title: Reducing stillbirths in low-income countries.
abstract: Worldwide, 98% of stillbirths occur in low-income countries (LIC), where stillbirth rates are ten-fold higher than in high-income countries (HIC). Although most HIC stillbirths occur prenatally, in LIC most stillbirths occur at term and during labor/delivery. Conditions causing stillbirths include those of maternal origin (obstructed labor, trauma, antepartum hemorrhage, preeclampsia/eclampsia, infection, diabetes, other maternal diseases), and fetal origin (fetal growth restriction, fetal distress, cord prolapse, multiples, malpresentations, congenital anomalies). In LIC, aside from infectious origins, most stillbirths are caused by fetal asphyxia. Stillbirth prevention requires recognition of maternal conditions, and care in a facility where fetal monitoring and expeditious delivery are possible, usually by cesarean section (CS). Of major causes, only syphilis and malaria can be managed prenatally. Targeting single conditions or interventions is unlikely to substantially reduce stillbirth. To reduce stillbirth rates, LIC must implement effective modern antepartum and intrapartum care, including fetal monitoring and CS.
authors.affiliation: Department Obstetrics and Gynecology, Columbia University, New York, NY, USA.
authors.forename: Robert L
authors.identifier: http://orcid.org/0000-0002-1283-8340
authors.initials: RL
authors.lastname: Goldenberg
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
authors.forename: Sarah
authors.identifier: http://orcid.org/0000-0002-6797-8631
authors.initials: S
authors.lastname: Saleem
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
authors.forename: Omrana
authors.identifier: http://orcid.org/0000-0003-2000-4001
authors.initials: O
authors.lastname: Pasha
authors.affiliation: Department Obstetrics and Gynecology, Columbia University, New York, NY, USA.
authors.forename: Margo S
authors.identifier: http://orcid.org/0000-0003-2940-2241
authors.initials: MS
authors.lastname: Harrison
authors.affiliation: Social Statistical and Environmental Health Sciences, Research Triangle Institute, Durham, NC, USA.
authors.forename: Elizabeth M
authors.identifier: http://orcid.org/0000-0001-8659-5444
authors.initials: EM
authors.lastname: Mcclure
mesh_terms: D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D005313:Fetal Death / Q000517:prevention & control*; D005315:Fetal Diseases / Q000401:mortality; D006801:Humans; D008428:Maternal Mortality; D008880:Midwifery; D011203:Poverty; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control*; D011295:Prenatal Care / Q000592:standards*; D012151:Resuscitation / Q000379:methods; D012307:Risk Factors; D050497:Stillbirth
keywords: Stillbirth; cesarean section; fetal growth restriction; fetal monitoring; high-income countries; low-income countries; perinatal mortality