Preventable stillbirths in India and Pakistan: a prospective, observational study. (19th July 2021)

• Record Type: Journal Article
• Authors: Goldenberg, RL; Saleem, S; Goudar, SS; Silver, RM; Tikmani, SS; Guruprasad, G; Dhaded, SM; Yasmin, H; Bano, K; Somannavar, MS; Yogeshkumar, S; Hwang, K; Aceituno, A; Parlberg, L; McClure, EM
• Other Names: Goudar Shivaprasad S investigator.; Dhaded Sangappa M investigator.; Nagmoti Mahantesh B investigator.; Harakuni Sheetal U investigator.; Somannavar Manjunath S investigator.; Yogeshkumar S investigator.; Guruprasad Gowdar investigator.; Raghoji Chaitali R investigator.; Nadig Naveen G investigator.; Aradhya Gayathri H investigator.; Kusagur Varun B investigator.; Patil Lingaraja Gowda C investigator.; Siddartha ES investigator.; Dhananjaya Shobha investigator.; Sarvamangala B investigator.; Veena GR investigator.; Kulkarni Vardendra G investigator.; Rajashekar KS investigator.; Sunilkumar K Byranahalli investigator.; Nagaraj TS investigator.; Jeevika MU investigator.; Harikiran Reddy R investigator.; Joish Upendra Kumar investigator.; Mangala GK investigator.; Pujar Sneharoopa investigator.; Saleem Sarah investigator.; Tikmani Shiyam Sunder investigator.; Ariff Shabina investigator.; Shaikh Lumaan investigator.; Uddin Zeeshan investigator.; Ghanchi Najia investigator.; Ahmed Imran investigator.; Feroz Anam investigator.; Reza Sayyeda investigator.; Roujani Sana investigator.; Masheer Shazia investigator.; Nausheen Sidrah investigator.; Yasmin Haleema investigator.; Bano Khadija investigator.; Tanveer Saba investigator.; Haider Maharukh investigator.; Raza Jamal investigator.; Shaikh Mehmood investigator.; Hanif Muhammad investigator.; Aceituna Anna investigator.; Bann Carla investigator.; Hwang Kay investigator.; Kim Jean investigator.; McClure Elizabeth investigator.; Moore Janet investigator.; Parlberg Lindsay investigator.; Parepelli Suchetia investigator.; Goldenberg Robert L investigator.;
• Is Part Of: BJOG. Volume 128:Number 11(2021)
• Page Start: 1762
• Page End: 1773
• Publication Date: 2021-07-19
• Subjects: Antepartum haemorrhage -- hypertension -- preventability -- small for gestational age -- stillbirth; Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1111/1471-0528.16820
• Languages: English
• ISSNs: 1470-0328

Abstract

Abstract : Objective: Stillbirths occur 10–20 times more frequently in low‐income settings compared with high‐income settings. We created a methodology to define the proportion of stillbirths that are potentially preventable in low‐income settings and applied it to stillbirths in sites in India and Pakistan. Design: Prospective observational study. Setting: Three maternity hospitals in Davangere, India and a large public hospital in Karachi, Pakistan. Population: All cases of stillbirth at ≥20 weeks of gestation occurring from July 2018 to February 2020 were screened for participation; 872 stillbirths were included in this analysis. Methods: We prospectively defined the conditions and gestational ages that defined the stillbirth cases considered potentially preventable. Informed consent was sought from the parent(s) once the stillbirth was identified, either before or soon after delivery. All information available, including obstetric and medical history, clinical course, fetal heart sounds on admission, the presence of maceration as well as examination of the stillbirth after delivery, histology, and polymerase chain reaction for infectious pathogens of the placenta and various fetal tissues, was used to assess whether a stillbirth was potentially preventable. Main outcome measures: Whether a stillbirth was determined to be potentially preventable and the criteria for assignment to those categories. Results: Of 984 enrolled, 872 stillbirths at ≥20 weeks of gestation met the inclusion criteria and were included; of these, 55.5% were deemed to be potentially preventable. Of the 649 stillbirths at ≥28 weeks of gestation and ≥1000 g birthweight, 73.5% were considered potentially preventable. The most common conditions associated with a potentially preventable stillbirth at ≥28 weeks of gestation and ≥1000 g birthweight were small for gestational age (SGA) (52.8%), maternal hypertension (50.2%), antepartum haemorrhage (31.4%) and death that occurred after hospital admission (15.7%). Conclusions: Most stillbirths in these sites were deemed preventable and were often associated with maternal hypertension, antepartum haemorrhage, SGA and intrapartum demise. Tweetable abstract: Most stillbirths are preventable by better care for women with hypertension, growth restriction and antepartum haemorrhage. Tweetable abstract: Most stillbirths are preventable by better care for women with hypertension, growth restriction and antepartum haemorrhage.