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Introduction: globally, intrapartum stillbirth accounts for 1 million deaths of babies annually, representing approximately one-third of global stillbirth toll. Intrapartum stillbirth occurs due to causes ranging from maternal medical and obstetric conditions; access to quality obstetric care services during pregnancy; and types, timing and quality of intrapartum care. Different medical conditions including hypertensive & metabolic disorders, infections and nutritional deficiencies during pregnancy are among risk factors of stillbirth. Ethiopia remains one of the 10 high-burden stillbirth countries with estimated rate of more than 25 per 1000 births. Methods: a case-control study using primary data from chart review of medical records of women who experienced intrapartum stillbirth in 23 public health facilities of Addis Ababa during the period July 1, 2010-June 30, 2015 was conducted. Data was collected from charts of all cases of intrapartum stillbirth meeting the inclusion criteria and randomly selected charts of controls in two to one (2:1) control to case ratio. Results: chronic medical conditions including diabetes, cardiac and renal diseases were less prevalent (1%) among the study population whereas only 6% of women experienced hypertensive disorder during the pregnancy in review. Moreover, 6.5% of the study population had HIV infection where being HIV negative was protective against intrapartum stillbirth (aOR 0.37, 95% CI 0.18-0.78). Women with non-cephalic foetal presentation during last ANC visit were three times more at risk of experiencing intrapartum stillbirth whereas singleton pregnancy had strong protective association against intrapartum stillbirth (p<0.05). Conclusion: untreated chronic medical conditions, infection, poor monitoring of foetal conditions and multiple pregnancy are among important risk factors for intrapartum stillbirth.
Study setting and design: this was a case-control study using primary data from chart review of medical records of women who experienced intrapartum stillbirth in 20 public health centres and 3 public hospitals of Addis Ababa during the period July 1, 2010 – June 30, 2015. In 2010, 26 public health centres offered Basic Emergency Obstetric and Neonatal Care (BEmONC) in Addis Ababa [12] out of which 20 were selected for this study due to service volume. Similarly, chart reviews were conducted in three out of the five public hospitals under the Addis Ababa City Administration, where Comprehensive Emergency Obstetric and Neonatal Care (CEmONC) had been practiced since 2010. Therefore, this study was conducted in a health-facility setting with intrapartum stillbirth as an outcome of interest. Sampling: all cases of intrapartum stillbirth that occurred in the public health facilities in Addis Ababa were recorded in the maternity registers which is the sampling frame for this study. Given intrapartum stillbirth is a relatively rare phenomenon, this study included all cases of intrapartum stillbirth meeting the inclusion criteria and recorded in the maternity care registers in 20 public health centres and three hospitals between July 1, 2010 – June 30, 2015. Controls were selected from the same maternity registers which helped as sampling frame in each public health facility using a lottery method and in two to one (2:1) control to case ratio. Therefore, in each facility, two medical charts of women with livebirths were selected for each case of intrapartum stillbirth. On every page of the maternity registers where cases of intrapartum stillbirth were taken, record numbers of women with livebirth were listed and rolled on pieces of paper of which an individual other than the data collector randomly selected the required number of controls. Sample size: accordingly, of the documented 112 intrapartum stillbirth cases in the 20 public health centres in Addis Ababa, 91 (81%) met the selection criteria and were included in this study. Similarly, there were a total of 944 cases of intrapartum stillbirth in the three public hospitals of which 637 (67%) qualified the inclusion criteria. A total of 427 charts of controls were reviewed in the 20 public health centres of which only 273 (64%) were included. Moreover, 1738 controls were also randomly identified in the three public hospitals in the city of which 1278 (74%) qualified the inclusion criteria. In general, 728 cases of intrapartum stillbirth and 1551 controls were considered from all the target public health facilities in Addis Ababa. Quantitative data on key variables related to maternal medical conditions that are considered risk factors to intrapartum stillbirth were collected from maternal ANC follow up and obstetric records of women who had given birth in the public health facilities in Addis Ababa from Jul 1, 2010 – June 30, 2015. Data entry and analysis were conducted using SPSS version 24 from August 1 – Sept 30, 2016. Bivariate analysis was conducted for key independent variables followed by multivariate logistic regression model for variables with p-value of 0.2 and less. Ethical Considerations: data was collected from medical records thereby minimising the concerns of confidentiality and requirements for individual consents. The data collector was trained and strictly monitored on the principles of confidentiality of clients' information during the process of data collection. The chart review was conducted within the respective facilities through consented authorisation of relevant facility leadership. Individual data sources remained anonymous during analysis and report presentation. Furthermore, ethical approval was obtained from the Higher Degrees of the University of South Africa (HSHDC/421/2015) and study permit was secured from health ethics committee of Addis Ababa Regional Health Bureau (AARHB) prior to data collection.
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