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Home / A Stillborn Baby Was Delivered in Teh Birhting Suite a Few Hours Ago

A Stillborn Baby Was Delivered in Teh Birhting Suite a Few Hours Ago

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Incidence of stillbirth and perinatal bloodshed and their associated factors amidst women delivering at Harare Maternity Hospital, Zimbabwe: a cross-sectional retrospective analysis

BMC Pregnancy and Childbirth volume five, Article number:9 (2005) Cite this article

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Abstract

Background

Death of an infant in utero or at birth has always been a devastating experience for the mother and of business organisation in clinical do. Infant mortality remains a claiming in the care of pregnant women worldwide, but particularly for developing countries and the demand to sympathize contributory factors is crucial for addressing appropriate perinatal health.

Methods

Using information available in obstetric records for all deliveries (17,072 births) at Harare Maternity Hospital, Zimbabwe, we conducted a cantankerous-sectional retrospective assay of a 1-yr data, (1997–1998) to assess demographic and obstetric risk factors for stillbirth and early neonatal death. We estimated risk of stillbirth and early neonatal decease for each potential run a risk cistron.

Results

The almanac frequency of stillbirth was 56 per one,000 total births. Women delivering stillbirths and early neonatal deaths were less likely to receive prenatal care (adjusted relative run a risk [RR] = two.54; 95% confidence intervals [CI] 2.19–two.94 and RR = ii.52; 95% CI 1.63–three.91), which for combined stillbirths and early neonatal deaths increased with increasing gestational age (Adventure Ratio [Hour] = 3.98, HR = 7.49 at 28 and twoscore weeks of gestation, respectively). Rural residence was associated with risk of babe dying in utero, (RR = 1.33; 95% CI ane.12–i.59), and the risk of death increased with increasing gestational historic period (60 minutes = 1.04, 60 minutes = ane.69, at 28 and twoscore weeks of gestation, respectively). Older maternal historic period was associated with risk of death (HR = one.50; 95% CI 1.21–one.84). Stillbirths were less likely to exist delivered past Cesarean section (RR = 0.64; 95% CI 0.51–0.79), only more likely to be delivered as breech (RR = four.65; 95% CI 3.88–5.57, equally were early on neonatal deaths (RR = 3.38; 95% CI ane.64–6.96).

Conclusion

The frequency of stillbirth, especially macerated, is loftier, 27 per 1000 full births. Early on prenatal care could help reduce perinatal decease linking the adult female to the health care system, increasing the probability that she would seek timely emergency care that would reduce the likelihood of expiry of her infant in utero. Improved quality of obstetric intendance during labor and delivery may aid reduce the number of fresh stillbirths and early neonatal deaths.

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Background

Perinatal bloodshed remains a challenge in the care of significant women worldwide, particularly in developing countries [1–3]. To address the problem of perinatal mortality, factors associated with stillbirth, a major correspondent of over 50% of perinatal deaths in developing countries, [four] must exist understood. Stillbirths are both mutual and devastating, and in developed countries, near ane third has been shown to be of unknown or unexplained origin [iv, five]. As is the perinatal mortality rate, the stillbirth ratio is an important indicator of the quality of antenatal and obstetric care [2, three, half-dozen], but studies accept not distinctively differentiated the frequency of and risk factors for macerated versus fresh stillbirths. Agreement the distribution of fresh and macerated stillbirths and deaths within the immediate postpartum period may help identify the quality of antenatal and obstetric care available to the pregnant women and prioritize advisable intervention strategies. Macerated stillbirths are oft associated with insults that occur in utero during the antenatal period, while fresh stillbirths and early on neonatal deaths or bloodshed (ENNM) may suggest issues with the intendance bachelor during labor and at delivery [three, vii, 8]. Few studies from Zimbabwe [9–eleven], have examined frequency of perinatal mortality and how this consequence varies across important demographic subgroups. Studies from developing countries have not considered the frequency of macerated and fresh stillbirths and their relationship to preterm birth or low birth weight (LBW) [1], and no such report has been conducted in Republic of zimbabwe.

