Maternal, newborn, child and adolescent health

Stillbirths

Definition

The definition recommended by WHO for international comparison is a baby born with no signs of life at or after 28 weeks' gestation.

Incidence

In 2009 there was over 2.6 million stillbirths globally, with more than 8 200 deaths a day. The majority of these deaths occur in developing countries. Ninety-eight percent occurred in low- and middle-income countries. At least half of all stillbirths occur in the intrapartum period, representing the greatest time of risk. Intrapartum deaths account for 45% of third-trimester stillbirths globally but only 14% of third-trimester deaths in developed countries.

Distribution

Two-thirds of stillbirths occur in south-east Asia and Africa and 55% occur in rural families from these areas. This reflects a similar distribution of maternal deaths and correlates with areas of low-skilled health professional attendants at birth. The stillbirth rate in sub-Saharan Africa is approximately 10 times that of developed countries (28 vs. 3 per 1 000 births).

Trends

Worldwide, the stillbirth rate has declined by 14% from 1995 to 2009, representing an annual decline of 1.1% per year. The improvement in stillbirth rate is less in developing countries. The rate of decline in the African region is 0.7% compared to 3.8% in the Western Pacific region.

Causes of stillbirth

The major causes of stillbirth include:

  • childbirth complications
  • maternal infections in pregnancy
  • maternal disorders (especially hypertension and diabetes)
  • fetal growth restriction
  • congenital abnormalities.

Almost half of stillbirths happen when the woman is in labour.

The majority of stillbirths are preventable, evidenced by the regional variation across the world. The rates correlate with access to maternal healthcare. Despite similar disparities for maternal and neonatal deaths, which are currently being addressed under the Millennium Development Goals, stillbirths remain an invisible public health priority.

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