Association Between Maternal And Fetal Risk Factors And Stillbirths In Tertiary Care Hospital In Belagavi- A One Year Observational Study

Abstract

BACKGROUD AND OBJECTIVES Stillbirth still remains the most prevalent adverse outcome of pregnancy. Death of a viable fetus is one of the unhappy events in the field of obstetrics. Stillbirth is a sensitive indicator for maternal care during antenatal and intrapartum period. It also reflects the obstetrician’s vigilant care during pregnancy. Thus it is important to identify the probable causes and risk factors associated with fetal loss to determine the risk of recurrences, prevention and to plan a strategy for its correction. This study was taken with the objective to know the association between maternal and fetal risk factors and stillbirths. METHODOLOGY A descriptive observational study is undertaken in labour room at KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi. The cases of intra-uterine fetal death either with ultrasound reports proving IUD and diagnosed on clinical examination by absence of fetal heart rate were studied during the study period of Jaunary 2017 December 2017. All stillbirths (> 20weeks of pregnancy or> 500gms of the fetus) (according to ACOG 2009) who gave consent were included in the study. Data was entered in Microsoft 2010 Excel sheet. Obtained data was tabulated and analysed using rates, ratios and percentages. Chi-Square Test is applied for each of the risk factor to know its association with stillbirth. Risk associated with factors estimated using Odds ratio. P value < .005 is considered significant. RESULT Total of 171 cases were included in the study out of 5755 total delivery. The incidence of stillbirth was found to be 2.97% and stillbirth rate was found to be 29.71 /1000 births. Among 171 stillbirths 77(45%) cases were registered cases and 94 (55%) were unregistered cases. The majority of the study population from urban area belonging to class 3 socio economic status as per Kuppuswamy socio economic classification system, 51 (29.82%) and class 3 socio economic status as per Modified BG Prasad socio economic classification system 36,(21.05%). Stillbirths were more common in the age group of 20-30 years with the incidence rate of 152(89%). Incidence of stillbirth was common in primipara 78 (45.61%), followed by second para 43(25.14%), Third para 32(18.71) and >4 th para 18 (10.52%). Stillbirth were more common in the gestational age of 28 weeks 1 day to 36 weeks 6 days, 90 (52.63%) in the present study. Most of the stillbirth were in antenatal period 156(91.22%).15 (8.77%) of stillbirth were in intrapartum period.136 (80%) stillbirth were delivered vaginally and 35(20%) were delivered through caesarean section. In the present study the most common causes of stillbirth were hypertensive disorders of pregnancy 33(19.29%), FGR (17.54%), Abruption (15.78%), congenital malformation (14.61%) and unknown (9.35%). Other causes were prelabor rupture of membranes (8.76%), Gestational diabetes mellitus (3.50%), non immune hydrops (2.92%). CONCLUSION Stillbirth rates are considered as an important indicator of the quality of obstetric care available in a country. According to the global figures 2015, Indian ranks first in the absolute number of stillbirth. In our study rate was 2.97% of stillbirth. To bring down these high rates of stillbirth, we should be aware of prevalence rates and risk factors leading to stillbirths and then plan strategies which are appropriate and tailor made to suit our local situation. Early identification of the these risk factors will lead to timely identification of appropriate preventive and interventional strategies which will help us to improve the overall pregnancy outcome such as stillbirths which have an adverse impact on life the woman and her family.