In Republic of zimbabwe, perinatal bloodshed remains unacceptably high. In Harare, the majuscule urban center, perinatal mortality declined from 83 per 1,000 live births in 1978, to 34 per one,000 live births in1984 and has changed piffling since so [12, 13]. In 1983, an audit of all births occurring within the Greater Harare Maternity Unit (GHMU), which comprises of Harare Maternity Hospital (HMH) and the 12 municipal clinics in Harare, estimated perinatal mortality to be 34.5 per 1,000 live births, with preterm birth being the leading crusade of perinatal bloodshed, bookkeeping for 19.3% of perinatal deaths [14]. By 1989, perinatal mortality had risen to 47 per 1,000 live births [12, xiii]. Iliff and Kenyon [12, 13] estimated that an increase in the number of and mortality from preterm births deemed for virtually half this increase. In the same written report, stillbirth ratio was estimated to be 26 per 1,000 total births. A more recent study estimated the frequency of stillbirth at HMH to be 57 per 1,000 total births [9], which, using conservative assumptions, translates to 33 per 1,000 total births for the GHMU. Prevention of perinatal deaths is critical, especially those associated with LBW and preterm birth, since intuitively, infants who are born early or small have increased risk of morbidity and mortality [2, 3, ix, 14].

Data on the frequency and distribution of adverse birth outcomes are important for planning maternal and kid health intendance services in developing countries, and knowledge of local patterns of morbidity and mortality is essential for improving antenatal and obstetric intendance. Ensuring a condom and good for you commitment for both female parent and child is a priority of the Republic of zimbabwe health care delivery system and is an essential component of prophylactic motherhood initiatives. In this preliminary report, nosotros assessed the contribution of socio-demographic and reproductive/obstetric take a chance factors to the frequency of fresh and diminished stillbirth and ENNM over a ane-year period at HMH, in Zimbabwe.

Methods

The study was carried out at HMH, the largest referral hospital in Zimbabwe. The report was canonical by the University of Michigan Institutional Review Board and the Medical Research Council of Republic of zimbabwe, and permission to conduct the written report was obtained from the Ministry of Health in Republic of zimbabwe, HMH and from the Harare Urban center Wellness Department.

The study methods accept been described elsewhere [9]. Briefly, information on all births occurring from Oct i, 1997, through September 30, 1998, at HMH was bathetic from the maternity delivery registry records. For each birth, information was abstracted on the engagement of nascence, residential area of the woman (rural/urban), whether the mother attended prenatal care or not, maternal age and parity, estimated gestation, birth weight; sex and vital status of the baby at birth, whether the infant was a single or multiple delivery, and the type of delivery. It was not possible to link births from multiple gestations in this information set. A woman was considered to have received prenatal care when she had at to the lowest degree ane visit for prenatal care during her pregnancy. Parity was the number of previous pregnancies ending subsequently 20 completed weeks of gestation including stillbirth (categorized as 0, one to 2, and more 2 pregnancies). Type of delivery denoted whether the infant was delivered vaginally presenting equally cephalic, face up to pubis or breech; vaginally with instrumental assistance; or past Cesarean section.

Eligibility criteria for this written report were based on the WHO definition of viability, that is, a birth weight of at least 500 grams gestational historic period at to the lowest degree of 20 weeks [15]. Births without data on vital status were excluded. A stillbirth was defined equally intrauterine decease of a fetus weighing at least 500 grams after 20 completed weeks of gestation occurring before the complete expulsion or extraction from its mother. A fresh stillbirth was defined as the intrauterine death of a fetus during labor or delivery, and a macerated stillbirth was divers every bit the intrauterine decease of a fetus one-time before the onset of labor, where the fetus showed degenerative changes [15] as reported in the obstetric records by the attention physician/midwife. An ENNM was defined every bit a death that occurred inside the first hour of life.

Gestational age (GA) at nascency was estimated by the number of days between the kickoff day of the last menstrual menstruation (LMP) and date of birth expressed in completed weeks after LMP and a clinical estimate every bit recorded in the maternity delivery record. Preterm nativity was divers as a nascency occurring at or before 37 completed weeks of gestation. A mail-term nascency was defined as a nascency occurring afterward 44 weeks of gestation. Birth weight was defined as the get-go measurement of body weight, commonly in the first hour of life, measured to the nearest gram. A LBW nascency was defined as the birth of an infant weighing less than 2,500 grams at nascence irrespective of gestational age. We too defined three LBW subgroups; term LBW birth, preterm LBW birth and very LBW nativity defined as infants weighing below ane,500 grams. A high nascency weight birth, based on the upper 10thursday percentile of our birth weight distribution, was divers equally the nascence of an infant weighing above 3,500 grams.

