linical Audit of Stillbirths at a Faith-Based Secondary Health Centre in Ibadan, Nigeria: A Six-Year Review

Objective:The determine the prevalence of stillbirth and identify associated factors among parturients in a faith-based secondary health centre.Method:This was a retrospective audit of two hundred and twenty-five stillbirth deliveries at the Our Lady of Apostle Catholic Hospital at Oluyoro, OkeOffainIbadan, Nigeria,betweenstst1January2010, and 31December, 2015. Data was extractedfromhospitalrecordsforsociodemographiccharacteristics, obstetricfactors,complications, and outcomes of pregnancy. Data analysis was done using SPSS version 20 and the level of statistical significance was set at p < 0.05. Results:The stillbirth rate was 27.75 per 1000 births. More than half (129; 57.4%) were macerated. The ratio of still birth rate among the booked and unbooked parturients was 1:21. The commoncausesofstillbirthswerehypertensivedisordersinpregnancy (24.9%), anaemia in pregnancy (20.4%); while the least were congenital anomalies (1.0%) and gestational diabetes mellitus (1.0%Conclusion: This study confirmed that most of the stillbirths were due to unsupervised or poorly supervised pregnancies. There is need to ensure quality antenatal care services for the early detection and management of risk factors in order to reduce the burden of stillbirths.

Prevalence of stillbirth at the Buea Regional Hospital, Fako Division south-west region, Cameroon

Introduction: the study investigated the prevalence of stillbirth at the Buea Regional Hospital, by taking cases of pregnant women who attended antenatal clinic(s) and those who did not attend but had thier deiveries at the Buea regional hospital. The study specifically estimated the prevalence of stillbirths; identified possible risk factors associated with stillbirths, and determined whether the number of antenatal clinic visits is related to the occurrence of stillbirths-because during antenatal clinic visits, pregnant women are educated on risk factors of stillbirths such as: preterm deliveries; sex of the stillbirth; history of stillbirth; history of abortion(s); what age group of mothers are more likely to have a stillbirth.Methods: the study was a hospital based retrospective study at the maternity in which there were 3577 deliveries registered at the Buea Regional Hospital dated May 1st, 2014 to April 30th, 2017. With the aid of a checklist data was collected, analysed and presented with the use of tables, pie-charts and bar charts.Results: the prevalence of stillbirths was 26‰; possible risk factors associated with stillbirths included: preterm deliveries; women aged 20-29 years; history of abortion(s); a history of stillbirth; sex of stilbirths were more of females than males; and insufficient antenatal clinic attendance (≤1 antenatal clinic attendence) had more stillbirths. Conclusion: the study estabished that stillbirths can occur in any woman of child-bearing age. possible risk factors associated with stillbirths included: preterm deliveries; women aged 20-29 years; history of abortion(s); a history of stillbirth; gender of stilbirths were more of females than males; and insufficient antenatal clinic attendance (≤1 antenatal clinic attendence) had more stillbirths

An audit of stillborn babies in mothers with diabetes mellitus at a tertiary South African Hospital

Objectives and design: This study is a retrospective audit spanning six years following the implementation of a new guideline on the management of diabetes in pregnancy. It aims to describe the patient profile of pregnancies complicated by diabetes and stillbirth.Setting: The study was performed in Tygerberg Hospital, Cape Town, a secondary and tertiary referral centre.Subjects: Fifty-eight pregnancies were complicated by stillbirth (> 500 g). Outcome measures: the patient profile, gestational age, co-morbidities, foetal/placental monitoring and avoidable factors were described.Results: Many patients (32%) booked after 24 weeks' gestation and missed appointments were common (26.2%). Stillbirths ascribed to diabetes constituted 2.3% of all stillbirths at the hospital during the study period. Of the stillbirths 28.1% had Type I diabetes mellitus (DM), 64.9% had Type II and 7.0% were in patients with gestational diabetes. The median HbA1c at delivery was 8.4% (range 6.0­14.1%). In the Type II group, 31 (77.5%) of the stillbirths occurred after 36 weeks, while those among the Type I cases ranged from 26 to 38 weeks.Conclusion: Stillbirths amongst pregnant women with diabetes constituted a small percentage of the total stillbirth burden. Emphasising the importance of appropriate antenatal care to women with diabetes and increased surveillance from 36 weeks' gestation may lower the number of stillbirths

Incidence and determinants of stillbirth among women who gave birth in Jimma University specialized hospital, Ethiopia

