Critical Assessment of Causes and Patterns of Stillbirths at Tertiary Care Hospital

Background: Stillbirth is a global health issue affecting over 7000 families daily, with emotional, social, and economic consequences. Stillbirth rate was 18.4 per 1000 births worldwide. India has the highest number of stillbirths, with 592-100 deaths per year. The Indian Newborn Action Plan aims to reduce stillbirths to <10 per 1000 births by 2030. However, knowledge about distal risk factors, such as socioeconomic, lifestyle, and comorbidities, is limited. Aim: To analyze the causes, preventability, and patterns of stillbirths, evaluate maternal, fetal, and institutional factors contributing to it, and propose actionable interventions. Methods: A retrospective study was conducted on all stillbirths over 28 weeks at a hospital Dr. RMLIMS, Gomtinagar, Lucknow using delivery registers, case files, and perinatal audit forms as data sources. Results: Out of 7024 deliveries, stillbirth rate was 78.30/1000 total births. Cause of intrapartum stillbirth showed statistically significant correlation with patient’s place of residence (rural>urban), distance of health centre from her house, time taken to reach first point of contact and her parity. The major obstetrical causes of stillbirth identified were APH 22.36%, hypertensive disorders of pregnancy 19.27%, IUGR 15.27%, unexplained causes 11.09%, malpresentations 9.64%, rupture uterus 9.09% and obstructed labour 6.36%. Severe anemia was found in 24.91% as an associated obstetrical cause of stillbirth. Conclusion: Stillbirth rates in India are higher than in developed countries, with antepartum obstetric complications being the most common. Intrapartum causes of stillbirth, such as obstructed labor and rupture uterus, account for 15.45% of cases, indicating the need for improved healthcare services to reduce stillbirth rates in developing countries.