A total of xviii,149 births were recorded in the 12-month report flow. On boilerplate between 50 to 60 deliveries occurred daily. We excluded 32 (0.2%) births below 20 weeks of gestation, 68 (0.4%) that did not have information on vital condition, 78 (0.4%), that weighed below 500 grams at nascency and 795 (4.four%) that were missing data on birth weight or estimated gestation. Finally we excluded an additional 103 (0.half dozen%) births for which nascence weight/gestational age combination were implausible based on the algorithm advocated by Alexander et al. [xvi], leaving 17,072 births for this analysis.

Statistical assay

The numbers of fresh, macerated, and un-typed stillbirths are presented every bit a proportion of all births, and ENNM are presented every bit a proportion of live births. To examine predictors of these outcomes, cross-tabulations by each covariate were examined using chi-square tests of homogeneity. Every bit the complete population of births over a 1-year flow within the hospital was ascertained, nosotros could directly estimate the run a risk of stillbirth and ENNM for each covariate. In the unadjusted analyses, relative risks (RR) and 95% conviction intervals (CI) were calculated for each demographic and reproductive risk factor using EP-INFO 2000. All 17,072 eligible births were included for stillbirth analyses. Given the differences in risk for singleton and multiple births, the subsequent multivariate analyses are express to singleton births, therefore 16,023 singleton births were used for the stillbirths and combined stillbirth and ENNM analyses. For ENNM only analyses, xv,117 alive singleton births were included.

Multivariable generalized linear regression models with a log-link function and binomial error using SAS [SAS Institute Inc., Cary, NC, U.s.a.] version viii.1, were used to model each issue. A log (rather than logit) link function and binomial errors were used to allow estimation of relative risks (rather than odds ratios). Relative risks of stillbirth and 95% conviction intervals were calculated later adjusting for maternal age, residence, prenatal care, parity, baby sexual practice and blazon of delivery. Every bit estimates were not stable due to collinearity, we combined births delivered as face to pubis with those of normal vaginal delivery for the type of delivery analysis, adjusting for maternal age, residence, parity, and babe sex activity.

Recent epidemiological literature has suggested at least ii alternative methods of calculating the probability of stillbirth by GA, with the differences being in the definition of the denominator [17, eighteen]. Ane method calculates the GA-specific probability of stillbirth as the number of stillbirths divided by the number of births at a given GA. A second method calculates the GA-specific adventure of stillbirth every bit the number of stillbirths at a given GA divided by the number of fetuses at the given GA even so remaining to be born [17–nineteen]. We provide estimates using the first definition in Tables two and Boosted files i and 2, and use the 2d definition in Tables three and iv and Figures 1 and 2. Covariate effects on gestational historic period-specific mortality were estimated using Cox regression model with estimated gestation at nativity as the time variable. Gamble ratios (HR) for stillbirth and 95% CI were calculated [17, eighteen]. All 16,023 singleton births were used for this analysis, and stillbirths and ENNM were combined as outcomes of interest [17, eighteen]. The interaction between each covariate and time (GA) was tested for show of non-proportion hazards. Covariates with no bear witness of non-proportion hazards (maternal age, infant sex activity and parity) were refitted without the interaction term. For covariates with evidence of non-proportion hazards (residence and prenatal care) we also calculated the take a chance of death at 20, 28, 32, 36, 40 and 42 weeks of gestation. The probabilities of death at each stage of GA were estimated using life tables for prenatal care and for urban versus rural residents, and are presented in Figures one and 2.

