Rates and causes of stillbirth in a demographic surveillance site in Karachi, Pakistan

Abstract

ObjectiveTo determine burden, timing and causes of stillbirths in aprospective cohort of pregnant from a low income community settingin peri urban KarachiIntroductionStillbirth remained a neglected issue absent from mention inMillennium Development Goals. An estimated 2.6 million babies arestillborn every year withhighest rate in Pakistan, 43.1 stillbirths/1000births. There is lack of good quality prospective population based datain Pakistanregarding burden, timing and causes of stillbirthsMethodsFrom Jan – Dec 2012, Community Helath Workers (CHWs)identified pregnant women through 3 monthly household visits.Pregnant women were then followed up till end of their pregnancy.In case of a stillbirth, a detailed verbal autopsy (VA) interview wasundertaken 2 weeks after the outcome by a research assistant. VAforms were then reviewed by 2 independent Physicians who assigneda cause for stillbirth. In case of disagreement, VA form was reviewedby a third physician. A consensus between two physicians wasrequired for a definitive cause.ResultsThere were a total of 273 stillbirths (3.04%) reported. Stillbirthrate was 30.7/1000 births. Distribution of antepartum and intrapartumstillbirths was 83% and 17%. Three most common causes of stillbirthsincluded pregnancy induced Hypertension(37%), antepartumhemorrhage (10%) and obstructed labor(6%) (fig. 1).ConclusionsWe have reported a high burden of stillbirths that take placeduring the intrapartum period. This reemphasizes need for goodquality antenatal care in these settings. Appropriate measure needsto be taken targeting most common causes of stillbirths, focusing onimproved antepartum health care facilities