Maternal and foetal medical conditions during pregnancy as determinants of intrapartum stillbirth in public health facilities of Addis Ababa: a case-control study

Abstract

Introduction: globally, intrapartum stillbirth accounts for 1 million deaths of babies annually, representing approximately one-third of global stillbirth
toll. Intrapartum stillbirth occurs due to causes ranging from maternal medical and obstetric conditions; access to quality obstetric care services
during pregnancy; and types, timing and quality of intrapartum care. Different medical conditions including hypertensive & metabolic disorders,
infections and nutritional deficiencies during pregnancy are among risk factors of stillbirth. Ethiopia remains one of the 10 high-burden stillbirth
countries with estimated rate of more than 25 per 1000 births. Methods: a case-control study using primary data from chart review of medical
records of women who experienced intrapartum stillbirth in 23 public health facilities of Addis Ababa during the period July 1, 2010 - June 30, 2015
was conducted. Data was collected from charts of all cases of intrapartum stillbirth meeting the inclusion criteria and randomly selected charts of
controls in two to one (2:1) control to case ratio. Results: chronic medical conditions including diabetes, cardiac and renal diseases were less
prevalent (1%) among the study population whereas only 6% of women experienced hypertensive disorder during the pregnancy in review. Moreover,
6.5% of the study population had HIV infection where being HIV negative was protective against intrapartum stillbirth (aOR 0.37, 95% CI 0.18-
0.78). Women with non-cephalic foetal presentation during last ANC visit were three times more at risk of experiencing intrapartum stillbirth whereas
singleton pregnancy had strong protective association against intrapartum stillbirth (p<0.05). Conclusion: untreated chronic medical conditions,
infection, poor monitoring of foetal conditions and multiple pregnancy are among important risk factors for intrapartum stillbirth.