Antenatal Care: Is It Really a Modifiable Factor for Stillbirth Prevention?

Abstract

Stillbirth is a major cause of perinatal death in India. Deciphering the cause of stillbirth will help in formulating prevention strategies to bring down the stillbirth rate. Our objective is to explore the antepartum and intrapartum causes and risk factors of stillbirths. Materials and methods: This was a prospective observational study done under WHO-SEARO project. This study included all stillbirths occurring in Safdarjung Hospital from August 2015 to December 2018. Verbal autopsies were done, and thorough antenatal records were documented and analyzed. Results: Out of 1,09,578 deliveries, 2,689 were stillbirths (2.4%). Among these, 1,583 (58.9%) were unsupervised and unbooked pregnancies, whereas 1,106 (41.1%) pregnancies were supervised and booked. Significantly lower percentage of patients in unbooked pregnancies had iron–folic acid intake; significantly higher percentage of mothers had anemia, hypertension, diabetes, and antepartum hemorrhage compared with booked pregnancies. Among antepartum causes, hypertension (23.4%), abruption (18.5%), and infection (3.4%) were the leading causes for stillbirths. Intrapartum causes constituted 39% of total stillbirths; a higher percentage was in the unbooked pregnancies. Approximately, 89% of patients with stillbirth had delayed seeking of healthcare facility. Conclusion: The most common cause of stillbirth was hypertensive disorders of pregnancy followed by abruptio placentae in this cohort. Various maternal-related factors are significantly higher in unbooked pregnancies. Reducing these factors might reduce the prevalence of stillbirth.