Study of the factors associated with stillbirth in pregnant women admitted in Imam Reza Teaching Hospital in Kermanshah (2011-2014)

Authors

1 Associate Professor, Department of Obstetrics and Gynecology, Delivery Research Center, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.

2 M.Sc. in Statistics, Delivery Research Center, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.

3 Professional Public Doctorate, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.

Abstract

Introduction: Stillbirth is a devastating pregnancy outcome and is often defined as fetal death after 20 weeks of gestation. Annually, 2.6 million stillbirths occur worldwide, 98% in developing countries. It is crucial that we understand the causes and contributing factors. This study was performed with aim to evaluate the factors associated with stillbirth in pregnant women admitted in Imam Reza Teaching Hospital in Kermanshah, Iran (2011-2014).
Methods: This descriptive study was performed on 423 cases of stillbirth in Imam Reza Teaching Hospital in Kermanshah during 2011-2014. Demographic data and target variables such as fetal, maternal, placental, amniotic fluid, uterine, trauma, and causes were recorded in data collection forms. Data were analyzed by SPSS software (version 16).
Results: Among 15376 births, 423 cases of stillbirth (2.75%) were registered. The causes of stillbirth were as follows: 117 cases (27.66%) fetal problems with the most frequency in gestational age of less than 27 weeks, 21 (4.96%) umbilical cord problems with the most frequency at 27-34 weeks of gestation, 68 (16.07%) placental problems with the most frequency  at 27-34 weeks of gestation, 147 (34.75%) amniotic fluid problems with the most frequency in less than 27 weeks of gestation, 42 (9.93%) uterus problems with the most frequency in more than 34 weeks of gestation, 149 (35.22%) maternal problems with the most frequency in less than 27 weeks of gestation, 42 (9.93%) due to trauma and often in less than 27 weeks of gestation, and 73 (17.26%) were classified as unknown.
Conclusion: The maternal, fetal and amniotic fluid problems were the most cause of stillbirth and it is required to be paid more attention in prenatal care.

