Published: 2017-01-16

Audit into stillbirths: a tertiary hospital experience

Aparajita Sophia D’souza, Garima Gupta, Shelesh Masih, Moneet Walia, Francis K Sridhar, Sunita Goyal


Background: The objective of the study was to evaluate the prevalence, risk factors and causes of stillbirth.

Methods: A retrospective cohort study was conducted from January 2014 until December 2014 in a tertiary referral teaching hospital in Punjab. The 2014 birth register from the department of Obstetrics and Gynecology was reviewed and the data was collected. The results were tabulated and data was analyzed as frequencies, percentages and descriptive statistics.

Results: During the one-year study period, there were 1528 registered pregnancies in the hospital and 64 pregnant women were diagnosed to have stillbirth resulting in a stillbirth rate of 40.63 / 1000 live births. More than 75% of the stillbirths were noted in women between 21 to 30 years of age. Pregnant women who were unbooked (72.5%) had higher rates of stillbirths. More than 80% of the stillbirths were preterm. Anaemia (41.93%), pre-eclampsia (25.8%) and antepartum hemorrhage (24.19%) were the most common maternal risk factors noted in these patients. Maternal factors contributed to 37.5% of the causes of stillbirths. The other causes for stillbirths were placental factors (32.8%) and fetal factors (6.2%). In 23.43% of the cases the cause was unknown.

Conclusions: India shares a high burden of stillbirths with priority gaps in reporting and recognizing at the health policy level. Better counting of stillbirths and improved cause-of-death data can advocate child survival strategies.



Stillbirths, Fetal death, Preterm

Full Text:



World Health Organization. ICD-10 International Statistical Classification of Diseases and Related Health Problems: Tenth revision. Volume 2. Instruction manual. Geneva: WHO, 2010.

MacDorman MF, Kirmeyer S. Fetal and perinatal mortality, United States, 2005. Natl Vital Stat Rep. 2009;57(8):1-19.

McClure EM, Nalubamba-Phiri M, Goldenberg RL. Stillbirth in developing countries. Int J Gynecol Obstet. 2006;94:82-90.

Cousens S, Blencowe H, Stanton C, Chou D, Ahmed S, Steinhardt L, et al. National, regional, and worldwide estimates of stillbirth rates in 2009 with trends since 1995: a systematic analysis. Lancet. 2011;377:1319-30.

Froen JF, Cacciatore J, McClure EM, Kuti O, Jokhio AH, Islam M, et al. Stillbirths: why they matter. Lancet. 2011;377:1353-66.

Froen JF, Gordijn SJ, Abdel-Aleem H, Bergsjo P, Betran A, Duke CW, et al. Making stillbirths count, making numbers talk issues in data collection for stillbirths. BMC pregnancy and childbirth 2009;9:58.

Lawn JE, Blencowe H, Pattinson R, Cousens S, Kumar R, Ibiebele I, et al. Stillbirths: Where? When? Why? How to make the data count? Lancet. 2011;377:1448-63.

Wou K, Oueller MP, Chen MF, Brown RN. Comparision of the aetiology of stillbirth over five decades in a single centre: a retrospective study. BMJ Open. 2014;4:e004635.

Frøen JF, Pinar H, Flenady V, Bahrin S, Charles A, Chauke L, et al. Causes of death and associated conditions (Codac): a utilitarian approach to the classification of perinatal deaths. BMC Pregnancy Childbirth. 2009;9:22.

Flenady V, Frøen JF, Pinar H, Torabi R, Saastad E, Guyon G, et al. An evaluation of classification systems for stillbirth. BMC Pregnancy Childbirth. 2009;9:24.

Gordijn SJ, Korteweg FJ, Erwich JJ, Holm JP, van Diem MT, Bergman KA, et al. A multilayered approach for the analysis of perinatal mortality using different classification systems. Eur J Obstet Gynecol Reprod Biol. 2009;144:99-104.

White P. Pregnancy complicating diabetes. Am J Med 1949;7:609–16.

The Stillbirth Collaborative Research Network Writing Group. Causes of death among stillbirths. JAMA. 2011;306:2459-68.

Ngoc NT, Merialdi M, Aleem HA, Carroli G, Purwar M, Zaveleta N et al. Causes of stillbirths and early neonatal deaths: data from 7993 pregnancies in six developing countries. Bulletin WHO. 2006;84:699-705.

Cung TG, Paus AS, Aghbar A, Kiserud T, Hinderaker SG. Stillbirths at a hospital in Nablus, 2010: a cohort study. Glob Health Action. 2014;7:25222.

Ashish KC, Nelin V, Wrammert J, Ewald U, Vitrakoti R, Baral GH, et al. Risk factors for antepartum stillbirth: a case-control study in Nepal. BMC Pregnancy Childbirth. 2015;15:146.

Martin JA, Hamilton BE, Sutton PD. Births: final data for 2007. Natl Vital Stat Rep. 2010;58:1-85.

Willinger M, Ko CW, Reddy UM. Racial disparities in stillbirth risk across gestation in the United States. Am J Obstet Gynecol. 2009;201:469 e1-8.

Gold KJ, DeMonner SM, Lantz PM, Hayward RA. Prematurity and low birth weight as potential mediators of higher stillbirth risk in mixed black/white race couples. J womens Health (Larchmt). 2010;19:767-73.

Salihu HM, Sharma PP, Kristensen S. Risk of stillbirth following a cesarean delivery: blackwhite disparity. Obstet Gynecol. 2006;107:383-90.

Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults. JAMA. 2010;303:235-41.

Centers for Disease Control and Prevention (CDC). Prenatal care and pregnancies complicated by diabetes—U.S. reporting areas, 1989. MMWR Morb Mortal Wkly Rep. 1993;42:119-22.

Walsh CA, Vallerie AM, Baxi LV. Etiology of stillbirth at term: a 10-year cohort study. J Matern Fetal Neonatal Med. 2008;21:494-501.

Syed M, Javed H, Yakoob MY, Bhutta ZA. Effect of screening and management of diabetes during pregnancy on stillbirths. BMC Public Health. 2011;11(suppl 3):S2.