title: A retrospective review of stillbirths at the national hospital in Timor-Leste.
abstract: BACKGROUND
  Timor-Leste has high maternal and infant mortality rates. Estimates of stillbirths are unreliable and limited by poor collection of vital health statistics. Lack of accurate data impedes the development of interventions to address local determinants of stillbirth.
  
  
  OBJECTIVE
  This study aimed to identify the rate, timing and causes of stillbirths at National Hospital Guido Valadares in Dili, Timor-Leste, between November 2009 and December 2010, during which data were available.
  
  
  METHODS
  Hospital birth registry and maternal records were retrospectively reviewed to identify stillbirths during the study period. The simplified Cause of Death and Associated Conditions system was utilised to classify stillbirths.
  
  
  RESULTS
  One hundred and fifty-three stillbirths were identified, producing a stillbirth rate of 29 per 1000 births. Of stillbirths with known timing, 70 (66.7%) occurred antepartum and 35 (33.3%) intrapartum. Cause of death could not be ascertained in 62.7% of cases due to poor or missing records. Where identified, the three most commonly classified causes of death were intrapartum fetal asphyxia, maternal infection and maternal hypertensive disorder.
  
  
  CONCLUSIONS
  This study highlights the need for standardised recording and coding of perinatal deaths at HNGV. The high proportion of antenatal death transfers from community health centres demonstrates the need for community and hospital staff training to improve the quality of antenatal and intrapartum obstetric care. A prospective study of stillbirths is recommended to obtain reliable data on the determinants of stillbirths in Timor-Leste. These data would inform evidence-based interventions for the improvement of maternity and obstetric care in community and hospital settings.
authors.affiliation: International Health Programme, School of Nursing and Midwifery, Curtin University, Perth, Western Australia, Australia.
authors.forename: Alexa
authors.initials: A
authors.lastname: Wilkins
authors.affiliation: Faculty of Health Sciences, International Health Programme, School of Nursing and Midwifery, Curtin University, Perth, Western Australia, Australia.
authors.forename: Jaya
authors.initials: J
authors.lastname: Earnest
authors.affiliation: Melbourne University Medical School, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Elizabeth Anne
authors.initials: EA
authors.lastname: Mccarthy
authors.affiliation: Melbourne University Medical School, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Alexis
authors.initials: A
authors.lastname: Shub
mesh_terms: D000328:Adult; D002423:Cause of Death; D003906:Developing Countries; D005260:Female; D006801:Humans; D008297:Male; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D050497:Stillbirth / Q000453:epidemiology*; D049648:Timor-Leste / Q000453:epidemiology
keywords: East Timor; cause of death; low-income countries; perinatal mortality; stillbirth