Tabular array ii Distribution and adventure of Deaths within First Hour of Life for 15,117 Alive, Singleton Deliveriesat Harare Maternity Hospital; October 1997 to September 1998

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Tabular array 3 Demographic and Obstetric Characteristics: Take a chance Ratios of Combined Stillbirth and Early on Neonatal Deaths for 16,023 Singleton Deliveriesat Harare Maternity Infirmary; October 1997 to September 1998

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Table 4 Demographic and Obstetric Characteristics for which the Run a risk Ratio Changed over Gestational Historic period, for Combined Stillbirth and Early Neonatal Deaths for 16,023 Singleton Deliveries at Harare Maternity Hospital; October 1997 to September 1998

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Figure 1
figure 1

Probability of Combined Stillbirth and Early Neonatal Death amid 16,023 Singleton Deliveries by Prenatal Care at Harare Motherhood Hospital; October 1997 through September 1998

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Figure 2
figure 2

Probability of Death amongst 16,023 Singleton Deliveries by Residence at Harare Motherhood Hospital; Oct 1997 through September 1998

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Results

Demographic and obstetric chance factors of stillbirth by type

Of the 959 stillbirths, 201 (21%) were fresh and 458 (48%) were macerated stillbirths; the blazon of stillbirth for 300 (31%) births could not ascertained from the available obstetrical records. The annual stillbirth ratio at HMH was 56 per one,000 total births, of which 12 per 1,000 were fresh stillbirths, 27 per 1,000 were macerated stillbirths, and 17 per ane,000 were for stillbirths whose type was not indicated in the obstetric records (Table 1). Historic period of mothers ranged from 10 to fifty years. Near mothers were 20 to 35 years old, with a mean historic period at delivery of 24.six years. Most mothers (86%) resided in urban areas. Women present late for prenatal care, GA less than 28 weeks accounted for 384 singleton births, of which 180 (47%) did not receive prenatal care. It is uncommon in Zimbabwe for women to present for prenatal care prior to 28 weeks of pregnancy [9, 20], and in the rural areas women could present at a wellness center at the time of labor if they are having difficulty. About 45% of the women were primiparous, with parity ranging from 0 to 12. The mean age of mothers with parity of 0, was xx.7 (range 10–41 years), compared to 27.vii (range 14–l) for women with parity ane and more. As expected, there were slightly more male than female person births. A total of 17.5% of the deliveries were by Cesarean section, and an additional two.2% required some form of instrumentation during delivery, while five.9% of the births were either breech or face up to pubis presentations. About 6% of the infants were from multiple gestations, and in crude assay, multiple gestation births were less likely to exist diminished stillbirths (RR = 0.57; 95% CI 0.35–0.93), only more than likely to die in the first 60 minutes of life (RR = 1.88; 95% CI 1.12–3.xiv).

Table one Distribution of births past Vital Status at Harare Maternity Hospital; October 1997 to September 1998

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Additional file i presents the rough relative risks of stillbirth by type of demographic and reproductive characteristics of the study population. Young mothers were less likely than older women (RR = 0.73; 95% CI 0.61–0.88) to deliver a stillborn infant, with the reduction in run a risk particularly axiomatic for macerated stillbirth (RR = 0.72; 95% CI 0.56–0.93). In contrast, women above 35 years had a 59% increased risk of stillbirth and 43% increment in the likelihood of delivering a diminished stillbirth. Rural women delivering at HMH had a 24% increased take a chance of stillbirth compared with women who resided in urban areas. Women who did not receive prenatal care consistently had over a 2.3-fold increase in the risk of stillbirth of any type. Compared to a normal vaginal delivery, breech deliveries were over four.vii times more likely to be stillbirth, while births past Cesarean section were less likely to result in any type of stillbirth. Delivery by instrumentation was 2.2 times more likely to result in a fresh stillbirth than was normal vaginal commitment.

Additional file 2 presents adjusted relative risks for stillbirth past demographic and reproductive characteristics. Except for parity, which is correlated with maternal age (Pearson coefficient r = 0.76 p-value = 0.0001), the risks did not change in the adjusted analysis. Overall, risks for united nations-typed stillbirths did not differ from those for fresh and macerated stillbirths, except for residence and commitment by Cesarean department.

