Determining the cause of stillbirth in Kumasi, Ghana

Abstract

Objective: To classify cause-of-death (COD) for stillbirths occurring in a major referral hospital in Kumasi, Ghana. Methods: In a retrospective review conducted between June 8, 2011, and June 12, 2012, detailed information was collected on all stillbirths delivered at Komfo Anokye Teaching Hospital in Kumasi, Ghana. Patient records were independently reviewed by investigators using the Perinatal Society of Australia and New Zealand's Perinatal Death Classification system to determine COD for each case.Results: COD was analyzed in 465 stillbirth cases. The leading causes of death were hypoxic interpartum death (105, 22.6%), antepartum hemorrhage (67, 14.4%), hypertension (52, 11.2%), and perinatal infection (32, 6.9%). One hundred and fifty seven (33.8%) stillbirths were classified as unexplained antepartum deaths. Conclusions: This evaluation of stillbirth in a busy, tertiary care hospital in Kumasi,Ghana provides crucial insight into the high volume of stillbirth in Ghana as well as its medical causes. The study demonstrated the high rate of stillbirth attributed to hypoxic intrapartum events, placental abruption, pre-eclampsia, and unspecified bacterial infections. Yet, our rate of unexplained stillbirths underscores the need for a stillbirth classification system that thoughtfully integrates the needs and limitations of low-resource settings as unexplained stillbirth rates are a common indicator of the effectiveness of a classification system.

Multilevel analysis of factors predicting pregnancy loss experiences among pregnant women in Ghana: a further analysis of nationally representative data

“…From the introduction above, it could be clearly seen that although globally the incidence and prevalence of pregnancy loss (stillbirth, miscarriage, and abortion) is low, the situation seems to be different on the side in developing countries, in sub-Saharan Africa and Ghana in particular. Most hospital-based studies on pregnancy loss experiences among women in Ghana have clearly shown that there is a high rate of pregnancy loss experience among women [20][21][22] .…”

“…A hospitalbased study found that 54.8% of stillborns were males and 45.2% were females. In addition, 55.9% of the stillbirths were macerated, and 44.1% were fresh stillbirths [20] . The same study found that low maternal educational level, low socioeconomic status, and late and irregular antenatal attendance were present in the majority of the mothers who had stillbirths.…”

Beyond counting induced abortions, miscarriages and stillbirths to understanding their risk factors: analysis of the 2017 Ghana maternal health survey

“…Various issues surround the recording and classification of induced abortions, miscarriages and stillbirths in most low and middle-income countries, including Ghana [14]. These include limited early evaluation and documentation of risk factors, limited early dating to prevent post-date miscarriages and stillbirths, a limited availability of diagnostic testing, a large proportion of deliveries occurring outside of health facilities, lack of early identification of fetal distress and prompt delivery of such foetuses [15] and incomplete health records.…”

“…Despite the wide recognition that stillbirths, induced abortions and miscarriages are common adverse pregnancy outcomes in Ghana [14,16], it appears empirical data on their risk factors are scanty. The few studies that have been carried out have found socio-economic (level of education, place of residence, wealth status, media exposure), demographic (age, religious beliefs, occupation) and biological (parity) predictors of stillbirths, induced abortions and miscarriages in Ghana [14][15][16][17][18][19][20][21][22].…”

The causes of stillbirths in south Asia: results from a prospective study in India and Pakistan (PURPOSe)

“…Although advances have been made in reducing child mortality in this region, the numbers and rates of stillbirths remain high. 1 , 2 , 3 The causes of stillbirth in this region, as in most low-income and middle-income countries (LMICs), are mostly identified with verbal autopsy or clinical determination. 4 , 5 , 6 Compared with other causes of death, an accurate cause cannot often be identified through verbal autopsy or clinical observation, and, in some settings, more than 75% of all stillbirths have unknown causes.…”