Maternal, Foetal And Placental Conditions Associated With Stillbirth: An Exploratory Study

ABSTRACT

Background: Stillbirth constitutes about 60% of the perinatal deaths. And this is an event which has always challenged the obstetricians for decades. Various maternal, foetal and placental factors may result to stillbirths. Yet, in spite of the modern facilities available and advances made in the medical field, many times no contributing factors can be attributed to the exact cause of stillbirth and refusal of autopsy examination seals the chapter, with the cause of stillbirth remaining unexplored. Objective: The objective of the current study was to explore the maternal, foetal and placental conditions associated with stillbirth and to ascertain the common causes of stillbirth. Methods: A hospital-based prospective study was conducted in the Department of Obstetrics and Gynaecology, Regional Institute of Medical College, Imphal, Manipur in the year 2003. At the time of admission, after obtaining informed verbal consent, a detailed history was taken followed by thorough physical examination and routine investigations were dome for all the admitted patients in the antenatal ward. After delivery, all the women who had stillbirth were approached again to undergo special investigations like blood sugar estimation, VDRL test, urine examination for culture and sensitivity, ELISA for HIV and TORCH antibodies, Widal test, liver function tests and kidney function test. Based on the above findings, the stillbirths were analysed as macerated stillbirths and fresh stillbirths. Results: Only 43 women out of all the 100 women who had stillbirths could be investigated for TORCH antibodies. Out of these 43 women, 4 (9.3%) women were positive for Ig M toxoplasma antibody, 3 (7.0%) women were positive for Ig M Rubella antibody, 10 (23.3%) women were positive for Ig M CMV and 9 (20.9%) women were positive for Ig M HSV I & II indicating present infection. Ig G antibody alone was positive in 25 (58.1%) women for toxoplasmosis, 29 (67.4%) women for Rubella, 31 (72.1%) women for CMV and 20 (67.4%) women for HSV I & II indicating past infection (Table 1). Forty-eight women underwent VDRL testing and 08 (20%) women were found to be positive. Only 20 women gave consent for their placenta to undergo histopathological examination. Among these the commonest histological finding was syncytial knots (70%). Maternal anaemia (78%) was by far the commonest medical condition associated in women who either had macerated or fresh stillbirth. And accidental haemorrhage with or without placenta previa and prolonged/obstructed labour were the common conditions associated with stillbirth. The most probable causes of stillbirth assigned for all the 100 stillbirths, made after careful clinical consideration were intra-partum asphyxia (59%), foetal asphyxia (19%), unexplained intra-uterine deaths (15%) and congenital malformations (7%). Conclusion: Proper antenatal care for screening high risk factors and management thereof and educating the women to overcome the fear for hospital delivery are the needs of the hour. Also, a constant supervision by the senior staffs and their availability for consultation while conducting deliveries in the medical institutions may prevent a sizeable number of stillbirths. Vaginal delivery of difficult and breech delivery may be avoided as far as possible. Instead, Caesarean section should be opted.