Keywords


  1. Loise J. Multiple cord entangles mentor and intra partum complication. Am J Obstet Gynecol 1995; 173:1228-31.
  2. Weeks JWAsrat TMorgan MANageotte MThomas SJFreeman RK. Antepartum, surveillance for a history of stillbirth: when to begin? Am J Obstet Gynecol 1995; 172(2 Pt 1):486-92.
  3. Kapoor RKSrivastava AKMisra PKSharma BThakur SSrivastava KI, et al. Perinatal mortality in urban slums in Lucknow. Indian Pediatr 1996; 33(1):19-23.
  4. Makhseed MM, el-Tomi N, Moussa MA, Musini VM. Post-war changes in the outcome of pregnancy in maternity hospital, Kuwait. Med Confl Surviv 1996; 12(2):154-67.
  5. Margan MD, Raymond EG, Cnattingius S, Kiely JL. Stillbirth evaluation what are needed? J Obstet Gynecol 1998; 178(6):1121-8.
  6. Shawky SMilaat W. Early teenage marriage and subsequent pregnancy out come. East Mediterr Health J 2000; 6(1):46-54.
  7. Al-Abdul Kareem AN, Balla SG. Con sammgui neaus marriage in an urban of Saudi Arabia. Rates and adverse health effect on the off spring. J Community Health 1992; 10:75-83.
  8. Out HJ, Bruinse HW, Christiaens GC, Van Vliet M, Meilof JF, De Groot PG, et al. Prevalence of antiphospholipid antibodies in patients with fetal loss. Ann Rheumatic Dis 1991; 50(8):553-7.
  9. Cunningham F, Leveno K, Bloom S, Spong CY, Dashe J. Williams Obstetrics. New York: McGraw-Hill; 2001. P. 1121.
  10. Machin GA, Ackerman J, Gilbert-Barness E. Abnormal umbilical cord coiling is associated with adverse perinatal outcomes. Pediatr Dev Pathol 2000; 3(5):462-71.
  11. Kliegman RM, Behrman RE, Jenson HB. Nelson textbook of pediatrics. 17th ed. Philadelphia: Saunders; 2003. P. 32-33.
  12. Tootoonchi P. A study of neonatal body weight and length at birth in hospitals of Tehran University of Medical Sciences. Iran J Pediatr 2005; 15(3):243-8.
  13. Mobashery E, Khoddam H, Shariati L. Relationship between fetal gender and some perinatal complications. J Babol Univ Med Sci 2008; 9(6):39-43. (Persian).
  14. Apgar V. A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg 1953; 32(4):260–7.
  15. Stoll BJ, Kliegman RM. The newborn infant. In: Behrman RE, Kliegman RM, Jenson HB, editors. Nelson textbook of pediatrics. 18th ed. Philadelphia: Saunders; 2008. P. 527-9.
  16. Lieberman E, Lang JM, Cohen AP, Frigoletto FD, Acker D, Rao R. The association of fetal sex with the rate of cesarean section. Am J Obstet Gynecol 1997; 176(3):667-71.
  17. Kavemanesh Z, Amirsalari S, Shafshar P, Torkaman M, Dastamooz A. Prevalence of Term LGA Newborns and Their Complications. Trauma Mont 2007; 11(4):379-84. (Persian).
  18. Gharibzadeh S, Javaheri H, Asgari Z, Parviz M. Evaluating of the risk factors of macrosomia in labors performed in Baharloo Hospital during two years (2001-2002). Ann Milit Health Sci Res 2005; 3(12):709-13. (Persian).
  19. Hadar E, Melamed N, Sharon-Weiner M, Hazan S, Rabinerson D, Glezerman M, et al. The association between stillbirth and fetal gender. J Matern Fetal Neonatal Med 2012; 25(2):158-61.
  20. Melamed N, Yogev Y, Glezerman M. Fetal gender and pregnancy outcome. J Matern Fetal Neonatal Med 2010; 23(4):338-44.
  21. Bekedam DJ, Engelsbel S, Mol BW, Buitendijk SE, van der Pal-de Bruin KM. Male predominance in fetal distress during labor. Am J Obstet Gynecol 2002; 187(6):1605-7.
  22. Sheiner E. The relationship between fetal gender and pregnancy outcome. Arch Gynecol Obstet 2007; 275(5):317-9.
  23. Stock SJBricker LNorman JEWest HM. Immediate versus deferred delivery of the preterm baby with suspected fetal compromise for improving outcomes. Cochrane Database Syst Rev 2016; 7:CD0089688.
  24. Maternal CE. Confidential Enquiry. Child Health (CEMACH) Perinatal mortality 2006. England: Wales and Northern Ireland; 2008.
  25. Gardosi J. Clinical implications of ‘unexplained’ stillbirths. Maternal and child health research consortium. 8th Annual Report. Confidential Enquiry into Stillbirths and Deaths in Infancy, London; 2001. P. 40-7.
  26. Gardosi J, Kady SM, McGeown P, Francis A, Tonks A. Classification of stillbirth by relevant condition at death (ReCoDe): population based cohort study. BMJ 2005; 331(7525):1113-7.
  27. Vergani P, Cozzolino S, Pozzi E, Cuttin MS, Greco M, Ornaghi S, et al. Identifying the causes of stillbirth: a comparison of four classification systems. Am J Obstet Gynecol 2008; 199(3):319.e1-4.
  28. Korteweg FJ, Gordijn SJ, Timmer A, Holm JP, Ravise JM, Erwich JJ. A placental cause of intra-uterine fetal death depends on the perinatal mortality classification system used. Placenta 2008; 29(1):71-80.
  29. Stillbirth Collaborative Research Network Writing Group. Causes of death among stillbirths. JAMA 2011; 306(22):2459-68.
  30. McClure EM, Nalubamba-Phiri M, Goldenberg RL. Stillbirth in developing countries. Int J Gynaecol Obstet 2006; 94(2):82–90.
  31. Di Mario S, Say L, Lincetto O. Risk factors for stillbirth in developing countries: a systematic review of the literature. Sex Transm Dis 2007; 34(7 Suppl):S11–21.
  32. McClure EM, Saleem S, Pasha O, Goldenberg RL. Stillbirth in developing countries: a review of causes, risk factors and prevention strategies. J Matern Fetal Neonatal Med 2009; 22(3):183–90.
  33. Aminu M, Unkels R, Mdegela M, Utz B, Adaji S, van den Broek N. Causes of and factors associated with stillbirth in low- and middle-income countries: a systematic literature review. BJOG 2014; 121(Suppl 4):141-53.
  34. Flenady V, Middleton P, Smith GC, Duke W, Erwich JJ, Khong TY, et al. Stillbirths: the way forward in high-income countries. Lancet 2011; 377(9778):1703–17.
  35. McClure EM, Pasha O, Goudar SS, Chomba E, Garces A, Tshefu A, et al. Epidemiology of stillbirth in low-middle income countries: a Global Network Study. Acta Obstet Gynecol Scand 2011; 90(12):1379–85.
  36. Hu IJ, Chen PC, Jeng SF, Hsieh CJ, Liao HF, Su YN, et al. A nationwide survey of risk factors for stillbirth in Taiwan, 2001– 2004. Pediatr Neonatol 2012; 53(2):105–11.
  37. Shrestha SR, Yadav BK. Risk factors associated with still births. J Nepal Med Assoc 2010; 49(177):84–7.
  38. Gordon A, Raynes-Greenow C, McGeechan K, Morris J, Jeffery H. Risk factors for antepartum stillbirth and the influence of maternal age in New South Wales Australia: a population based study. BMC Pregnancy Childbirth 2013; 13:12.
  39. Ananth CV, Berkowitz GS, Savitz DA, Lapinski RH. Placental abruption and adverse perinatal outcomes. JAMA 1999; 282(17):1646–51.
  40. Ananth CV, Wilcox AJ. Placental abruption and perinatal mortality in the United States. Am J Epidemiol 2001; 153(4): 332–7.
  41. Gibbs JM, Weindling AM. Neonatal intracranial lesions following placental abruption. Eur J Pediatr 1994; 153(3):195–7.

Lin MG. Umbilical cord prolapse. Obstet Gynecol Surv 2006; 61(4):269-77.