Stillbirth; frequency and correlates in severe acute maternal morbidity [SAMM] and maternal death at tertiary health care centre

ABSTRACT

Pakistan stands second in the world s rating of highest stillbirth rate. This gives an emergency call to authorities involved in maternity health care of Pakistan to take serious and quick steps to address the problem. Retrospective observational study at tertiary health care centre to see frequency and risk factors for stillbirth in cases of severe acute maternal morbidity [SAMM] and maternal death over period from January 2008 till Jan 2010. High stillbirth rate 438 /1000 was found in the study group as compared to still birth rate of 74 /1000 in rest of the deliveries during the same period. Data analysis by using multivariate regression for variables after adjusting for co variable showed significant association [p value < .05] with still births of following factors grand multipara [adjusted OR 1.887 Cl 1.156-3.081] primigravida [adjusted OR 1.623 Cl -1.023-2.573] low education [adjusted OR 19.378 Cl- 2.586-145.208] lack of standard antenatal [care Non booked [adjusted OR 10.101 Cl 3.847-26.518] referred cases [OR 5.879 Cl 2.166-15.954]] preterm deliveries [adjusted OR 2.994 Cl 1.512-5.931] and vaginal deliveries 1.986 [Cl 1.351-2.920] whereas uterine rupture [adjusted OR 4.003 Cl 1.647-9.729] prepartum haemorrhage [adjusted OR 3.617 Cl 1.756-7.451] and hypertension [adjusted OR 3.298 Cl 2.040- 5.330]were significant obstetric risk factors. Audit of SAMM and maternal death with emphasis on risk factors of still birth would help to find strategies to reduce preventable causes of stillbirth .This would be important relatively quick contribution to efforts of achieving MDG 4