Open AccessReducing stillbirths in low‐income countries
Author(s) -
Goldenberg Robert L.,
Saleem Sarah,
Pasha Omrana,
Harrison Margo S.,
Mcclure Elizabeth M.
Publication year - 2016
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/aogs.12817
Subject(s) - medicine , obstetrics , fetal distress , fetus , antepartum hemorrhage , syphilis , pregnancy , obstructed labour , asphyxia , caesarean section , human immunodeficiency virus (hiv) , immunology , biology , genetics
Worldwide, 98% of stillbirths occur in low‐income countries ( LIC ), where stillbirth rates are ten‐fold higher than in high‐income countries ( HIC ). Although most HIC stillbirths occur prenatally, in LIC most stillbirths occur at term and during labor/delivery. Conditions causing stillbirths include those of maternal origin (obstructed labor, trauma, antepartum hemorrhage, preeclampsia/eclampsia, infection, diabetes, other maternal diseases), and fetal origin (fetal growth restriction, fetal distress, cord prolapse, multiples, malpresentations, congenital anomalies). In LIC , aside from infectious origins, most stillbirths are caused by fetal asphyxia. Stillbirth prevention requires recognition of maternal conditions, and care in a facility where fetal monitoring and expeditious delivery are possible, usually by cesarean section (CS). Of major causes, only syphilis and malaria can be managed prenatally. Targeting single conditions or interventions is unlikely to substantially reduce stillbirth. To reduce stillbirth rates, LIC must implement effective modern antepartum and intrapartum care, including fetal monitoring and CS.