alarcón
- Department of Neonatology, Sant Joan de déu Hospital, Barcelona, Spain
| | - Quique Bassat
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Icrea, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| |
Collapse
|
3
|
Poudel S, Ghimire PR, Upadhaya N, Rawal L. Factors associated with stillbirth in selected countries of South Asia: A systematic review of observational studies. PLoS One 2020; 15:e0238938. [PMID: 32936823 PMCID: PMC7494090 DOI: 10.1371/journal.pone.0238938] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 08/26/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Despite having the high rate of stillbirth in most of the countries of South Asia, there is a lack of synthesized evidence based on factors associated with stillbirth. This study systematically synthesizes the evidence on factors associated with stillbirth in the four selected countries of South Asia. METHODS This review was conducted using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Studies that examined factors associated with stillbirth in South Asia were searched using five major electronic search databases including MEDLINE, CINAHL, Embase, PsycINFO, and Scopus, published between January 2000 and December 2019. In the meta-analysis, significant heterogeneity was detected among studies (I2 >50%), and hence a random effect model was used. RESULTS A total of 20 studies met the inclusion criteria. The pooled rate of stillbirth from the studies in Bangladesh, India, Nepal, and Pakistan was 25.15 per 1000 births. Pregnancy complications, maternal health conditions, fetal complications, lack of antenatal care, and lower Socio Economic Status (SES) were the most common factors associated with stillbirth in countries of South Asia. CONCLUSION This study confirmed that stillbirth in selected countries of South Asia remains high. To reduce stillbirth, a greater focus needs to be on timely management of preterm labor, maternal hypertension, and provision of financial support for quality antenatal and delivery care. The interventions should be targeted for women living in remote areas, who are less educated and those with low SES.
Collapse
Affiliation(s)
| | | | - Nawaraj Upadhaya
- Department of Research and Development, HealthWorks, Amsterdam, The Netherlands
| | - Lal Rawal
- School of Health Medical and Applied Sciences, CQUniversity, Sydney, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, Australia
| |
Collapse
|
4
|
Gebreslasie KZ, Weldemariam S, Gebre G, Mehari MA. Intimate partner violence during pregnancy and risk of still birth in hospitals of Tigray region Ethiopia. Ital J Pediatr 2020; 46:107. [PMID: 32718326 PMCID: PMC7385947 DOI: 10.1186/s13052-020-00857-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 06/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pregnancy may represent a time of exceptional vulnerability to intimate partner violence because of changes in women's conditions. Despite the fact that intimate partner violence during pregnancy confers considerable risk to the health of the woman and her fetus, data regarding to association of stillbirth and intimate partner violence is lacking in Tigray region. The objective of this study is to assess intimate partner violence during pregnancy and its association with still birth among postpartum mothers in hospitals in Tigray Region of Ethiopia. METHODS Cross-sectional study design was used to assess 648 women about intimate partner violence during pregnancy and its association with still birth. Simple random sampling technique was employed to select health facilities and systematic sampling was used to select the study participants. Data was entered by using Epi info version 3.5.1 and analyzed using SPSS version 20. Logistic regression analysis was done to assess the association between exposure to intimate partner violence during pregnancy and stillbirth while adjusting for possible confounders. RESULTS The prevalence of still birth was 3.6%in this study population. There was a statistically significant association between exposure to intimate partner violence during pregnancy and still birth. Pregnant women who were exposed to intimate partner violence during pregnancy were three times more likely to have still birth 3.3(95% CI: 1.1-9.7) as compared to those who were not exposed. Another important factor associated with stillbirth was low birthweight 16.7(95% CI,6-46). CONCLUSIONS The prevalence of still birth in this study was high. Women who subjected to intimate partner violence during pregnancy had greater risk of having stillbirth baby.
