A study of fresh stillbirths weighing 2500 g or more at three academic hopspitals

Date
2015-04-17
Authors
Bothma, Marlene
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Abstract
Background and Objectives Globally an estimated 1.19 million stillbirths occur during labour, with almost all of these deaths occurring in low - and middle-income countries. In South Africa labour related complications are one of the top primary obstetric causes of perinatal deaths. The objectives of this study were: 1) To determine the incidence of fresh stillbirths weighing 2500 g or more at three academic hospitals; 2) To identify the direct cause, along with associated risk factors for these deaths; and 3) To identify avoidable factors relating to poor or substandard intrapartum care with specific emphasis on intrapartum fetal heart rate monitoring. Methods This was a prospective, cross sectional, descriptive study conducted at three obstetric units in Johannesburg, Gauteng. The hospitals were Chris Hani Baragwanath Academic Hopsital, Charlotte Maxeke Johannesburg Academic Hospital and Rahima Moosa Mother and Child Hospital. Three six-month periods were sampled at each of the three hospitals consecutively, for a total eighteen month data collection period from May 2011 until October 2012. The study population was all fresh stillbirths weighing 2500 g or more born at these institutions. 10 Results A total of 52 women with fresh stillbirths eligible for inclusion were identified. Twenty-three (44.2%) were nulliparous. Sixteen women (30.8%) were HIV infected. Twelve women had a previous caesarean section. The mean gestational age was 38.4±2.3 weeks with a mean birth weight of 3052±460 g. Six women had prolonged active phase of labour, with the cervix dilating at a rate of less than 1cm/hour. None of the patients had augmentation of labour and meconium stained liquor was found in 23 (44.2%) of the cases. There were 30 women (57.7%) with identifiable catastrophic events relating to the intrapartum stillbirth: 16 had abruptio placentae, 7 had cord prolapse, 4 had a ruptured uterus and there were 3 cases of entrapment of the aftercoming head of breech. Twenty-two women (42.3%) had appropriate fetal monitoring and 15 (28.8%) had inadequate or no fetal monitoring. The remaining 15 (28.8%) of the 52 cases were diagnosed as intra-uterine fetal deaths on arrival at hospital. The mean time from recognition of emergency to delivery (n=25) was 107.8±92.3 minutes. The emergency was not recognised in 12 (32.4%) of the cases presenting with live babies on admission. Conclusion Fresh stillbirths ≥2500 g are still common and may occur in normal labour, with only 57.7% of the fresh stillbirths in this study having an identifiable catastrophic event leading to the fetal demise. There appears to be a failure to detect or respond to evidence of fetal distress even in facilities with skilled staff and available resources, which points to shortfalls in the quality of intrapartum care.
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A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Obstetrics and Gynaecology 5 November 2014
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