Stillbirths: Epidemiology, Evidence, and Priorities for Action

Mohammad Yawar Yakoob, Joy E. Lawn, Gary L. Darmstadt, Zulfiqar A. Bhutta

Research output: Contribution to journalReview articlepeer-review

40 Citations (Scopus)

Abstract

The annual global burden of stillbirths amounts to an estimated 3.2 million%, 98% of which occur in low- and middle-income countries (LMICs). Of these, 1.02 million (32%) are intrapartum, ie, taking place during labor. The most important causes of stillbirths in LMICs include obstructed or prolonged labor, hypertensive diseases of pregnancy, syphilis and gram-negative infections, malaria in endemic areas, and undernutrition. Interventions that target these causes can play an important role in reducing stillbirths. There is a clear benefit of emergency obstetrical care, particularly Cesarean delivery, on intrapartum rates in LMICs when Cesarean rates are less than 8% to 10%. Provision of a skilled birth attendant is another important intervention whereby labor complications can be prevented, identified, managed, and/or referred. Among interventions for infections, syphilis screening and treatment can prevent as many as 50% of all stillbirths in areas with high syphilis prevalence, reducing the risk of stillbirths among treated women to that of untreated women. Intermittent preventive treatment of malaria and insecticide-treated mosquito nets are also interventions with strong recommendation, especially in the first 2 pregnancies. Balanced energy protein supplementation is an important nutritional intervention to prevent stillbirths in undernourished women, especially in LMICs. Creation of increased demand for health services within communities and increasing their uptake also can play a role in averting stillbirths. Other potential social and behavioral interventions include birth spacing, smoking cessation and indoor air pollution control, although the evidence for these is weak.

Original languageEnglish
Pages (from-to)387-394
Number of pages8
JournalSeminars in Perinatology
Volume34
Issue number6
DOIs
Publication statusPublished - Dec 2010

Keywords

  • Definition of stillbirths
  • Epidemiology
  • Interventions
  • Risk factors
  • Stillbirths

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