Demographic and obstetric risk factors of ENNM

The early neonatal mortality ratio was 9 per 1000 live births. Table 2 presents the distribution and adventure for ENNM past demographic and reproductive characteristics. Mothers under xx years old were 69% more likely than mothers 20 to 35 years of age to deliver an infant who died within the start hour of life, and similarly, risk for primiparous women was 81% compared to multiparous women. Male infants had a 69% increased gamble of dying within the showtime hr of life. Women who did not receive prenatal intendance consistently had over a 2.iv-fold increase in the risk of ENNM. Compared to a normal vaginal delivery, breech deliveries were 9.ix times more likely to terminate up as ENNM. Delivery by instrumentation was 3.7 times more probable to event in ENNM than was normal vaginal commitment. Except for maternal age and parity the risks remained the same or elevated in adapted analysis.

Relationship of mortality to demographic and obstetric factors

Table three presents the crude hazard ratios for mortality (stillbirths and ENNM combined) for demographic and obstetric characteristics that had constant take a chance ratios over GA. There was a fifty% increased chance of death for mothers over age 35 years compared with mothers twenty to 35 years of historic period. There was a 20% increased risk of expiry for mothers parity above 2 compared with mothers with parity 1 to ii. Babe sex was not significantly associated with mortality.

Relationship of mortality to prenatal care and residence

Table 4 presents crude hazard ratios for mortality (stillbirths and ENNM combined) for demographic and obstetric characteristics for which hazard ratios change over GA. These variables included prenatal care and residence. The hazard ratio for prenatal care decreased with increasing gestation, from 4.76 at 28 weeks to 1.35 at 42 weeks. Effigy 1 depicts the hazard function by GA comparing mothers who did and did non receive prenatal intendance. At 20 weeks, the take chances functions for mothers who did not receive prenatal intendance and those who did are similar. However, because of the low probability of death before calendar week 35 amid those receiving prenatal care, the relatively higher probability among those not receiving prenatal care results in a high relative risk. After week 35, the mortality (stillbirths and ENNM combined) risk in both groups increases proportionally, but for those without prenatal intendance remain at higher gamble and the issue is attenuated at 42 weeks.

Every bit gestation increased, the adventure of mortality for rural residence increased, from 1.04 at 28 weeks to 1.69 at xl weeks and one.84 at 42 weeks of gestation (Table vi). Effigy two depicts the hazard function by gestational historic period comparing rural and urban residence. Upwardly to 35 weeks the hazards are very like, across 35 weeks, the hazards increase proportionally for both groups, only predominantly higher for births from mothers who resided in rural areas.

Distribution of stillbirth and ennm by birth weight and ga categories

Additional file 3 shows the distribution of stillbirth and ENNM by birth weight and GA categories, using the traditional methods (nascency weight-specific mortality, where LBW is analyzed equally preterm LBW, term LBW) [eighteen]. 16 percent of all stillbirths were LBW and 17% were preterm. Virtually three% of neonatal deaths were LBW, and 3% were preterm births.

Word

This newspaper evaluates the distribution of and risk factors for fresh and macerated stillbirth and ENNM among mothers giving birth at the largest infirmary serving Harare, Zimbabwe. The proportion of macerated stillbirths in Harare is higher than in more adult countries, suggesting the presence of insults to the developing fetus and the demand for timely screening and management of chronic conditions and infections. A considerable proportion of the stillbirths were fresh stillbirths, and the frequency of ENNM was loftier, suggesting the need for improved obstetric intendance and availability of emergency services during the delivery menstruum. Lack of prenatal care was associated with increased risk of stillbirth and ENNM whether we analyzed using traditional methods (gestational age-specific mortality) [18] or with GA as a time-varying cistron every bit argued by other experts [21–23]. Similarly, rural residence was associated with increased risk of all stillbirth and ENNM whether we analyzed using traditional methods (gestational historic period-specific mortality) or with GA as a fourth dimension-varying gene. But about importantly, using GA equally a time-varying factor clarifies where and when the hazard of expiry is more than prominent. Fresh or macerated stillbirths and ENNM were more likely to exist delivered breech, but less likely to be delivered past Cesarean section. Cesarean department appears to protect against stillbirth in this population. Fresh stillbirths and ENNM were also associated with delivery by instrumentation.

