The global network: a prospective study of stillbirths in developing countries.
OBJECTIVE
Our goal was to determine stillbirth rates in a multisite population-based study in community settings in the developing world.


METHODS
Outcomes of all community deliveries in 5 resource-poor countries (Democratic Republic of Congo, Guatemala, India, Zambia, and Pakistan) and in 1 mid-level country (Argentina) were evaluated prospectively over an 18-month period. Births of > 1000 g with no signs of life were defined as stillbirth.


RESULTS
Outcomes of 60,324 deliveries were included. Stillbirth rates ranged from 34 per 1000 in Pakistan to 9 per 1000 births in Argentina. Increased stillbirth rates were associated significantly with lower skilled providers, out-of-hospital births, and low cesarean section rates. Maceration was present in 17.2% of stillbirths.


CONCLUSIONS
The stillbirth rates among births of > or = 1000 g in these developing countries were substantially higher than reported stillbirth rates in developed countries (3-5/1000 births). Because most developed countries define stillbirth as > or = 20 weeks of gestation or > or = 500 g and because almost one-half of all stillbirths are < 1000 g, the developing/developed country difference is actually larger than apparent from this study. Maceration was uncommon, which indicates that most of the deaths probably occurred during labor. The low rates of physician attendance, hospital delivery, and cesarean section deliveries suggest that stillbirth rates could be reduced by access to higher quality institutional deliveries.
McClure
Elizabeth M
EM
Research Triangle Institute, Research Triangle Park, NC 27709, USA. mcclure@rti.org
Wright
Linda L
LL
Goldenberg
Robert L
RL
Goudar
Shivaprasad S
SS
Parida
Sailajanandan N
SN
Jehan
Imtiaz
I
Tshefu
Antoinette
A
Chomba
Elwyn
E
Althabe
Fernando
F
Garces
Ana
A
Harris
Hillary
H
Derman
Richard J
RJ
Panigrahi
Pinaki
P
Engmann
Cyril
C
Buekens
Pierre
P
Hambidge
Michael
M
Carlo
Waldemar A
WA
D000328:Adult; D001118:Argentina / Q000453:epidemiology; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D003906:Developing Countries / Q000706:statistics & numerical data*; D005260:Female; D006166:Guatemala / Q000453:epidemiology; D006801:Humans; D007194:India / Q000453:epidemiology; D007231:Infant, Newborn; D008297:Male; D010154:Pakistan / Q000453:epidemiology; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D050497:Stillbirth / Q000453:epidemiology*; D015024:Zambia / Q000453:epidemiology