Stillbirths at the National Referral Hospital in Bhutan: a historical description of the rate and related factors, 2006-2008

Abstract

Introduction: A fetal death or stillbirth is a baby born weighing >500 grams and with no signs of life at or after 28 weeks of gestation.

Methods: This was a cross-sectional survey to estimate the rate of stillbirths and a case series study to describe all stillbirths occurring at Bhutan’s national referral centre, Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), from June 2006 to July 2008. Ethical approval was granted by the Ministry of Health. All pregnant women who had stillbirths with fetuses weighing >500 grams were included. Antenatal and socio-demographic details and examination of the newborn were abstracted from records.

Results: There were 96 stillbirths among 5,417 births at JDWNRH, for a rate of 17.72 per 1,000 births. The mean age of women with stillbirths was 26.5 years (range 15 to 44 years). The majority of stillbirths occurred in women aged between 20 to 34 years and in primipara. The majority (87.5%) of the women had at least one antenatal visit, 69.8% had at least two visits while 12.5% had zero antenatal visits. At birth, there were 39 fresh stillbirths and 57 macerated. Seventy-six stillborn babies (79.2%) had weight lesser than 2500 grams. The most common cause was congenital infections, severe pregnancy induced hypertension, prelabour premature rupture of membranes, chorioamnionitis, and prolonged rupture of membranes. Congenital anomalies causing death was relatively lower in rank. The proportion of unexplained stillbirths was 15.6%.

Conclusions: The rate of stillbirth was substantially high in our population. Many of the causes of stillbirth were preventable and measures can be reinforced to improve birth outcomes.