Collapse
Affiliation(s)
| | | | - Gelawdiyos Gebre
- Mekelle University, College of Health Science, Mek'ele, Ethiopia
| | - Mihret-Ab Mehari
- Mekelle University, College of Health Science, Mek'ele, Ethiopia
| |
Collapse
|
5
|
Zhu X, Niu H, Wang H, Li X, Qi T, Ding W, Han L, Zhang M, Guan H, Li S, Tang C, Yin Y, Cao X, Liu H, Gao C, Yue H, Sun B. High risk pregnancy associated perinatal morbidity and mortality: a second birth population-based survey in Huai'an in 2015. BMC Pregnancy Childbirth 2019; 19:224. [PMID: 31269904 PMCID: PMC6609375 DOI: 10.1186/s12884-019-2323-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 04/30/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The objective of this survey was to explore the association between pregnancy complications and perinatal outcome from regionally total birth population. METHODS In this prospectively collected data of complete birth registries from all level I-III hospitals in Huai'an in 2015, perinatal morbidity and mortality in relation to pregnancy complications and perinatal outcome were analyzed using international definitions. The results were compared with that of 2010 survey in the same region. RESULTS Of 59,424 total births in the hospitals of level I (n = 85), II (16) and III (6), delivery rate was 30.4, 40.1 and 29.5%, and rates of pregnancy complications were 12.9, 9.8 and 21.1% (average 14.1%), with antenatal corticosteroids rate in < 37 gestational weeks being 17.3, 31.0 and 39.9% (mean 36.6%), respectively. The preterm birth rate was 0.6, 2.7 and 9.5% (mean 4.06%), and the composite rate of fetal death, stillbirth, and death immediately after delivery was 0.1, 0.4 and 0.6%, respectively. By multivariable logistic regression analysis, congenital anomalies, low Apgar scores, multi-pregnancy and amniotic fluid contamination were risk factors of adverse perinatal outcomes. Despite a higher rate of pregnancy complications than in 2010 survey, perinatal and neonatal mortality continued to fall, in particular in very preterm births. The high cesarean delivery rate in non-medically indicated cases remained a challenge. CONCLUSIONS Our regional birth-population data in 2015 revealed a robust and persistent improvement in the perinatal care and management of high risk pregnancies and deliveries, which should enable more studies using similar concept and protocol for vital statistics to verify the reliability and feasibility.
Collapse
Affiliation(s)
- Xiaoqin Zhu
- Unit of Population Health Information, Departments of Obstetrics and Neonatology, Huai’an Women and Children’s Hospital, Huai’an, 223002 Jiangsu China
| | - Huiyuan Niu
- Unit of Population Health Information, Departments of Obstetrics and Neonatology, Huai’an Women and Children’s Hospital, Huai’an, 223002 Jiangsu China
| | - Hui Wang
- Unit of Population Health Information, Departments of Obstetrics and Neonatology, Huai’an Women and Children’s Hospital, Huai’an, 223002 Jiangsu China
| | - Xiaoqiong Li
- Unit of Population Health Information, Departments of Obstetrics and Neonatology, Huai’an Women and Children’s Hospital, Huai’an, 223002 Jiangsu China
| | - Tingting Qi
- Unit of Population Health Information, Departments of Obstetrics and Neonatology, Huai’an Women and Children’s Hospital, Huai’an, 223002 Jiangsu China
| | - Weijie Ding
- Unit of Population Health Information, Departments of Obstetrics and Neonatology, Huai’an Women and Children’s Hospital, Huai’an, 223002 Jiangsu China
| | - Liangrong Han
- Unit of Population Health Information, Departments of Obstetrics and Neonatology, Huai’an Women and Children’s Hospital, Huai’an, 223002 Jiangsu China
| | - Muling Zhang
- Departments of Obstetrics and Pediatrics, Huai’an First General Hospital, Huai’an, 223002 Jiangsu China
| | - Honghua Guan
- Departments of Obstetrics and Pediatrics, Huai’an Second General Hospital, Huai’an, 223002 Jiangsu China
| | - Shouzhong Li
- Departments of Obstetrics and Pediatrics, Huaiyin District Hospital, Huai’an, 223300 Jiangsu China
| | - Chunhong Tang
- Departments of Obstetrics and Pediatrics, Chuzhou District Hospital, Huai’an, 223200 Jiangsu China
| | - Yaodong Yin
- Departments of Obstetrics and Pediatrics, Lianshui County Hospital, Huai’an, 223400 Jiangsu China
| | - Xihui Cao
- Departments of Obstetrics and Pediatrics, Xuyi County Hospital, Huai’an, 211700 Jiangsu China
| | - Hong Liu
- Departments of Obstetrics and Pediatrics, Hongze County Hospital, Huai’an, 223100 Jiangsu China
| | - Cui Gao
- Departments of Obstetrics and Pediatrics, Jinhu County Hospital, Huai’an, 211600 Jiangsu China
| | - Hongni Yue
- Unit of Population Health Information, Departments of Obstetrics and Neonatology, Huai’an Women and Children’s Hospital, Huai’an, 223002 Jiangsu China
| | - Bo Sun
- Departments of Pediatrics and Neonatology, Children’s Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102 China
| |
Collapse
|