Can clinical risk factors for late stillbirth in West Africa be detected during antenatal care or only during labour?
BACKGROUND
Recent studies have shown that the most important risk factors for perinatal mortality in developing countries are not detectable during antenatal care but can be observed only shortly before or during labour. Although 60% of perinatal deaths in these countries are stillbirths, few epidemiological studies focus on them. We tested the hypothesis that the risk factors for late stillbirth in West Africa are detectable principally shortly before or during labour.


METHODS
Data came from a prospective population-based study (the MOMA survey) that collected information about 20 326 pregnant women in seven areas, primarily urban, in West Africa.


RESULTS
There were 19 870 singleton births. The stillbirth rate was 25.9 per 1000 total births (95% CI: 23.7-28.1). In the crude analysis, after adjustment and consideration of prevalence, the principal risk factors for late stillbirth were: late antenatal or intrapartum vaginal bleeding, intrapartum hypertension, dystocia, and infection. Other risk factors were: maternal height (<150 cm), maternal age (>35 years), previous stillbirths, hypertension at the 8-month antenatal visit and number of antenatal visits (<2).


CONCLUSIONS
The principal risk factors for late stillbirth observed in our study could be detected only in the late antenatal and intrapartum period. These results highlight the potential benefits of partograph use. They need to be confirmed by studies incorporating continuous intrapartum fetal monitoring.
Chalumeau
Martin
M
Institut National de la Santé et de la Recherche Médicale. Unité 149 Recherches Epidémiologiques en Santé Périnatale et Santé des Femmes, Paris, France.
Bouvier-Colle
Marie-Hélène
MH
Breart
Gérard
G
D000328:Adult; D000354:Africa, Western / Q000453:epidemiology; D000704:Analysis of Variance; D005260:Female; D005313:Fetal Death / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D015999:Multivariate Analysis; D007744:Obstetric Labor Complications / Q000175:diagnosis* / Q000453:epidemiology*; D018743:Perinatal Care; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000453:epidemiology*; D011446:Prospective Studies; D012044:Regression Analysis; D017584:Reproductive History; D012307:Risk Factors