E M McClure1, A Garces2, S Saleem3, J L Moore1, C L Bose4, F Esamai5, S S Goudar6, E Chomba7, M Mwenechanya7, O Pasha3, A Tshefu8, A Patel9, S M Dhaded6, C Tenge5, I Marete5, M Bauserman4, S Sunder3, B S Kodkany6, W A Carlo10, R J Derman11, P L Hibberd12, E A Liechty13, K M Hambidge14, N F Krebs14, M Koso-Thomas15, M Miodovnik15, D D Wallace1, R L Goldenberg16. 1. RTI International, Durham, NC, USA. 2. Materno Infantil Unidad de Planificación, INCAP, Guatemala City, Guatemala. 3. Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan. 4. Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. 5. Department of Paediatrics, Moi University College of Health and Sciences, Eldoret, Kenya. 6. KLE University's JN Medical College, Belagavi, India. 7. Department of Paediatrics, University of Zambia, Lusaka, Zambia. 8. Kinshasa School of Public Health, Kinshasa, DRC. 9. Lata Medical Research Foundation, Nagpur, India. 10. Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA. 11. Department of Obstetrics, Thomas Jefferson University, Philadelphia, PA, USA. 12. Boston University, Boston, MA, USA. 13. Department of Pediatrics, Indiana University, Indianapolis, IN, USA. 14. Department of Pediatrics, University of Colorado, Denver, CO, USA. 15. Perinatology and Pregnancy Branch, NICHD, Bethesda, MD, USA. 16. Columbia University Medical Center, New York, NY, USA.
Abstract
OBJECTIVE: We sought to classify causes of stillbirth for six low-middle-income countries using a prospectively defined algorithm. DESIGN: Prospective, observational study. SETTING: Communities in India, Pakistan, Guatemala, Democratic Republic of Congo, Zambia and Kenya. POPULATION: Pregnant women residing in defined study regions. METHODS: Basic data regarding conditions present during pregnancy and delivery were collected. Using these data, a computer-based hierarchal algorithm assigned cause of stillbirth. Causes included birth trauma, congenital anomaly, infection, asphyxia, and preterm birth, based on existing cause of death classifications and included contributing maternal conditions. MAIN OUTCOME MEASURES: Primary cause of stillbirth. RESULTS: Of 109 911 women who were enrolled and delivered (99% of those screened in pregnancy), 2847 had a stillbirth (a rate of 27.2 per 1000 births). Asphyxia was the cause of 46.6% of the stillbirths, followed by infection (20.8%), congenital anomalies (8.4%) and prematurity (6.6%). Among those caused by asphyxia, 38% had prolonged or obstructed labour, 19% antepartum haemorrhage and 18% pre-eclampsia/eclampsia. About two-thirds (67.4%) of the stillbirths did not have signs of maceration. CONCLUSIONS: Our algorithm determined cause of stillbirth from basic data obtained from lay-health providers. The major cause of stillbirth was fetal asphyxia associated with prolonged or obstructed labour, pre-eclampsia and antepartum haemorrhage. In the African sites, infection also was an important contributor to stillbirth. Using this algorithm, we documented cause of stillbirth and its trends to inform public health programs, using consistency, transparency, and comparability across time or regions with minimal burden on the healthcare system. TWEETABLE ABSTRACT: Major causes of stillbirth are asphyxia, pre-eclampsia and haemorrhage. Infections are important in Africa.
OBJECTIVE: We sought to classify causes of stillbirth for six low-middle-income countries using a prospectively defined algorithm. DESIGN: Prospective, observational study. SETTING: Communities in India, Pakistan, Guatemala, Democratic Republic of Congo, Zambia and Kenya. POPULATION: Pregnant women residing in defined study regions. METHODS: Basic data regarding conditions present during pregnancy and delivery were collected. Using these data, a computer-based hierarchal algorithm assigned cause of stillbirth. Causes included birth trauma, congenital anomaly, infection, asphyxia, and preterm birth, based on existing cause of death classifications and included contributing maternal conditions. MAIN OUTCOME MEASURES: Primary cause of stillbirth. RESULTS: Of 109 911 women who were enrolled and delivered (99% of those screened in pregnancy), 2847 had a stillbirth (a rate of 27.2 per 1000 births). Asphyxia was the cause of 46.6% of the stillbirths, followed by infection (20.8%), congenital anomalies (8.4%) and prematurity (6.6%). Among those caused by asphyxia, 38% had prolonged or obstructed labour, 19% antepartum haemorrhage and 18% pre-eclampsia/eclampsia. About two-thirds (67.4%) of the stillbirths did not have signs of maceration. CONCLUSIONS: Our algorithm determined cause of stillbirth from basic data obtained from lay-health providers. The major cause of stillbirth was fetal asphyxia associated with prolonged or obstructed labour, pre-eclampsia and antepartum haemorrhage. In the African sites, infection also was an important contributor to stillbirth. Using this algorithm, we documented cause of stillbirth and its trends to inform public health programs, using consistency, transparency, and comparability across time or regions with minimal burden on the healthcare system. TWEETABLE ABSTRACT: Major causes of stillbirth are asphyxia, pre-eclampsia and haemorrhage. Infections are important in Africa.
