DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20173482

Classification of stillbirth by relative condition at death (Re Co De) at various trimesters of pregnancy: a rural tertiary teaching hospital based study

V. Meera Rajagopal, Kalpana Betha, Satya Priya G.

Abstract


Background: New global health figures show India to have the highest rates of stillbirth in the world. While maternal and under 5 child mortality rates have halved, stillbirth remains a neglected global endemic. To reduce stillbirths, the prevalence, risk factors and causes must be known. The aim of the present study is to know the prevalence and classify stillbirths by ReCoDe classification system at different trimesters of pregnancy.

Methods: This was a retrospective study done between January 2013 to March 2017 at MediCiti Institute of Medical Sciences, a rural tertiary teaching hospital, Telangana, India. A total of 112 cases of stillbirths were included. Data was obtained on demographic variables, risk factors such as preeclampsia, etc. Data regarding mode of delivery, fetal asphyxia, were recorded.

Results: Stillbirth rate was 12.1/1000 births. Fifty four percent of the women were unbooked. Preterm stillbirths were a majority (67%). The intra-partum still birth rate was low (15.1%) contrary to what is seen in low middle-income countries. Gestational hypertension/Pre-eclampsia, abruptio placenta, fetal growth restriction and oligohydramnios were the leading causes of stillbirths.

Conclusions: Pregnant women from rural background with low socio-economic status are prone for stillbirths. As stillbirths were more among unbooked cases, the study highlights the importance of counselling, creating awareness in the rural areas regarding the importance of regular antenatal checkups. Identifying risk factors like pre-eclampsia, anemia etc., at early weeks will enable us to initiate appropriate strategies to improve pregnancy outcome.


Keywords


Abruptio placenta, Fetal growth restriction, Oligohydramnios, Pre-eclampsia, Preterm birth, Stillbirth

Full Text:

PDF

References


An executive summary for the Lancet’s series. Stillbirths. Lancet. 2011. Available at www.thelancet.com/pb/assets/raw/Lancet/stories/series/stillbirths/stillbirths.pdf

Under 5 child mortality rate falls significantly by 4 points during 2014 Press Information Bureau. Government of India. Ministry of Health and Family Welfare. Available at pib.nic.in/newsite/PrintRelease.aspx?relid=150940

Liu LC, Wang YC, Yu MH, Su HY. Major risk factors for stillbirth in different trimesters of pregnancy-A systematic review. Taiwanese J Obstet Gynecol. 2014;53(2):141-5.

Little RE, Weinberg CR. Risk factors for antepartum and intrapartum stillbirth. Am J Epidemiol 1993;137:1177-89.

Getahun D, Ananth CV, Kinzler WL. Risk factors for antepartum and intrapartum stillbirth: a population-based study. Am J Obstet Gynecol. 2007;196:499-507.

Wigglesworth JS. Monitoring perinatal mortality-a pathophysiological approach. Lancet. 1980;27:684-7.

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.

Cunnigham FG. Williams Obstetrics. 24th Ed. Mc Graw Hill Education;2014:729.

Yakoob MY, Lawn JE, Darmstadt GL, Bhutta ZA. Stillbirths: epidemiology, evidence, and priorities for action. In Seminars in perinatology, WB Saunders. 2010;34:6387-394.

Butler NR, Bound JP, Spector WG. Classification and causes of perinatal mortality. British Medical J. 1996;2(5003):1191-6.

Prasanna N, Mahadevappa K, Antaratani RC, Lokare L. Cause of death and associated conditions of stillbirths. International Journal of Reproduction, Contraception, Obstetr Gynecol. 2017;4(6):1970-4.

Balu D, Nayak A, Swarup A. A study of intrauterine fetal death in a tertiary care hospital. Int J Reprod Contracept Obstet Gynecol. 2015;4:2028-31.

Sharma PP, Salihu HM, Oyelese Y, Ananth CV, Kirby RS. Is race a determinant of stillbirth recurrence? Obstet Gynecol. 2006;107:391-7.

Lawn J, Shibuya K, Stein C. No cry at birth: global estimates of intrapartum stillbirths and intrapartum-related neonatal deaths. Bull World Health Organ 2005;83(6):409-17.

Ifnan F, Jameel MB. Maternal morbidity and mortality associated with delivery after intrauterine fetal death. J Coll Physicians Surg Pak. 2006;16(10):648-51.

Parihar BC, Goyal A. A study to evaluate the causes of stillbirths according to the ReCoDe classification. Int J Reprod Contracept Obstet Gynecol. 2017;6:1288-94.