The incidence of stillbirth, 56 per i,000 full births we report for HMH, is higher than the 26 per 1,000 total births reported by Iliff and colleagues using 1989 data from HMH and 9 Harare municipal clinics [12, 13], and college than the 45 per 1,000 live births at Mpilo Motherhood Hospital [24], another big referral hospital in the second largest city in Zimbabwe. Our findings differ from previous Zimbabwean studies because HMH is the largest referral center in this country, and would be expected to take college bloodshed rates than other hospitals referring their most complicated cases. When nosotros recalculate our rates based on the number of deliveries in the GHMU, 56% of which occur at HMH [9, 25], and assuming no stillbirths occurred in the clinics, we gauge a population-based stillbirth ratio of 33 per 1,000 total births, a figure more comparable to that reported by Iliff and colleagues.

In this population, more than stillbirths were macerated, suggesting being of problems linked to the antenatal flow, which could exist related to congenital malformations [ii, 4]; obstetric hemorrhage; preclampsia [two, four–6, 26]; infections such as syphilis [7, 8, 26, 27]; or existing maternal chronic weather condition such as hypertension, cardiac illness, and diabetes [two, 4–6], none of which our study had the ability to evaluate. Smoking, which is an important factor peculiarly in adult countries, was not a gene for this population [28]. Fresh stillbirths contribute i.2% of all births while ENNM contribute 0.9% of live births at this institution, and both are likely to be related to fetal hypoxia [2, 12, 26], congenital malformations [2, 4, 12], quality of delivery care given to a woman during labor and delivery, and poor access to emergency obstetric care.

Equally would be expected, lack of prenatal care was consistently and strongly associated with stillbirths and ENNM, similar to what other studies have reported [7, 29–31]. Although women in Zimbabwe usually begin prenatal care at 28 weeks of gestation a considerable number will present at infirmary before that time for a problem related to their pregnancy leading to an adverse birth result [[9, 20], and [28]]. Had the adverse nativity effect not occurred prior to 28 weeks of gestation, these women could have had an opportunity to present for prenatal care, later on in their pregnancy as is common for most women in Zimbabwe. The risk of mortality (stillbirths and ENNM combined) increases with increasing GA earlier 35 weeks of gestation, but decreases proportionally thereafter. At that place was a crossover of risk of mortality by prenatal intendance much after in the course of pregnancy, at 42 weeks of gestation, a miracle reported merely at earlier gestational age by other studies [17–xix]. Thus, the risk of mortality was much college for women who did not receive prenatal intendance compared to those who did in the earlier gestational ages, and was moderately higher proportionally afterwards 35 weeks of gestation, and was attenuated at term. In developing countries, prenatal care, fifty-fifty if only attended once, remains an important factor in obstetric care, equally this may exist a critical linkage betwixt the woman with maternity intendance services [ix, 28]. In contrast, research findings in middle-income countries emphasize the importance of the number of prenatal intendance visits and the adequacy and quality of prenatal intendance services. WHO recommends using prenatal care as a strategy for improved obstetric care [32]. Our information advise that prenatal intendance may help ensure that interventions occur in a timely way.

Rural residence was associated with increased chance of all stillbirths equally reported past previous studies [ix, 28]. The hazard of mortality (stillbirths and ENNM combined) increased with increasing GA, similar to other study reports [17–19]. Earlier 35 weeks both rural and urban women take a similar risk of mortality. Although the gamble of bloodshed increases proportionally to term for both groups, rural women take a college take a chance of having their babe dying in utero and within the first 60 minutes of life. Prior to 28 weeks a considerable number of women from rural residence did not receive prenatal intendance, 39 (x%). Afterward 35 weeks rural women who stop up with their infant dying in utero or within the fist hour of life might have been women referred to HMH from rural centers with a status/complication related or leading to the adverse birth outcome. Caution should be taken when interpreting this finding, because we take two artifacts. Intuitively, subsequently 35 weeks, women who did not receive prenatal care are primarily from rural areas and were likely not to receive prenatal care throughout their pregnancy. Secondly, we do not have the counter population (rural women who attended prenatal care) in our denominator.

