title: Incidence of intrapartum stillbirth and associated risk factors in tertiary care setting of Nepal: a case-control study.
abstract: BACKGROUND
  Each year, 1.2 million intrapartum stillbirths occur globally. In Nepal, about 50 % of the total number of stillbirths occur during the intrapartum period. An understanding of the risk factors associated with intrapartum stillbirth will facilitate the development of preventative strategies to reduce the associated burden of death. This study was conducted in a tertiary-care setting with the aim to identify risk factors associated with intrapartum stillbirth.
  
  
  METHODS
  A case-control study was completed from July 2012 to September 2013. All women who had an intrapartum stillbirth during the study period were included as cases, and 20 % of women with live births were randomly selected upon admission to create the referent population. Relevant information was retrieved from clinical records for case and referent women. In addition, interviews were completed with each woman to determine their demographic and obstetric history.
  
  
  RESULTS
  During the study period, 4,476 women were enrolled as referents and 136 women had intrapartum stillbirths. The following factors were found to be associated with an increased risk for intrapartum stillbirth: poor familial wealth quintile (Adj OR 1.8, 95 % CI-1.1-3.4); less maternal education (Adj OR, 3.2 95 % CI-1.8-5.5); lack of antenatal care (Adj OR, 4.8 95 % CI 3.2-7.2); antepartum hemorrhage (Adj OR 2.1, 95 % CI 1.1-4.2); multiple births (Adj. OR-3.0, 95 % CI- 1.9-5.4); obstetric complication during labor (Adj. OR 4.5, 95 % CI-2.9-6.9); lack of fetal heart rate monitoring per protocol (Adj. OR-1.9, 95 % CI 1.5-2.4); lack of partogram use (Adj. OR-2.1, 95 % CI 1.1-4.1); small-for-gestational age (Adj. OR-1.8, 95 % CI-1.2-1.7); preterm birth (Adj. OR-5.4, 95 % CI 3.5-8.2); and being born preterm with a small-for-gestational age (Adj. OR-9.0, 95 % CI 7.3-15.5).
  
  
  CONCLUSIONS
  Being born preterm with a small-for-gestational age was associated with the highest risk for intrapartum stillbirth. Inadequate fetal heart rate monitoring and partogram use are preventable risk factors associated with intrapartum stillbirth; by increasing adherence to these interventions the risk of intrapartum stillbirth can be reduced. The association of the lack of appropriate antenatal care with intrapartum stillbirth indicates that quality antenatal care may improve fetal health and outcomes.
  
  
  BACKGROUND
  ISRCTN97846009.
authors: International Maternal and Child Health, Department of Women's and Children's Health, University Hospital, SE-751 85, Uppsala, Sweden. aaashis7@yahoo.com.|United Nation's Children's Fund, Nepal Country Office, UN House, Pulchowk, Nepal. aaashis7@yahoo.com.
authors: Ashish
authors: http://orcid.org/0000-0002-0541-4486
authors: A
authors: Kc
authors: International Maternal and Child Health, Department of Women's and Children's Health, University Hospital, SE-751 85, Uppsala, Sweden.
authors: Johan
authors: J
authors: Wrammert
authors: International Maternal and Child Health, Department of Women's and Children's Health, University Hospital, SE-751 85, Uppsala, Sweden.
authors: Uwe
authors: U
authors: Ewald
authors: Latter-day Saint Charities, Salt Lake City, UT, USA.
authors: Robert B
authors: RB
authors: Clark
authors: Paropakar Maternity and Women's Hospital, Thapathali, Nepal.
authors: Jageshwor
authors: J
authors: Gautam
authors: Paropakar Maternity and Women's Hospital, Thapathali, Nepal.
authors: Gehanath
authors: G
authors: Baral
authors: Patan Academy of Health Sciences, Lalitpur, Nepal.
authors: Kedar P
authors: KP
authors: Baral
authors: International Maternal and Child Health, Department of Women's and Children's Health, University Hospital, SE-751 85, Uppsala, Sweden.
authors: Mats
authors: M
authors: Målqvist
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008423:Maternal Age; D009390:Nepal / Q000453:epidemiology; D007744:Obstetric Labor Complications; D011247:Pregnancy; D011248:Pregnancy Complications; D011446:Prospective Studies; D012307:Risk Factors; D050497:Stillbirth / Q000453:epidemiology*; D063128:Tertiary Health Care; D055815:Young Adult