title: Global Network for Women's and Children's Health Research: probable causes of stillbirth in low- and middle-income countries using a prospectively defined classification system.
abstract: OBJECTIVE
  We sought to classify causes of stillbirth for six low-middle-income countries using a prospectively defined algorithm.
  
  
  METHODS
  Prospective, observational study.
  
  
  METHODS
  Communities in India, Pakistan, Guatemala, Democratic Republic of Congo, Zambia and Kenya.
  
  
  METHODS
  Pregnant women residing in defined study regions.
  
  
  METHODS
  Basic data regarding conditions present during pregnancy and delivery were collected. Using these data, a computer-based hierarchal algorithm assigned cause of stillbirth. Causes included birth trauma, congenital anomaly, infection, asphyxia, and preterm birth, based on existing cause of death classifications and included contributing maternal conditions.
  
  
  METHODS
  Primary cause of stillbirth.
  
  
  RESULTS
  Of 109 911 women who were enrolled and delivered (99% of those screened in pregnancy), 2847 had a stillbirth (a rate of 27.2 per 1000 births). Asphyxia was the cause of 46.6% of the stillbirths, followed by infection (20.8%), congenital anomalies (8.4%) and prematurity (6.6%). Among those caused by asphyxia, 38% had prolonged or obstructed labour, 19% antepartum haemorrhage and 18% pre-eclampsia/eclampsia. About two-thirds (67.4%) of the stillbirths did not have signs of maceration.
  
  
  CONCLUSIONS
  Our algorithm determined cause of stillbirth from basic data obtained from lay-health providers. The major cause of stillbirth was fetal asphyxia associated with prolonged or obstructed labour, pre-eclampsia and antepartum haemorrhage. In the African sites, infection also was an important contributor to stillbirth. Using this algorithm, we documented cause of stillbirth and its trends to inform public health programs, using consistency, transparency, and comparability across time or regions with minimal burden on the healthcare system.
  
  
  CONCLUSIONS
  Major causes of stillbirth are asphyxia, pre-eclampsia and haemorrhage. Infections are important in Africa.
authors.affiliation: RTI International, Durham, NC, USA.
authors.forename: E M
authors.initials: EM
authors.lastname: McClure
authors.affiliation: Materno Infantil Unidad de Planificación, INCAP, Guatemala City, Guatemala.
authors.forename: A
authors.initials: A
authors.lastname: Garces
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
authors.forename: S
authors.initials: S
authors.lastname: Saleem
authors.affiliation: RTI International, Durham, NC, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Moore
authors.affiliation: Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: C L
authors.initials: CL
authors.lastname: Bose
authors.affiliation: Department of Paediatrics, Moi University College of Health and Sciences, Eldoret, Kenya.
authors.forename: F
authors.initials: F
authors.lastname: Esamai
authors.affiliation: KLE University's JN Medical College, Belagavi, India.
authors.forename: S S
authors.initials: SS
authors.lastname: Goudar
authors.affiliation: Department of Paediatrics, University of Zambia, Lusaka, Zambia.
authors.forename: E
authors.initials: E
authors.lastname: Chomba
authors.affiliation: Department of Paediatrics, University of Zambia, Lusaka, Zambia.
authors.forename: M
authors.initials: M
authors.lastname: Mwenechanya
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
authors.forename: O
authors.initials: O
authors.lastname: Pasha
authors.affiliation: Kinshasa School of Public Health, Kinshasa, DRC.
authors.forename: A
authors.initials: A
authors.lastname: Tshefu
authors.affiliation: Lata Medical Research Foundation, Nagpur, India.
authors.forename: A
authors.initials: A
authors.lastname: Patel
authors.affiliation: KLE University's JN Medical College, Belagavi, India.
authors.forename: S M
authors.initials: SM
authors.lastname: Dhaded
authors.affiliation: Department of Paediatrics, Moi University College of Health and Sciences, Eldoret, Kenya.
authors.forename: C
authors.initials: C
authors.lastname: Tenge
authors.affiliation: Department of Paediatrics, Moi University College of Health and Sciences, Eldoret, Kenya.
authors.forename: I
authors.initials: I
authors.lastname: Marete
authors.affiliation: Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: M
authors.initials: M
authors.lastname: Bauserman
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
authors.forename: S
authors.initials: S
authors.lastname: Sunder
authors.affiliation: KLE University's JN Medical College, Belagavi, India.
authors.forename: B S
authors.initials: BS
authors.lastname: Kodkany
authors.affiliation: Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: W A
authors.initials: WA
authors.lastname: Carlo
authors.affiliation: Department of Obstetrics, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Derman
authors.affiliation: Boston University, Boston, MA, USA.
authors.forename: P L
authors.initials: PL
authors.lastname: Hibberd
authors.affiliation: Department of Pediatrics, Indiana University, Indianapolis, IN, USA.
authors.forename: E A
authors.initials: EA
authors.lastname: Liechty
authors.affiliation: Department of Pediatrics, University of Colorado, Denver, CO, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Hambidge
authors.affiliation: Department of Pediatrics, University of Colorado, Denver, CO, USA.
authors.forename: N F
authors.initials: NF
authors.lastname: Krebs
authors.affiliation: Perinatology and Pregnancy Branch, NICHD, Bethesda, MD, USA.
authors.forename: M
authors.initials: M
authors.lastname: Koso-Thomas
authors.affiliation: Perinatology and Pregnancy Branch, NICHD, Bethesda, MD, USA.
authors.forename: M
authors.initials: M
authors.lastname: Miodovnik
authors.affiliation: RTI International, Durham, NC, USA.
authors.forename: D D
authors.initials: DD
authors.lastname: Wallace
authors.affiliation: Columbia University Medical Center, New York, NY, USA.
authors.forename: R L
authors.initials: RL
authors.lastname: Goldenberg
mesh_terms: D000349:Africa / Q000453:epidemiology; D000465:Algorithms; D001208:Asia / Q000453:epidemiology; D003906:Developing Countries; D005260:Female; D014943:Global Health; D006166:Guatemala / Q000453:epidemiology; D006801:Humans; D000068101:Maternal-Child Health Services; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011446:Prospective Studies; D012042:Registries; D050497:Stillbirth / Q000453:epidemiology*
keywords: Cause of death classification system; low-income countries; stillbirth