Introduction: worldwide approximately 2.7 million are stillborn, more than 98% of these occur in developing countries. To address the problem, incidence and determinants of stillbirth must be understood. Therefore the aim of this study was to assess incidence and determinants of stillbirth among women who gave birth in Jimma University specialized hospital.Methods: a cross-sectional study design among 413 mothers who gave birth in Jimma specialized hospital was employed. Study subjects were selected by systematic sampling technique from the list of women who gave birth in hospital in one month study period. Data were collected by using pretested and structured questionnaire. Data were edited, cleaned, coded, entered and analyzed using SPSS-20 statistical software. Univarate and bivariate (logistic regressions) analysis was employed.Results: the incidence rate of stillbirth in the Hospital during a month period was 8% or 80 per 1000 total births. The predictors that showed an independent close association with stillbirth were absence of complication (OR = 0.1, 95% CI (0.04-0.2)), referral from other health facility (OR = 0.3, 95% CI (0.1-0.7)), having antenatal care (OR = 0.3, 95% CI (0.1-0.7)) and normal vaginal delivery (OR = 0.2, 95% CI ( 0.1-0.8)). Conclusion: the incidence rate of stillbirths in our setting is high and the identified determinants were related to both ante-partum and intra-partum-period. Therefore, effort should be made to improve antenatal, obstetric services and delivery services in terms awareness, access, timing and referral system to emergency care and specialized service to reduce the number of stillbirths

A retrospective analysis of eclampsia as a major cause of maternal and perinatal mortality in Sagamu

Background: While eclampsia remains a leading cause of maternal death in the developing world, the prevalence and case fatality of the condition in the developed world has reduced due to early detection and prompt treatment. The understanding of the factors associated with eclampsia may reduce the burden and enhance the quality of foeto-maternal outcome.Objective: To determine the prevalence of eclampsia and the associated foeto-maternal outcome. Methods: A retrospective study of patients who presented with eclampsia at the Olabisi Onabanjo University Teaching Hospital (OOUTH) between January 2008 and December 2012 was carried out. The hospital records were retrieved and the data extracted included the age, parity, gestational age at presentation, booking status, mode of delivery, outcome of baby and mother, and the total delivery in the hospital over the period.Results: The prevalence of eclampsia over the period was 1.1%. Eclampsia was common among women aged 25years and below (64.3%), nulliparous women (78.6%) and unbooked (100.0%). Caesarean section was carried out on 63.0% of the patients on account of unfavourable cervix, while 22.2% of patients had spontaneous vagina delivery. Most (96.4%) received magnesium sulphate (MgSO4) therapy but 22.2% convulsed while receiving it. Maternal mortality was 7.1% while perinatal mortality rate was 250/1000 live birth.Conclusion: Eclampsia remains a cause of maternal morbidity and preventable death in the understudied community. Early antenatal booking and the use of MgSO4 are effective in reducing the burden

Trends in Perinatal Health Indices in the Amajuba District; KwaZulu-Natal; South Africa; 1990-2012

Background. In order to address the high perinatal mortality rate; South Africa (SA) commenced a number of interventions from 1995. These included the abolition of user fees; basic antenatal care; on-the-spot diagnosis and treatment of syphilis; and the prevention of mother-to-child transmission of HIV. However; there is a dearth of information on the long-term effect of these programmes on perinatal indicators in district hospitals; where most births and deaths occur.Objective. To determine the levels and trends in maternal and neonatal indicators in Amajuba District; KwaZulu-Natal Province; SA; and to ascertain the dynamics of these indicators vis-a-vis the transformation of healthcare in SA. Methods. The study location was Madadeni Hospital and its nine feeder maternity clinics. Information pertaining to all deliveries and their outcome from these health facilities from 1990 to 2012 was extracted from the clinical registers. Data were analysed using SPSS version 15.0 (IBM; USA). Quantitative variables were summarised as means; while qualitative data were expressed as proportions and percentages. The trends for each outcome variable for the entire study period (1990 - 2012) were analysed and presented as line graphs and tables. Results. There were 154 821 live births and 4 133 stillbirths from 1990 to 2012. The overall mean values for stillbirth rate; perinatal mortality rate; neonatal mortality rate and maternal mortality ratio were 26.3 (standard deviation 5.6); 40.9 (9.6); 16.8 (4.7) and 114 (56.6); respectively. There was a general improvement in all the perinatal health indices in the early 90s; followed by a general worsening until the early 2000s; after which a consistent decline was noted. Conclusion. The perinatal health indices in Amajuba District have followed a pattern similar to that found in the rest of SA: an increase during the late 90s to early 2000s; followed by a decline from the late second half of the first decade of this century

Stillbirth Rates in Singleton Pregnancies in a Stable Population at Karl Bremer and Tygerberg Hospitals Over 50 Years

