Prevalence and determinants of singleton stillbirths at a tertiary hospital in Port-Harcourt, Nigeria.

Abstract

Background: Nigeria makes a substantial contribution to the global burden of stillbirths. Stillbirth accounts for about
50% of perinatal mortality and the stillbirth rate is an indicator of the quality of antenatal and intrapartum care. The
study sought to determine the prevalence and determinants of stillbirths.
Methodology: This was a retrospective, unmatched case-control study over two years from May 2022 to April 2024.
Cases were women with stillbirths that occurred at a gestational age of ≥28 weeks, while controls were women with
livebirths, in a 1 case for 2 controls ratio. Data extracted from the hospital records, using a predesigned collection form,
included demographic, medical, obstetric, and neonatal characteristics as exposure variables. Data was analysed with
SPSS version 25, using descriptive and inferential statistics. Multivariate logistics regression was used to determine
adjusted odds ratios with 95% confidence intervals and a P-value of <0.05.
Results: There were 3,425 live births and 120 stillbirths, giving a stillbirth rate of 35 per 1000 livebirths. Analysis was
performed for 114 cases and corresponding 228 controls, 6 cases were excluded for incomplete data. Maternal age
ranged from 20-48 years and parity from 0-7, with no statistical difference between either group (P=0.982 and P=0.638
respectively). There were 58(50.9%) macerated and 56(49.1%) fresh stillbirths, with 21(37.5%) of the fresh stillbirths
alive at presentation. Factors associated with stillbirth after multivariate analysis included unbooked status (aOR=9.64;
P=0.0001), vaginal delivery (aOR=2.04; P=0.034), abruption placenta (aOR=25.58; P=0.007), preterm delivery at GA
≤36weeks (aOR=3.26; P=0.012), and low birth weight <2500g (aOR=3.53; P=0.016). Obstructed labour and ruptured
uterus were significant in bivariate analysis but could not be fitted into multivariate analysis because of non-occurrence
in controls.
Conclusion: The stillbirth rate at our Centre was 35 per 1000 livebirths. Associated factors for stillbirth were unbooked
status, vaginal delivery, abruption placenta, preterm delivery, and birth weight <2500g.