Assigning Cause Of Stillbirth- Comparision Of Two Methods: One Year Hospital Based Observational Study

Abstract

Background and objectives Developing countries account for 98% of estimated 3.3 million stillbirth which occur annually. While many developed countries have stillbirth rates as low as 3-5/ 1000 birth. A large number of factors have been associated with the risk of fetal death like genetic, maternal, systemic infections, placental and fetal pathology Assigning the cause of stillbirths, is accepted as crucial step towards the goal of reducing stillbirth. However, the use of suboptimal system may lead to a loss of important information and contributes to high proportion of unexplained deaths which is a major public health problem and also fails to assign long term prevention strategies. The present study was undertaken to compare assigning causes of stillbirth by clinician and investigator and know the stillbirth rate and type of stillbirth. Materials and methods One year observational study was conducted from January 2018 to December 2018 in the Department of Pediatrics, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi. A total of 161 stillbirths with gestation ≥20 weeks were studied. Maternal and stillbirth data was collected in a structured proforma. The clinician assigned the cause of stillbirth based on their routine system for determining the cause of stillbirth and the investigator of the study assigned the cause per Global Network cause of stillbirth algorithm. The clinician’s assigned causes of stillbirths were regrouped into broad categories as per the algorithm. Interrater agreement was assessed by Cohen’s Kappa. Results During the study period there were 4232 deliveries and 161 (3.80%) stillbirths. Stillbirth rate in our study was 38 /1000 births. Unregistered cases were 55.90%. The mean age of women in the study was 24.8 ± 4.12 and 44.10% were in 20-25 years age group. Higher risk of stillbirth was noted among primi (58.39%) and in gestational age group of 29-36 weeks (61.25%) with mean gestation 33.14 ± 4.60 weeks. Nearly threeforth (72%) of stillbirths were delivered through vaginal route and 80.7% occurred in antepartum period. Fresh stillbirths accounted for 62.11%. Out of 161 stillbirths 87.14% were female. More than half i.e 54.66% of stillbirths weighed <1500 gm. Clinicians assigned causes were regrouped as per algorithm for easy comparison. Asphyxia (68.94%) was the major cause followed by congenital anomalies (11.18%). Assignment by investigator using the algorithm showed 68.32% were due to asphyxia. Interrater agreement was assessed by Cohen’s Kappa. This showed clinician and investigator agreement in assigning cause of stillbirth is 86%. As per the agreement levels, Complications of prematurity (1), Asphyxia (0.98) and Congenital anomaly (0.93) showed a perfect agreement. Infection (0.65) showed a substantial agreement and Unknown (0.56) moderate agreement Conclusion Assigning the cause, is accepted as crucial step towards the goal of reducing stillbirth. The Rate in our study was 38/1000 births. The Global Network Cause of Death algorithm to classify causes of stillbirth provides a reliable data in low resource settings. Interrater agreement assessed by Cohen’s Kappa, showed clinician and investigator agreement in assigning the cause of stillbirth is 86%. This simple classification system, which does not need extensive investigations can be used to inform and provide public health strategies to reduce stillbirth rate and achieve better pregnancy outcome.