Evaluation of Clinicosocial Factors Associated with Antepartum and Intrapartum Stillbirths at Kathmandu Medical College Teaching Hospital

Abstract

ABSTRACT Objective To assess the prevalence and biosocial and obstetric risk factors for antepartum and intrapartum stillbirths at a tertiary hospital in Kathmandu, Nepal. Study Design A prospective hospital based study during a one year period from 1st November 2007 to 30th October 2008. Results:18 stillbirths occurred out of the 790 deliveries that took place during the study period giving an overall stillbirth rate of 22.7 per 1000 births of which 22.2% occurred in the intrapartum period. The majority(89.9%) of patients were in the low risk age group, viz. 20-35 years. 62% were overweight, 16% obese and 22% had normal BMI. More than half (56%) were either illiterate or had only primary education and 33.3% were moderate smokers. 66.6% were nullipara and there were no grand multipara in the series. 72% had regular prenatal visits but only 33% presented with a history of loss of fetal movements. 50% delivered preterm and 22.2% were post-term while 66.6% had low birth weights. Hypertensive disorders of pregnancy and IUGR were the leading causes of stillbirths, others being prolonged PROM, cholestasis of pregnancy and congenital anomalies. 11.1% were unexplained and there was one case each of gestational diabetes, antepartum hemorrhage and vaginal breech delivery. Conclusion Avoidable intrapartum stillbirths continue to be quite high where timely and appropriate intrapartum intervention must be taken to prevent fetal loss. The identified antenatal risk factors should serve as potential targets for antenatal intervention and due importance of maternal fetal movement scoring must be stressed in the at risk patient.