Abstract:
Objective. To determine population-based stillbirth rates and to determine whether
the timing and maturity of the stillbirths suggest a high proportion of potentially
preventable deaths. Design. Prospective observational study. Setting. Communi-
ties in six low-income countries (Democratic Republic of Congo, Kenya, Zambia,
Guatemala, India, and Pakistan) and one site in a mid-income country (Argentina).
Population. Pregnant women residing in the study communities. Methods. Over a
five-year period, in selected catchment areas, using multiple methodologies, trained
study staff obtained pregnancy outcomes on each delivery in their area. Main out-
come measures. Pregnancy outcome, stillbirth characteristics. Results. Outcomes
of 195 400 deliveries were included. Stillbirth rates ranged from 32 per 1 000 in
Pakistan to 8 per 1 000 births in Argentina. Three-fourths (76%) of stillbirth off-
spring were not macerated, 63% were ≥37 weeks and 48% weighed 2 500g or more.
Across all sites, women with no education, of high and low parity, of older age,
and without access to antenatal care were at significantly greater risk for stillbirth
(p<0.001). Compared to those delivered by a physician, women delivered by nurses
and traditional birth attendants had a lower risk of stillbirth. Conclusions. In these
low-middle income countries, most stillbirth offspring were not macerated, were
reported as ≥37 weeks’ gestation, and almost half weighed at least 2 500g. With
access to better medical care, especially in the intrapartum period, many of these
stillbirths could likely be prevented.
