Etiologies and Timing of Stillbirth at a Tertiary Teaching Hospital in Mekelle, Ethiopia [24K]

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Abstract

INTRODUCTION:

Stillbirth remains a tragic event. The overwhelming majority globally (98%) occurs in low- and middle-income countries (LMICs), though data is limited. Ayder Referral Hospital (ARH), a tertiary hospital in northern Ethiopia, utilizes a World Health Organization (WHO) form to record stillbirth. This study aimed to determine the etiology and timing of stillbirths delivered at ARH.

METHODS:

Our study was a retrospective chart review of stillbirths delivered at ARH between January 1, 2013 and December 31, 2015. We used delivering obstetricians' notes using the WHO form and physical examination of fetus and placenta to determine etiology and timing of stillbirths.

RESULTS:

Over the study period, there were 4,582 live births and 322 stillbirths delivered at ARH. The top five causes of stillbirth were unexplained (41.3%), abruptio placenta (15.5%), fetal congenital anomalies (14.9%), birth asphyxia (12.1%), and cord accidents (6.8%). Most (62.2%) stillbirths occurred intrapartum, including during the latent (6.1%), active (6.1%) and second (50.0%) stages of labor. In 70.8% of stillbirths, fetal heart tone (FHT) was absent on admission to ARH, including 28.6% that had no FHT upon arrival at referring institution, 18.0% that occurred en route to ARH, and 24.2% that arrived at ARH directly with no referral.

CONCLUSION:

Stillbirth continues to be significant problem in northern Ethiopia. Additional research is needed given that 41.3% of stillbirths were unexplained. Nearly two-thirds of stillbirths occurred intrapartum and 18.0% in transit from referral institutions, suggesting women need access to care before labor starts and transportation from referring institutions should be improved.

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