Risk Factors for Antepartum Stillbirth at a Tertiary Care Teaching Hospital in Nepal – A Case Control Study

Introduction: Antepartum stillbirths are a major contributor to perinatal mortality, especially in low-resource settings like Nepal. This study aimed to identify maternal and fetal risk factors associated with antepartum stillbirths at a tertiary care hospital. Methods: A retrospective case-control study was conducted at Patan Hospital from May 2021 to May 2024. All women with antepartum stillbirths at ≥ 28 weeks gestation or fetal weight ≥ 1000 g were included as cases. For each case, two women with singleton live births delivered immediately after the stillbirth were selected as controls. Data were analyzed using multivariable logistic regression to determine independent predictors. Results: A total of 423 participants (141 cases, 282 controls) were included. On multivariable analysis, significant predictors of antepartum stillbirth were hypertensive disorders of pregnancy (AOR 29.46; 95% CI: 3.00– 288.8), diabetes mellitus (AOR 7.78; 95% CI: 1.77–34.17) and intrauterine growth restriction (AOR 5.95; 95% CI: 1.43–24.76). Each additional week of gestation reduced the odds of stillbirth by 37% (AOR 0.63; 95% CI: 0.478–0.836; P < 0.001). Other variables such as anemia, lesser than 4 ANC visits, oligohydramnios, and low birth weight were not statistically significant in the adjusted model. Conclusions: Hypertensive disorders, diabetes mellitus, intrauterine growth restriction, and shorter period of gestation were major predictors of antepartum stillbirth. Early detection and management of these risk factors may help reduce stillbirth rates in similar settings.