Predictors of term stillbirths in an inner-city maternity hospital in Lagos, Nigeria.

OBJECTIVE

To determine the rates, pattern and correlates of term/viable stillbirths (gestational age >or= 37 weeks and fetal weight >or= 2,500 g).

DESIGN

Unmatched case-control, cross-sectional study.

SETTING

Inner-city maternity hospital, Lagos, Nigeria.

METHODS

About two-thirds of all documented stillbirths from 2005 to 2007 were analyzed to determine factors that correlated with viability by comparing term stillbirths first with pre-term stillbirths and then with term live births using multiple logistic regression.

MAIN OUTCOME MEASURES

Prevalence rates and adjusted odds ratios at 95% confidence intervals (CIs).

RESULTS

Of the total 7,216 deliveries over the three year period, there were 917 qualifying stillbirths out of which 404 (44.1%) were macerated and 13 (1.4%) were identified with congenital anomalies. Over half (57.0%) of the mothers with stillbirths had no antenatal care. Compared with pre-term stillbirths, term stillbirths were significantly associated with multiparity (odds ratio (OR) 0.69; 95% CI 0.48-0.99), antepartum hemorrhage (OR 0.54; 95% CI 0.35-0.83), premature rupture of membranes (OR 0.26; 95% CI 0.14-0.52), hypertensive conditions in pregnancy (OR 0.60; 95% CI 0.39-0.92), cesarean section (OR 1.71: 95% CI 1.13-2.60), cephalopelvic disproportion (OR 3.56; 95% CI 1.43-8.86), prolonged/obstructed labor (OR 1.94; 95% CI 1.22-3.07), and congenital abnormalities (OR 0.20; 95% CI 0.05-0.79). Young maternal age (OR 2.50; 95% CI 1.22-5.14), lack of antenatal care (OR 1.57; 95% CI 1.22-3.07), cord accidents (OR 29.63; 95% CI 14.23-61.71), and fetal distress (OR 5.30; 95% CI 3.35-8.38) emerged as additional risk factors when compared with term live births.

CONCLUSIONS

While the uptake of antenatal care was generally poor, most factors associated with the unacceptably high proportion of viable stillbirths in this resource-poor setting were identical to risk factors for total stillbirths and can be effectively managed with improved maternal education and obstetric care.