Predictors of Intrapartum Stillbirths in Singletons in Six Public Hospitals in the Greater Accra Region, Ghana
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Date
2019-07
Authors
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Publisher
University of Ghana
Abstract
Introduction .
Globally. 2.6 million stillbirths are recorded annually: 50% occur during labour
(intrapartum). Ghana records 11,000 stillbirths annually and 40% occur during. labour. The
Greater Accra Region records 2000 stillbirths annually: 40 % of them occur intrapartum.
An understanding of the contributory factors will facilitate the development of preventive
strategies to reduce the huge numbers of intrapartum stillbirths.
Objectives
The objectives of this study were to identify contributors to intrapartum stillbirths; explore
perceptions about stillbirth from women with experience of intrapartum stillbirth, document
views of health professionals about causes and prevention of intrapartum stillbirths and
develop a model to predict intrapartum stillbirths.
Method
This was a retrospective 2: I unmatched case-control study with a qualitative component.
The study sample was all deliveries between 1st January to 31st December 2016 in six public
hospitals in the Greater Accra Region. Cases were selected through census while controls
were selected from the live births using systematic random sampling. Relevant information
was retrieved from clinical records for both cases and controls. Thirteen (10%) women from
the cases and 14 health workers were purposively selected for in-depth interviews. Bivariate
and multi variable data analyses were used to determine association between the variables
and intrapartum stillbirth. Qualitative data were analysed by themes using NVIVO II. The
Area Under the Receiver Operating Characteristics Curve (AUROq and the Brier Score
(BS) were used to identify factors to include in the model to predict intrapartum stillbirths.
Approval for the study was obtained from the Ghana Health Service Ethics Review
Committee.
Results
During the study period. there were 36,168 deliveries with 918 stillbirths; 362 (39%)
occurred intrapartum. Through the census, 125 cases were identified, in addition, 250
controls and 27 participants were included in the study. Mean age of cases and controls were
28.8= 5.54 and 28.9 ± 6.05 years respectively. Mean gestational age was 36.5 ± 3.95 weeks
for cases and 38.8 ± 2.69 weeks for controls; median birth weight was 2. 7kg.± 0.92 for cases
and 3.1kg ± 0.65 for controls. The following maternal factors were associated with
intrapartum stillbirths: pregnancy-induced hypertension (PIH) (aOR 3.70); antepartum
haemorrhage (APH) (aOR, 3.28) and premature rupture of membranes (PROM) (aOR 3.36).
The major fetal contributory factor was low gestational age (aOR. 0.86). Service delivery
factors included lack of trained health staff, inadequate number of beds, theatre space.
Non use of partograph to monitor women in labour and non-auditing of perinatal deaths. Fetal
autopsy was not performed on stillbirths. The best model to predict intrapartum stillbirth
was the model with combination of maternal (PHI. APH and PROM); fetal (low gestational
age) and service delivery (mode of delivery and health provider who conducted the delivery)
factors.
Conclusions and recommendations
Improved management of PIH, APH, PROM and preterm delivery will reduce intrapartum
stillbirth. Hospitals should improve on monitoring of women during labour. Auditing of
intrapartum stillbirths should be mandatory for all hospitals and Ghana Health Service
(GHS) should include fetal autopsy in stillbirth auditing to identify other causes of fetal
deaths. The best model to predict intrapartum stillbirth is a combination of maternal, fetal
and health service delivery factors. Thus, interventions to reduce intrapartum stillbirth must
combine maternal, fetal and service delivery factors to make them effective.
Description
PhD - Public Health
Keywords
Stillbirth, intrapartum, Singletons, Maternal Health Care, Ghana