Objectives. To determine the changes in stillbirth rates in singleton pregnancies in a stable population over a period of 50 years. Methods. Stillbirth rates for singleton pregnancies where the fetus weighed 1 000 g or more were collected from 1962 to 2011. From 1972 to 2011; rates included fetuses weighing 500 g or more at birth. Results. When the birth weight was 1 000 g or more the stillbirth rate declined from 70 to 12.6 per 1 000 births; and when the birth weight was 500 g or more it dropped from 34.2 to 24.5. The decline was very much slower towards the end of the study period. Conclusion. To achieve further sustained reductions in stillbirth rates; healthcare workers should continue to emphasise quality of healthcare; but they should also address and prevent specific conditions associated with stillbirth; such as smoking and drinking during pregnancy

Stillbirth Rate in a Teaching Hospital in South-Eastern Nigeria: A Silent Tragedy

Background: Stillbirths often are not seen as a major public health problem; for despite increasing attention and investment on maternal; neonatal; and child health; stillbirths remain invisible. Aim: The objective of this study was to determine the stillbirth rate at the Imo State University Teaching Hospital; Orlu. Subjects and Methods : Analysis of the case records of stillbirths that occurred in the institution over a 5-year period from 1 st July 2005 to 30 th June 2010 was made. Data retrieved was analyzed for age of the women; parity; presumptive risk factor for the stillbirth; and booking status of the women. Also; the total births during the period of study were obtained. A P-value of 0.05 is said to be significant at confidence level of 95 (95/100). Results : There were a total of 1;142 deliveries within the study period; out of which 206 resulted in stillbirths. This gave an institutional stillbirth rate of 18 (180/1000 deliveries). One-hundred and fifty-five 75.2 (155/206) of the stillbirths were macerated stillbirth. The age range of the women was 15-44 years. The modal age was 31 years. The age group of 26-30 years had the highest prevalence rate of stillbirths of 79 (38.3 ;79/206); while age group of more than 40 years contributed the least with four stillbirths 4 (1.9 ; 4/206). Conclusion : The stillbirth rate at the institution is too high and efforts must be made to reduce it

Stillbirth Rate in a Teaching Hospital in South-eastern Nigeria: A Silent Tragedy

Stillbirths often are not seen as a major public health problem; for despite increasing attention and investment on maternal; neonatal; and child health; stillbirths remain invisible. Aim: The objective of this study was to determine the stillbirth rate at the Imo State University Teaching Hospital; Orlu. Subjects and Methods : Analysis of the case records of stillbirths that occurred in the institution over a 5-year period from 1 st July 2005 to 30 th June 2010 was made. Data retrieved was analyzed for age of the women; parity; presumptive risk factor for the stillbirth; and booking status of the women. Also; the total births during the period of study were obtained. A P-value of 0.05 is said to be significant at confidence level of 95 (95/100). Results : There were a total of 1;142 deliveries within the study period; out of which 206 resulted in stillbirths. This gave an institutional stillbirth rate of 18 (180/1000 deliveries). One-hundred and fifty-five 75.2 (155/206) of the stillbirths were macerated stillbirth. The age range of the women was 15-44 years. The modal age was 31 years. The age group of 26-30 years had the highest prevalence rate of stillbirths of 79 (38.3; 79/206); while age group of more than 40 years contributed the least with four stillbirths 4 (1.9; 4/206). Conclusion : The stillbirth rate at the institution is too high and efforts must be made to reduce it

Stillbirths at the Jos University Teaching Hospital: Incidence; Risk; and Etiological Factors

Introduction: Death of a fetus in-utero or intrapartum is both devastating to the couple and of concern to the clinician. Identifying the etiological and risk factors of stillbirths will help in the prevention or reduction of its occurrence. Materials and Methods: This was a prospective observational study of all stillbirths over a 16-month period (from January 2006 to April 2007) at the maternity Unit of Jos University Teaching Hospital. Information on maternal socio-demographic details; history of antenatal complications of the index pregnancy; and maternal medical history were obtained by personal interview of all mothers who had a stillbirth. For each stillbirth; information was obtained on the type of stillbirth; estimated gestational age at delivery; sex of baby; and the mode of delivery. These characteristics were subjected to analysis. Etiological causes were assessed using the clinico-pathological approach advocated by Baird-Pattinson. Results: There were a total of 3;904 deliveries with 158 stillbirths during the study period; giving a stillbirth rate of 40.5 per 1;000 total births. There were 84 (53.2) macerated and 74 (46.8) fresh stillbirths. Of the 3;904 total deliveries; there were 2;022 (51.8) males and 1;882 (48.2) females. There were 84 male and 74 female stillbirths; giving stillbirth rates of 41.5 per 1;000 and 39.3 per 1;000 total deliveries for male and female deliveries; respectively; which was not statistically significant (X2 = 4.6865; P 0.3564). The major causes were abruptio placentae (17.7); hypertensive disorders of pregnancy (12.7) and maternal HIV infection 10.7of stillbirths. Other causes were cord accidents (7.0); placenta praevia (3.8); and anemia in pregnancy (3.8). Forty-six (29.1) of the stillbirths were unexplained. The main risk factors identified were lack of antenatal care; poor antenatal clinic attendance; home delivery; and late presentation of complicated labor to the facility. Conclusion: The stillbirth rate in our centre is high; major causes being abruptio placenta and maternal medical conditions. Maternal HIV infection has emerged as a major contributor to stillbirths in this study

