Characteristics and correlates of stillbirths at Moi Teaching and Referral Hospital, Eldoret-Kenya

Abstract

Background: Few obstetric complications are as emotionally devastating for patients and clinicians as stillbirths. There were 2.64 million stillbirths globally in 2009; the stillbirth rate in Kenya was estimated at 21.8 per 1000 births. The last study on this subject at this hospital was in 1994 when hospital incidence was 30.5 per 1000 births. The World Health Organisation (WHO) defines a stillbirth as a baby born dead at or after 22 weeks gestation. For international comparability the WHO allows a cut off at 28 weeks gestation. This study was based on a cut off gestation of 28 weeks because of the minimal chance of survival of a baby born earlier than 28 weeks in Kenya.Objective: 1.To describe characteristics of stillbirths delivered at MTRH. 2. To describe maternal and perinatal characteristics associated with stillbirths at MTRH.3.To explore the correlation between maternal/perinatal characteristics and the type of stillbirth. (macerated or fresh stillbirth) Methods: the study was carried out in maternity and pathology departments of MT&RH. The period of data collection was between May and October 2015. This was a cross-sectional descriptive study. The study involved evaluating the clinical circumstances, maternal records abstraction, and findings of laboratory investigations (blood/urine tests and placental histopathology). The target populationincluded mothers who delivered stillbirths at MT&RH at 28 weeks or later’ gestation. Cases were recruited consecutively. Data was collected using interviewer-administered semi-structured questionnaires, medical records abstraction, and laboratory results. Data was entered into Microsoft Access software and analysed using R Core Team, 2015. Correlation between categorical outcome variables (type of stillbirth) and categorical independent variables (maternal and perinatal characteristics) was done using Fisher’s exact test. Continuous variables were compared using independent samples t-test. The findings have been presented in form of tables.Results: During the study period 121 stillbirths were delivered at MTRH. There were 5250 deliveries in this unit in this period, translating to approximate hospital stillbirth rate of 23.03 per 1000 births. 113 mothers were recruited. Out of these, 104 placentae were examined histopathologically. A tenth (11.5%)of the mothers who delivered stillbirths were aged 35 years and over, while 5.3% were less than 18 years of age. A quarter (27.2%) of these mothers had attended at least four antenatal visits. Forty-five percent of the respondents were primigravidae. About a third (31.9%) of the stillbirths were fresh stillbirths(FSB). Majority of the stillbirths (58.4%) were male. Forty seven (41.6%) of the stillbirths were small-for-gestational age(SGA). The major maternal conditions among mothers with stillbirths were hypertensive disorders and urinary tract infections affecting 15.0% and 14.1% of the respondents respectively. Seventy-five percent of the examined placentae had pathological abnormalities. SGA was associated with FSB, OR: 2.32; 95% CI [1.04, 5.19; P=0.044]. No association between abnormal placentalpathology and type of stillbirth (P>0.999).Conclusion: The main maternal conditions associated with stillbirths were hypertensive disorders and UTI. Majority of the placentae had pathological findings. SGA was associated with increased risk of FSB. There was no association between abnormal placentae and type of stillbirth. Recommendations: 1. Stakeholders in obstetrics should explore cost-effective approaches to enhance diagnosis of SGA fetuses in early third trimester to reduce fresh stillbirth rates. 2. A case-control study should be carried out to help establish the clinical significance of placental pathological findings among stillbirths in our setup.