title: A study of fresh stillbirths weighing 2500g or more at three academic hospitals in South Africa.
abstract: OBJECTIVE
  To determine the frequency of fresh stillbirths weighing 2500g or more, to assess the risk factors and direct obstetric causes, and to describe avoidable factors in terms of substandard intrapartum management.
  
  
  METHODS
  A prospective, cross-sectional, descriptive study was conducted at three obstetric teaching units in Johannesburg, South Africa. Data were consecutively collected for 6months at each of the hospitals, leading to an 18-month data collection period from May 1, 2011, to October 31, 2012. The study population was hospital-born, singleton fresh stillbirths weighing 2500g or more.
  
  
  RESULTS
  Overall, 52 fresh stillbirths were eligible. Intrapartum catastrophic events were recorded in 30 (58%) cases (16 placental abruption, 7 cord prolapse, 4 ruptured uterus, and 3 entrapment of aftercoming head during breech delivery). Intrauterine fetal death was recorded on arrival at hospital in 15 (29%) cases. Twenty-two (42%) women underwent cardiotocography monitoring; 15 (29%) had no fetal monitoring. Among 25 cases in which the emergency was recognized, the median time from recognition of emergency to delivery was 182minutes (range 13-360).
  
  
  CONCLUSIONS
  There appears to be a failure to detect or respond to evidence of fetal distress even in facilities with skilled staff and available resources.
authors.affiliation: Department of Obstetrics and Gynaecology, University of the Witwatersrand, Johannesburg, South Africa. Electronic address: marlene.bothma@ogdr.co.za.
authors.forename: Marlene
authors.initials: M
authors.lastname: Bothma
authors.affiliation: Department of Obstetrics and Gynaecology, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Eckhart J
authors.initials: EJ
authors.lastname: Buchmann
mesh_terms: D000328:Adult; D001724:Birth Weight; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D005323:Fetal Monitoring / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D054238:Perinatal Mortality; D011203:Poverty; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D050497:Stillbirth / Q000453:epidemiology*; D055815:Young Adult
keywords: Birth asphyxia; Fetal monitoring; Intrapartum-related deaths; Low-income countries; Perinatal mortality; Stillbirth