Causes of and factors associated with stillbirth in low- and middle-income countries: a systematic literature review

Aminu, Mamuda ORCID: https://orcid.org/0000-0002-2335-7147, Unkels, Regine, Mdegela, Mselenge ORCID: https://orcid.org/0000-0002-0374-6583, Utz, Bettina, Adaji, Sunday and Van Den Broek, Nynke ORCID: https://orcid.org/0000-0001-8523-2684 (2014) 'Causes of and factors associated with stillbirth in low- and middle-income countries: a systematic literature review'. BJOG: An International Journal of Obstetrics & Gynaecology, Vol 121, Issue S4, pp. 141-153.

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Abstract

Background
Annually, 2.6 million stillbirths occur worldwide, 98% in developing countries. It is crucial that we understand causes and contributing factors.

Methods
We conducted a systematic review of studies reporting factors associated with and cause(s) of stillbirth in low- and middle-income countries (2000–13). Narrative synthesis to compare similarities and differences between studies with similar outcome categories.

Main results
A total of 142 studies with 2.1% from low-income settings were investigated; most report on stillbirths occurring at health facility level. Definition of stillbirth varied; 10.6% of studies (mainly upper middle-income countries) used a cut-off point of ≥22 weeks of gestation and 32.4% (mainly lower income countries) used ≥28 weeks of gestation. Factors reported to be associated with stillbirth include poverty and lack of education, maternal age (>35 or <20 years), parity (1, ≥5), lack of antenatal care, prematurity, low birthweight, and previous stillbirth. The most frequently reported cause of stillbirth was maternal factors (8–50%) including syphilis, positive HIV status with low CD4 count, malaria and diabetes. Congenital anomalies are reported to account for 2.1–33.3% of stillbirths, placental causes (7.4–42%), asphyxia and birth trauma (3.1–25%), umbilical problems (2.9–33.3%), and amniotic and uterine factors (6.5–10.7%). Seven different classification systems were identified but applied in only 22% of studies that could have used a classification system. A high percentage of stillbirths remain ‘unclassified’ (3.8–57.4%).

Conclusion
To build capacity for perinatal death audit, clear guidelines and a suitable classification system to assign cause of death must be developed. Existing classification systems may need to be adapted. Better data and more data are urgently needed.

Item Type:	Article
Subjects:	WA Public Health > WA 30 Socioeconomic factors in public health (General) WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WA Public Health > Statistics. Surveys > WA 950 Theory or methods of medical statistics. Epidemiologic methods WQ Obstetrics > Pregnancy > WQ 200 General works WQ Obstetrics > Pregnancy Complications > WQ 225 Spontaneous abortion. Fetal death
Faculty: Department:	Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):	https://doi.org/10.1111/1471-0528.12995
Depositing User:	Caroline Hercod
Date Deposited:	01 Oct 2014 10:35
Last Modified:	17 Jul 2020 10:59
URI:	https://archive.lstmed.ac.uk/id/eprint/4463

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