Reducing stillbirths in low‐income countries

• DOI: 10.1111/aogs.12817
• Publication Date: 2015-11-18T05:04:39Z
• Authors: Robert L. Goldenberg; Sarah Saleem; Omrana Pasha; Margo S. Harrison; Elizabeth M. Mcclure
• Keywords: Family Medicine; Resuscitation; Fetal monitoring; Midwifery; 03 medical and health sciences; 0302 clinical medicine; Pregnancy; Risk Factors; Humans; Fetal Death; Poverty; Perinatal mortality; Fetal growth restriction; Prenatal Care; High-income countries; Stillbirth; Delivery, Obstetric; Low-income countries; 3. Good health; Pregnancy Complications; Fetal Diseases; Maternal Mortality; Female; Public Health; Cesarean section

AbstractWorldwide, 98% of stillbirths occur in low‐income countries (LIC), where stillbirth rates are ten‐fold higher than in high‐income countries (HIC). Although most HIC stillbirths occur prenatally, in LIC most stillbirths occur at term and during labor/delivery. Conditions causing stillbirths include those of maternal origin (obstructed labor, trauma, antepartum hemorrhage, preeclampsia/eclampsia, infection, diabetes, other maternal diseases), and fetal origin (fetal growth restriction, fetal distress, cord prolapse, multiples, malpresentations, congenital anomalies). In LIC, aside from infectious origins, most stillbirths are caused by fetal asphyxia. Stillbirth prevention requires recognition of maternal conditions, and care in a facility where fetal monitoring and expeditious delivery are possible, usually by cesarean section (CS). Of major causes, only syphilis and malaria can be managed prenatally. Targeting single conditions or interventions is unlikely to substantially reduce stillbirth. To reduce stillbirth rates, LIC must implement effective modern antepartum and intrapartum care, including fetal monitoring and CS.