Authors: Joy E Lawn; Michael G Gravett; Toni M Nunes; Craig E Rubens; Cynthia Stanton Journal: BMC Pregnancy Childbirth Date: 2010-02-23 Impact factor: 3.007
Authors: Elizabeth M McClure; Sarah Saleem; Shivaprasad S Goudar; Janet L Moore; Ana Garces; Fabian Esamai; Archana Patel; Elwyn Chomba; Fernando Althabe; Omrana Pasha; Bhalachandra S Kodkany; Carl L Bose; Mabel Berreuta; Edward A Liechty; K Hambidge; Nancy F Krebs; Richard J Derman; Patricia L Hibberd; Pierre Buekens; Albert Manasyan; Waldemar A Carlo; Dennis D Wallace; Marion Koso-Thomas; Robert L Goldenberg Journal: Reprod Health Date: 2015-06-08 Impact factor: 3.223
Authors: J Frederik Frøen; Halit Pinar; Vicki Flenady; Safiah Bahrin; Adrian Charles; Lawrence Chauke; Katie Day; Charles W Duke; Fabio Facchinetti; Ruth C Fretts; Glenn Gardener; Kristen Gilshenan; Sanne J Gordijn; Adrienne Gordon; Grace Guyon; Catherine Harrison; Rachel Koshy; Robert C Pattinson; Karin Petersson; Laurie Russell; Eli Saastad; Gordon C S Smith; Rozbeh Torabi Journal: BMC Pregnancy Childbirth Date: 2009-06-10 Impact factor: 3.007
Authors: J Frederik Frøen; Sanne J Gordijn; Hany Abdel-Aleem; Per Bergsjø; Ana Betran; Charles W Duke; Vincent Fauveau; Vicki Flenady; Sven Gudmund Hinderaker; G Justus Hofmeyr; Abdul Hakeem Jokhio; Joy Lawn; Pisake Lumbiganon; Mario Merialdi; Robert Pattinson; Anuraj Shankar Journal: BMC Pregnancy Childbirth Date: 2009-12-17 Impact factor: 3.007
Authors: Robert L Goldenberg; Lulu Muhe; Sarah Saleem; Sangappa Dhaded; Shivaprasad S Goudar; Janna Patterson; Assaye Nigussie; Elizabeth M McClure Journal: J Matern Fetal Neonatal Med Date: 2018-08-23
Authors: Ana L Garces; Elizabeth M McClure; Wilton Pérez; K Michael Hambidge; Nancy F Krebs; Lester Figueroa; Carl L Bose; Waldemar A Carlo; Constance Tenge; Fabian Esamai; Shivaprasad S Goudar; Sarah Saleem; Archana B Patel; Melody Chiwila; Elwyn Chomba; Antoinette Tshefu; Richard J Derman; Patricia L Hibberd; Sherri Bucher; Edward A Liechty; Melissa Bauserman; Janet L Moore; Marion Koso-Thomas; Menachem Miodovnik; Robert L Goldenberg Journal: Acta Paediatr Date: 2017-04-05 Impact factor: 2.299
Authors: Jacquelyn K Patterson; Aleha Aziz; Melissa S Bauserman; Elizabeth M McClure; Robert L Goldenberg; Carl L Bose Journal: Semin Perinatol Date: 2019-03-16 Impact factor: 3.300
Authors: Elizabeth M McClure; Sarah Saleem; Shivaprasad S Goudar; Shiyam Sunder Tikmani; Sangappa M Dhaded; Kay Hwang; Gowdar Guruprasad; Dhananjaya Shobha; B Sarvamangala; S Yogeshkumar; Manjunath S Somannavar; Sana Roujani; Sayyeda Reza; Jamal Raza; Haleema Yasmin; Anna Aceituno; Lindsay Parlberg; Jean Kim; Carla M Bann; Robert M Silver; Robert L Goldenberg Journal: Lancet Glob Health Date: 2022-07 Impact factor: 38.927
Authors: Aleena M Wojcieszek; Emily Shepherd; Philippa Middleton; Zohra S Lassi; Trish Wilson; Margaret M Murphy; Alexander Ep Heazell; David A Ellwood; Robert M Silver; Vicki Flenady Journal: Cochrane Database Syst Rev Date: 2018-12-17
Authors: Aleena M Wojcieszek; Emily Shepherd; Philippa Middleton; Glenn Gardener; David A Ellwood; Elizabeth M McClure; Katherine J Gold; Teck Yee Khong; Robert M Silver; Jan Jaap Hm Erwich; Vicki Flenady Journal: Cochrane Database Syst Rev Date: 2018-04-30