Does antenatal care timing influence stillbirth risk in the third trimester? A secondary analysis of perinatal death audit data in South Africa.
OBJECTIVE
To explore stillbirth risk across gestation in three provinces of South Africa with different antenatal care schedules.


METHODS
Retrospective audit of perinatal death data using South Africa's Perinatal Problem Identification Programme.


METHODS
In 2008, the Basic Antenatal Care Programme was introduced in Limpopo and Mpumalanga provinces, reducing appointments to five visits at booking, 20, 26, 32, 38 weeks and 41 weeks if required. In the Western Cape province seven appointments remained at booking, 20, 26, 32, 34, 36, 38 and 41 weeks if required.


METHODS
All audited stillbirths (n = 4211) between October 2013 to August 2015 in Limpopo, Mpumalanga and Western Cape.


METHODS
Stillbirth risk (26-42 weeks of gestation, >1000 g) across gestation was calculated using Yudkin's method. Stillbirth risk was compared between provinces and relative risks were calculated between Limpopo/ Mpumalanga and Western Cape.


METHODS
Stillbirth risk across gestation.


RESULTS
Stillbirth risk peaked at 38 weeks of gestation in Limpopo (relative risk [RR] 3.11, 95% CI 2.40-4.03, P < 0.001)and Mpumalanga (RR 3.09, 95% CI 2.37-4.02, P < 0.001) compared with Western Cape, where no peak was observed. Stillbirth risk at 38 weeks gestation in Limpopo and Mpumalanga were statistically greater than both the 37 and 39 weeks gestation within provinces (P < 0.001). As expected, a peak at 41 weeks of gestation was observed in all provinces.


CONCLUSIONS
The increased period of stillbirth risk occurs after a 6-week absence of antenatal care. This calls for a refocus on the impact of reduced antenatal care visits during the third trimester.


CONCLUSIONS
Reduced antenatal care in the third trimester may increase stillbirth risk.
Centre for Health Services Research, School of Population Health, The University of Western Australia, Crawley, WA, Australia.
T
T
Lavin
SA MRC Maternal and Infant Health Care Strategies Unit, School of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa.
R C
RC
Pattinson
D005260:Female; D005865:Gestational Age; D006801:Humans; D008427:Maternal Health Services; D008428:Maternal Mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality / Q000517:prevention & control*; D011264:Pregnancy Trimesters; D011295:Prenatal Care; D012189:Retrospective Studies; D012307:Risk Factors; D013019:South Africa; D050497:Stillbirth; D013997:Time Factors; D014850:Waiting Lists
Antenatal care; South Africa; perinatal mortality; stillbirth