Conclusions and Recommendations

 PGPR Workshop:
 Antenatal and Intrapartum Causes of Perinatal Asphyxia and
Stillbirths in Developing Countries
October 6, 2006, Bangkok, Thailand

 

Summary of Research Recommendations  


  1. In many developing countries the majority of stillbirths are “fresh”, indicative of intrapartum foetal death. This indicates inadequate obstetrical care. That problem arises from economic, political and financial restrictions on the provision of health services. The question is how to affordably provide obstetric care in low income settings.
  2. In certain developing countries antepartum stillbirths are more frequent. The causes of these deaths may be infections or nutritional failure; in most cases the cause is unknown. There is an urgent need to study this problem. This should include epidemiologic study of vaginal carriage, funisitis rates and study of placental pathology.
  3. The true incidence and etiology of most stillbirths in developing countries is unknown. Community-based health care workers should be trained to follow pregnancies prospectively and provide details of all pregnancy outcomes. Data of stillbirths should include the gestational age and weight of the foetus.
  4. Health care workers should be trained in the use of the verbal autopsy. That technique should be further developed and evaluated in terms of its effect on foetal morbidity and mortality.
  5. Placental pathology should be studied in cases of stillbirth and perinatal asphyxia. Initially this should be done in representative sentinel studies.
  6. Mothers of stillborn babies should be studied for signs of infection.
  7. The effect of micronutrient deficiency on stillbirths and perinatal asphyxia should be studied.
  8. Defects in health system are a major cause of stillbirths. There may be failure to recognize problems; failure in transportation to clinical facilities; and/or failure in reception and care at clinical facilities. These issues should be studied in each community.
  9. Community-based health care workers should be trained in monitoring labour, including determining cardiac rates, evaluating foetal movements, determining the progress of labour and using partography.
  10. A formal study of maternal monitoring of foetal movement should be performed.
  11. The importance of foetal loss in various societies should be studied.
  12. The organizational barriers to improved obstetrical care should be studied.
  13.  A randomized control trial should be performed to determine the value of perinatal audit on reducing maternal and foetal mortality.
  14. The training and effectiveness of community-based health care workers should be critically evaluated.
  15. The role of infectious disease in the causal pathway of perinatal asphyxia should be studied, not only in the mother but also in the newborn by gastric aspirate, placental smear and placental pathology in addition to the standard techniques of evaluating infection in the neonatal period.