Stillbirths in urban Guinea-Bissau: A hospital- and community-based study

BackgroundStillbirth rates remain high in many low-income settings, with fresh (intrapartum) stillbirths accounting for a large part due to limited obstetrical care. We aimed to determine the stillbirth rate and identify potentially modifiable factors associated with stillbirth in urban Guinea-Bissau.MethodsThe study was carried out by the Bandim Health Project (BHP), a Health and Demographic Surveillance System site in the capital Bissau. We assessed stillbirth rates in a hospital cohort consisting of all deliveries at the maternity ward at the National Hospital Simão Mendes (HNSM), and in a community cohort, which only included women from the BHP area. Stillbirth was classified as fresh (FSB) if fetal movements were reported on the day of delivery.ResultsFrom October 1 2007 to April 15 2013, a total of 38164 deliveries were registered at HNSM, among them 3762 stillbirths (99/1000 births). Excluding deliveries referred to the hospital from outside the capital (9.6%), the HNSM stillbirth rate was 2786/34490 births (81/1000). During the same period, 15462 deliveries were recorded in the community cohort. Of these, 768 were stillbirths (50/1000).Of 11769 hospital deliveries among women from Bissau with data on fetal movement, 866 (74/1000) were stillbirths, and 609 (70.3%) of these were FSB, i.e. potentially preventable. The hospital FSB rate was highest in the evening from 4 pm to midnight (P = 0.04). In the community cohort, antenatal care (ANC) attendance correlated strongly with stillbirth reduction; the stillbirth rate was 71/1000 if the mother attended no ANC consultations vs. 36/1000 if she attended ≥7 consultations (PConclusionIn Bissau, the stillbirth rate is alarmingly high. The majority of stillbirths are preventable FSB. Improving obstetrical training, labour management (including sufficient intrapartum monitoring and timely intervention) and hospital infrastructure is urgently required. This should be combined with proper community strategies and additional focus on antenatal care.

背景：死胎率在众多低收入地区仍居高不下，其中因产科护理资源匮乏导致的产时新鲜死胎占比极高。本研究旨在明确几内亚比绍市区的死胎率，并识别与死胎相关的潜在可干预因素。
方法：本研究由位于首都比绍的健康与人口监测系统（Health and Demographic Surveillance System）站点班蒂姆健康项目（Bandim Health Project, BHP）开展。研究分别对两个队列进行死胎率评估：一是西芒·门德斯国家医院（National Hospital Simão Mendes, HNSM）产科病房所有分娩病例组成的医院队列；二是仅纳入班蒂姆健康项目覆盖区域内女性的社区队列。若产妇在分娩当日报告有胎儿活动，则将死胎归类为新鲜死胎（Fresh Stillbirth, FSB）。
结果：2007年10月1日至2013年4月15日期间，西芒·门德斯国家医院共登记38164例分娩病例，其中死胎3762例，发生率为99‰。剔除从首都以外转诊至该院的分娩病例（占比9.6%）后，该医院的死胎率为81‰（2786/34490）。同期社区队列共记录15462例分娩，其中死胎768例，发生率为50‰。在11769例来自比绍本地、且有胎儿活动记录的医院分娩病例中，866例为死胎（74‰），其中609例（70.3%）为新鲜死胎，即具备潜在可预防性。医院的新鲜死胎发生率在当日下午4点至午夜时段最高（P=0.04）。在社区队列中，产前检查（Antenatal Care, ANC）就诊情况与死胎率降低显著相关：未接受任何产前检查的产妇其死胎率为71‰，而就诊次数≥7次的产妇死胎率仅为36‰（原文P值未完整给出）。
结论：比绍地区的死胎率高得令人担忧，且大部分死胎为可预防的新鲜死胎。当前亟需加强产科培训、产程管理（包括充分的产时监护与及时干预）以及医院基础设施建设，同时应配套完善社区相关策略，并进一步强化产前检查工作。