title: The relationship of intrapartum and antepartum stillbirth rates to measures of obstetric care in developed and developing countries.
abstract: BACKGROUND
  The objective of this study was to explore the relationship between intrapartum and antepartum stillbirths and various measures of obstetric care in developing and developed countries.
  
  
  METHODS
  For 51 countries, we obtained data about intrapartum and antepartum stillbirth rates and obstetric care measures from the World Health Organisation (WHO) and other sources. Using piecewise regression techniques, the relationships between the intrapartum and antepartum stillbirth rates and the various measures of obstetric care were determined.
  
  
  RESULTS
  Developed countries had lower total stillbirth rates (6.0 versus 21.3/1,000 births, p=0.0002) as well as a lower fraction of stillbirths that were intrapartum (0.16 versus 0.31, p=0.0019). Developed country antepartum stillbirth rates were 5.2 versus 14.0/1,000 in developing countries (p=0.0002). The highest antepartum stillbirth rates, all in southern Africa and Asia, ranged from 25 to 35/1,000 births. Intrapartum stillbirth rates averaged 0.9/1,000 births for developed countries compared to 7.3/1,000 in developing countries (p=0.0024), but ranged as high as 20-25/1,000 births for some countries in southern Africa and Asia. The relationship between intrapartum stillbirth and the various measures of care were generally stronger than those for antepartum stillbirth. Over the entire range of values, for each 1% increase in the percentage of women with at least 4 antenatal visits, the intrapartum stillbirth rate decreased by 0.16 per 1,000 births (p<0.0001). As cesarean section rates increased from 0 to 8%, for each 1% increase, there was a decrease of 1.61 intrapartum stillbirths per 1,000 births. There was no relationship between the cesarean section rates and intrapartum stillbirth rates in developed countries.
  
  
  CONCLUSIONS
  The intrapartum stillbirth rate is more closely related to various measures of obstetric care than the antepartum stillbirth rate. Increases in cesarean section rates up to 8% are associated with significant improvements in intrapartum stillbirth rates.
authors.affiliation: Department of Obstetrics and Gynecology, Drexel University, Philadelphia, PA, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Goldenberg
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: McClure
authors.forename: Carla M
authors.initials: CM
authors.lastname: Bann
mesh_terms: D036861:Delivery, Obstetric; D019049:Developed Countries / Q000706:statistics & numerical data*; D003906:Developing Countries / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011295:Prenatal Care; D019984:Quality Indicators, Health Care; D012044:Regression Analysis; D050497:Stillbirth / Q000453:epidemiology*