title: Predisposing factors associated with stillbirth in Tanzania.
abstract: OBJECTIVE
  To determine whether specific medical conditions and/or fetal compromise during labor are associated with fresh stillbirth (FSB), and whether absent fetal heart rate (FHR) before delivery can increase risk of FSB.
  
  
  METHODS
  An observational cohort study was conducted at three university referral hospitals in Tanzania between January and September 2013. Maternal, labor, and neonatal characteristics were recorded for all deliveries. FSB was defined as an Apgar score of 0 at 1 and 5minutes, with intact skin and suspected death during labor or delivery.
  
  
  RESULTS
  Among 15 305 deliveries, there were 499 stillbirths (243 FSBs and 256 macerated stillbirths). Stillbirth was significantly more likely than a live birth after maternal transfer (odds ratio [OR] 3.27; 95% confidence interval [CI] 2.73-3.92; P<0.001) and when FHR was absent (OR 996.29; 95% CI 632.19-1570.09; P<0.001). Risk of stillbirth increased with uterine rupture (OR 138.62; 95% CI 60.73-316.44), placental abruption (OR 40.96; 95% CI 28.97-57.91), cord prolapse (OR 13.49; 95% CI 6.97-26.11), and prematurity (OR 6.87; 95% CI 4.71-10.03; P<0.001 for all).
  
  
  CONCLUSIONS
  In low-resource settings, FSB may be prevented by using a combined strategy of clinical risk identification, early detection of abnormal FHR, and expedited delivery.
authors.affiliation: Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Hussein
authors.initials: H
authors.lastname: Kidanto
authors.affiliation: Ministry of Health and Social Welfare, Dar es Salaam, Tanzania.
authors.forename: Georgina
authors.initials: G
authors.lastname: Msemo
authors.affiliation: Ministry of Health and Social Welfare, Dar es Salaam, Tanzania.
authors.forename: Donan
authors.initials: D
authors.lastname: Mmbando
authors.affiliation: Ministry of Health and Social Welfare, Dar es Salaam, Tanzania.
authors.forename: Neema
authors.initials: N
authors.lastname: Rusibamayila
authors.affiliation: Stavanger Acute medicine Foundation for Education and Research, Stavanger University Hospital, Stavanger, Norway.
authors.forename: Hege
authors.initials: H
authors.lastname: Ersdal
authors.affiliation: Department of Pediatrics, Division of Newborn Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA. Electronic address: jmp2007@med.cornell.edu.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Perlman
mesh_terms: D000037:Abruptio Placentae / Q000453:epidemiology; D001034:Apgar Score; D015984:Causality; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000145:classification*; D005260:Female; D006340:Heart Rate, Fetal; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D016017:Odds Ratio; D011247:Pregnancy; D050497:Stillbirth / Q000453:epidemiology*; D013636:Tanzania / Q000453:epidemiology; D014597:Uterine Rupture / Q000453:epidemiology
keywords: Fresh stillbirths; Low-resource area; Stillbirths; Tanzania