title: The global network: a prospective study of stillbirths in developing countries.
abstract: 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.
authors.affiliation: Research Triangle Institute, Research Triangle Park, NC 27709, USA. mcclure@rti.org
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: McClure
authors.forename: Linda L
authors.initials: LL
authors.lastname: Wright
authors.forename: Robert L
authors.initials: RL
authors.lastname: Goldenberg
authors.forename: Shivaprasad S
authors.initials: SS
authors.lastname: Goudar
authors.forename: Sailajanandan N
authors.initials: SN
authors.lastname: Parida
authors.forename: Imtiaz
authors.initials: I
authors.lastname: Jehan
authors.forename: Antoinette
authors.initials: A
authors.lastname: Tshefu
authors.forename: Elwyn
authors.initials: E
authors.lastname: Chomba
authors.forename: Fernando
authors.initials: F
authors.lastname: Althabe
authors.forename: Ana
authors.initials: A
authors.lastname: Garces
authors.forename: Hillary
authors.initials: H
authors.lastname: Harris
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Derman
authors.forename: Pinaki
authors.initials: P
authors.lastname: Panigrahi
authors.forename: Cyril
authors.initials: C
authors.lastname: Engmann
authors.forename: Pierre
authors.initials: P
authors.lastname: Buekens
authors.forename: Michael
authors.initials: M
authors.lastname: Hambidge
authors.forename: Waldemar A
authors.initials: WA
authors.lastname: Carlo
mesh_terms: 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