Etiology of Stillbirths in Developing Countries

The Etiology of Stillbirths in Developing Countries

 

Robert L. Goldenberg, of the University of Alabama at Birmingham, U.S.A. began his presentation by saying that the definition of stillbirth varies from country to country (Figure 2.1) and that in order to compare statistics there is a need for a standard definition.

 

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Dr. Goldenberg also pointed out that there are additional problems which make it difficult to accurately determine the incidence and causes of stillbirths in developing countries (
Figures 2.2, 2.3); however, there is evidence that stillbirths are a major problem in developing countries and this has not improved in recent years (Figures 2.4, 2.5).

 

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The timing of stillbirths can be defined in terms of duration of gestation as well as their relation to labour (
Figure 2.6). Strikingly, the intrapartum stillbirth rate is extremely high in developing countries (Figure 2.7) and, as such, could almost certainly be prevented by appropriate medical care (Figure 2.8).

 

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Stillbirth rates in several developing countries are high and relate to problems during labour and in maternal health as well as inadequacies in the health system (
Figures 2.9, 2.10, 2.11, 2.12, 2.13, 2.14).

 

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The differences between the causes of stillbirths occurring in developing countries and those occurring in developed countries are shown in
Figure 2.15.

 

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There are many causes of antepartum foetal deaths (
Figure 2.16) and in some countries more than half of stillbirths are caused by infection.

 

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Syphilis represents a major problem in some developing countries (
Figure 2.17) and the outcome of these pregnancies is usually very bad (Figure 2.18). In some countries syphilis has been the cause of a high percentage of stillbirths (Figure 2.19).

 

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Malaria, especially when complicated by placental malaria, is also a major cause of stillbirths and abortions (
Figure 2.20)

 

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Lyme disease and African tick-borne relapsing fever are also associated with stillbirths.

 

In one large American study bacterial infections were the single most important cause of perinatal mortality (Figure 2.21). In developing countries, there is some evidence that infection is present in a significant number of stillbirths (Figure 2.22, 2.23)

 

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In order to reduce antepartum stillbirths, antenatal care must focus on the problems cited above (
Figure 2.24). Intrapartum stillbirths almost certainly can be reduced by appropriate obstetrical care including the use of caesarian section (Figures 2.25, 2.26).

 

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