Analysis of Stillbirths in a Nigerian Mission Hospital

Background: In Nigeria; perinatal mortality remains a major health problem with the balance heavily tilted towards the stillbirth component. Knowledge of the relative importance of the different causes of stillbirth is lacking; even in hospital settings.Objective: To determine the stillbirth rate in a Nigerian mission hospital and document its risk factors.Methods: In this retrospective study; the case records of 131 mothers who had stillbirths were studied and the data obtained analyzed. The relevant hospital delivery registers were also examined.Results: Stillbirth rate was 39.7 per 1000 births with 51.9and 48.1being macerated and fresh stillbirths respectively. Antepartum haemorrhage; preeclampsia/eclampsia and prolonged/obstructed labour were the three leading risk factors for stillbirth. Low birthweight babies were also at increased risk of foetal death. Majority (61.8) of mothers whose babies were stillborn belonged to low social class.Conclusion: Our stillbirth rate remains unacceptably high and strategies to reduce it must focus on antenatal and intrapatum emergency obstetric care and early referrals in hospital setting

Analysis of Stillbirths in a Nigerian Mission Hospital

Background:In Nigeria; perinatal mortality remains a major health problem with the balance heavily tilted towards the stillbirth component. Knowledge of the relative importance of the different causes of stillbirth is lacking; even in hospital settings.Objective: To determine the stillbirth rate in a Nigerian mission hospital and document its risk factors.Methods: In this retrospective study; the case records of 131 mothers who had stillbirths were studied and the data obtained analyzed. The relevant hospital delivery registers were also examined.Results: Stillbirth rate was 39.7 per 1000 births with 51.9and 48.1being macerated and fresh stillbirths respectively. Antepartum haemorrhage; preeclampsia/eclampsia and prolonged/obstructed labour were the three leading risk factors for stillbirth. Low birthweight babies were also at increased risk of foetal death. Majority (61.8) of mothers whose babies were stillborn belonged to low social class.Conclusion: Our stillbirth rate remains unacceptably high and strategies to reduce it must focus on antenatal and intrapatum emergency obstetric care and early referrals in hospital setting

Mothers' Access to Supportive Hospital Services after the Loss of a Baby through Stillbirth or Neonatal Death

Every year; 3-5 of pregnant mothers in South Africa lose their babies to a stillbirth or neonatal death. These mothers need adequate services to prevent complications in their grieving process. Most of these babies are lost in hospital settings; so the treatment medical staff provide is vital. This study examined mothers' experiences of accessing hospital; religious; formal and social services after a stillbirth or neonatal death. An exploratory research design was used to conduct applied research. A semi-structured interview schedule was used with a sample of 15 mothers who had lost a baby in the last 5 years. The findings were analysed quantitatively and qualitatively. The primary focus of this article is the quantitative findings relating to hospital services. The sample was small and these results cannot be generalised; but some conclusions are reached and recommendations are made to service providers in hospitals working with mothers who have lost babies. Mothers generally experienced the support services from hospitals as inadequate; compared to what hospitals could offer. Mothers that receive support after the loss of a baby generally cope better. This support thus assists them in the grieving process. Hospital staff can be trained to provide these services

Pregnancy Termination in Sub-Saharan Africa: The Need for Refined Data

Purpose: This study examines the levels and pattern of; as well as the factors associated with; pregnancy termination in seventeen Sub-Sahara African countries. Methods: The 2000 round of demographic and health survey (DHS) data sets for the countries are used. The study population are women aged 15-49 who have ever been exposed to the risk of pregnancy and interviewed during the surveys. Univariate analysis is done to examine the distribution of the women. Bivariate analysis of selected background; contraceptive; sexual behaviour and fertility variables by having ever had a terminated pregnancy are also carried out. Lastly; multivariate logistic regression models are fitted to examine the magnitude of associated variables while controlling for others. Results: the associated factors vary from country to country. However; age and marital status are associated with and are critical predictors of having ever had a terminated pregnancy in all the countries. For example; the odds of having ever had a terminated pregnancy is about 54 and 32 times (for currently and formerly married women; respectively) that of those that have never married in Rwanda. Conclusion: This study has come up with findings that provoke more thinking and research on the topic of pregnancy termination and to reproductive health in general. This is because `ever had a terminated pregnancy' as used in the DHS context made no distinction between the three different pathways through which a pregnancy may not result into a live birth