Stillbirths in developing countries

In reviewing the research on stillbirth in developing countries, it becomes clear that, since almost half of the deliveries in these settings occur at home, under-reporting of stillbirths is a significant problem, and reliable data concerning rates and causes are difficult to obtain. Hospital stillbirth data are often subject to substantial bias and the ability to generalize from these data is unknown. Nevertheless, at least 4 million stillbirths occur yearly, the vast majority in developing countries, with rates in many developing countries tenfold higher than elsewhere. Classification systems have been adapted for developing countries; however, there is not a standard system, nor is there agreement regarding stillbirth definitions, making comparisons of cause of stillbirth over time or between sites problematic. From available data, prolonged and obstructed labor, preeclampsia and various infections, all without adequate treatment, appear to account for the majority of stillbirths in developing countries. Despite the large number of stillbirths worldwide, the topic of stillbirths in developing countries has stimulated very little research, programmatic or policy attention. Better access to appropriate obstetric care, especially during labor, should reduce developing country stillbirth rates dramatically.