For maternal age, infant sexual practice and parity in our report, which were not fourth dimension-dependent, using either traditional methods (gestational age-specific bloodshed) [xviii] or the analysis where GA is a fourth dimension varying factor did not change the risk of mortality (stillbirths and ENNM combined). Only, using GA every bit a time-varying factor for the analysis helps us to sympathise further the relationship between some of the maternal factors and mortality, which otherwise would accept been missed. For prenatal intendance and residence, nosotros were able to show how the adventure of mortality was distributed at each stage of GA. Nosotros were able to separate effects at early periods versus later stages in pregnancy, which is useful for wellness-care planners, policy makers, and implementers, in terms of targeting resources. For case, for prenatal intendance, nosotros were able to evidence that the risk of morality is high at early on gestation. The hazard of mortality persists subsequently in pregnancy, but decreasing proportionally throughout pregnancy, being college for women who did not receive prenatal care. This finding suggests a need to focus and emphasize on early booking and the critical role of prenatal intendance in developing countries. With regards to residence, knowledge that infants of rural women who go referred to urban institutions have the highest risk of mortality may advise the need to pay more than attention during the antenatal period and to ameliorate the referral system and emergency care services.

Stillbirths, irrespective of blazon, and ENNM were less probable to exist delivered past Cesarean section. It is believable that factors leading to stillbirth may crusade mothers to take a Cesarean section, but our results evidence that Cesarean section was consistently protective of either stillbirth or ENNM. This finding may propose that obstetricians are careful non to perform Cesarean section unless it is indicated for stillbirths, or ENNM, or that whenever a Cesarean section is performed, it saves life of the infant.

Stillbirths and ENNM were likely to be delivered breech. For fresh stillbirths and ENNM, this finding is consistent with the clinical observation that because of the nature and dynamics of this type of delivery, these infants are likely to dice during or at delivery [9, 28]. Similarly, infants delivered past some course of instrumentation were more than likely to die within the first hour of life. For macerated stillbirths, this finding may be more related to preterm infants and would exist consistent with the clinical observation that the infants turn to optimal birth presentation at nigh 34 weeks of gestation. About 242 (47%) of singleton births delivered as breech were preterm. Intuitively, infants that are at risk because of their small size and level of maturity are likely to face the additional run a risk of breech presentation.

Maternal historic period furnishings were common in stillbirths, consistent with other studies [33–35]. Only the effects of maternal age were more prominent for macerated versus fresh stillbirths, again strengthening the possibility that maternal chronic disease conditions in after years of life may play a significant role. Additionally, older mothers were at greater risk for stillbirth, just lower run a risk for neonatal death. The rough risk for young maternal historic period, which was similar to crude risk for primiparity for early neonatal births, was attenuated after decision-making for residence, parity, prenatal care and infant sex.

This study has some limitations. As the written report was a retrospective analysis of information obtained from commitment logs, nosotros were unable to examine take chances factors such equally chronic and comorbid weather condition, congenital malformations, obstetric complications, and infections. Although we could not identify the stillbirth status of nearly one-3rd of stillbirths, risk estimates for un-typed stillbirths were similar to those for fresh and macerated stillbirths. Arguably, focusing solely on births within HMH raises concerns about selection bias. Still, when we adjust our estimated rate to the base population, our rates are comparable to those previously reported [ix, 12–14]. Data on gestational age was limited to the clinicians' estimate and LMP information reported as weeks recorded in the obstetric log, thus some fault in the classification of preterm births is likely [36, 37]. Regardless, this pilot study is i of the few to characterize socio-demographic and reproductive risk factors for stillbirth and ENNM in this population [ix]. Our ability to distinguish risks for diminished and fresh stillbirth has direct implications on quality of care given to pregnant women in Zimbabwe.

We were not able to show risk by combined nascency weight and GA categories, which would otherwise exist important for clinicians [17–19], [38, 39], for to do and so is impossible as birth weight varies with GA [17]. Therefore, information technology would be not feasible to put both variables in the same model. Our use of GA as a time-varying variable in this analysis helps anticipate and define where risk occurs in the GA continuum.

Conclusion

Our findings suggest that before perinatal intendance could aid in early identification and treatment of adventure factors for macerated stillbirth, especially those that are preventable. Zimbabwean women enter prenatal care late in pregnancy, booking at 28 weeks or later [9, 29–31]. Effective programs to decrease the frequency of stillbirth may require that entry to prenatal care brainstorm by at to the lowest degree 20 weeks of gestation. Increased focus on health education programs, which emphasize the benefits of prenatal care and early on booking in the first trimester or past 20 weeks of pregnancy, is needed. Earlier booking for prenatal intendance creates a critical linkage between the adult female and the wellness intendance organisation, which may increase the probability that the woman will seek emergency intendance in a timely manner. In Zimbabwe, more than focus is needed on the timing and adequacy of care in maternal and child health programs, and more than enquiry is needed on barriers to early entry to prenatal intendance.

There is likewise a need to improve quality of care and access to emergency intendance during labour and commitment to reduce the number of fresh stillbirths and ENNM. Cesarean section should be made readily available as it improves birth outcomes. Further studies should incorporate information from women served by the entire GHMU, to ameliorate babe bloodshed and morbidity in Zimbabwe.

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Acknowledgements

Funding for the research was from the University of Michigan, University of Zimbabwe and W.K. Kellogg Foundation. We thank the Harare Motherhood Hospital staff, and the Department of Community Medicine at the University of Zimbabwe for providing space and support during data collection. This project was partially supported past grant #D43-TW01276 from the Fogarty International Center and the National Institute of Child Health and Homo Development. We admit the piece of work done past enquiry assistants, Ms J Musengi, Ms D Matsika, Ms Thou Sithole, Mrs. F Shonhiwa and Ms T. Feresu, and S Nardie for editing this manuscript.

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Affiliations

  1. Section of Preventive and Societal Medicine, University of Nebraska Medical Centre 984350 Nebraska Medical Center, Omaha, NE, 68198-4350, United states of america

    Shingairai A Feresu

  2. Department of Epidemiology, Schoolhouse of Public Wellness, University of Michigan, 109 Observatory Rd, Ann Arbor, MI, 48105, USA

    Siobán D Harlow

  3. Department of Community Medicine, University of Zimbabwe, Box A178, Avondale, Harare, Zimbabwe

    Shingairai A Feresu

  4. Centre for Statistical Consultation and Enquiry, Academy of Michigan, 3554 Rackham Building, 915 E Washington St, Ann Arbor, MI, 48109-1070, USA

    Kathy Welch & Brenda W Gillespie

Corresponding author

Correspondence to Shingairai A Feresu.

Additional data

Competing interests

The author(s) declare that they have no competing interests.

Authors' contributions

SF conceived of the study, participated in design of the study, carried out the data drove and all analyses and drafted the manuscript.

SD participated in conceiving and designing the study, directed the analysis of the study and reviewed the manuscript.

KW participated in the assay of the study and formulated the probability functions used to construct the figures.

BG participated in the analysis of the study, reviewed models to calculate the relative adventure, and reviewed the manuscript. All authors read and approved the concluding manuscript.

Electronic supplementary material

12884_2004_61_MOESM1_ESM.doc

Additional File ane: Demographic and Obstetric Characteristics and Crude Risks of Stillbirth for 16,023 Singleton Deliveries at Harare Maternity Hospital; October 1997 to September 1998 (DOC 43 KB)

12884_2004_61_MOESM2_ESM.doc

Additional File 2: Adjusteda Demographic and Obstetric Characteristics and Risks of Stillbirth for xvi,023 Singleton Deliveries at Harare Maternity Hospital; October 1997 to September 1998 (DOC 42 KB)

12884_2004_61_MOESM3_ESM.dr.

Boosted File three: Frequency of Stillbirth by Nativity Weight and Gestational Age Categories for 17,072 Deliveries at Harare Motherhood Hospital; Oct 1997 to September 1998 (DOC 62 KB)

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Feresu, Due south.A., Harlow, South.D., Welch, K. et al. Incidence of stillbirth and perinatal mortality and their associated factors amid women delivering at Harare Maternity Infirmary, Republic of zimbabwe: a cantankerous-sectional retrospective assay. BMC Pregnancy Childbirth 5, 9 (2005). https://doi.org/ten.1186/1471-2393-5-9

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Keywords

  • Prenatal Intendance
  • Perinatal Mortality
  • Obstetric Care
  • Adverse Nascency Event
  • Normal Vaginal Delivery

A Stillborn Baby Was Delivered in Teh Birhting Suite a Few Hours Ago

Source: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-5-9