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Review
. 2019 Aug;43(5):308-314.
doi: 10.1053/j.semperi.2019.03.021. Epub 2019 Mar 16.

Challenges in classification and assignment of causes of stillbirths in low- and lower middle-income countries

Jacquelyn K Patterson  1 , Aleha Aziz  2 , Melissa S Bauserman  3 , Elizabeth M McClure  4 , Robert L Goldenberg  2 , Carl L Bose  3
Affiliations
Review

Challenges in classification and assignment of causes of stillbirths in low- and lower middle-income countries

Jacquelyn K Patterson et al. Semin Perinatol. 2019 Aug.

Abstract

Stillbirths account for 2.6 million deaths annually. 98% occur in low- and lower middle-income countries. Accurate classification of stillbirths in low-resource settings is challenged by poor pregnancy dating and infrequent access to electronic heart rate monitoring for both the newborn and fetus. In these settings, liveborn infants may be misclassified as stillbirths, and stillbirths may be misclassified as miscarriages. Causation is available for only 3% of stillbirths globally due to the absence of registration systems. In low-resource settings where culture and autopsy are infrequently available, clinical course is used to assign cause of stillbirth. This method may miss rare or subtle causes, as well as those with non-specific clinical presentations. Verbal autopsy is another technique for assigning cause of stillbirth when objective medical data are limited. This method requires family engagement and physician attribution of cause. As interventions to reduce stillbirths in LMICs are increasingly implemented, attention to accurate classification and assignment of causes of stillbirth are critical to charting progress.

Keywords: Low-resource setting; Stillbirth.

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Figures

Fig. 1.
Fig. 1.
World Health Organization recommendations for classification of mortality of the fetus and newborn based on timing of demise.
See this image and copyright information in PMC

References

    1. Blencowe H, Cousens S, Jassir FB, et al. National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis. Lancet Glob Health. 2016;4(2):e98–e108. - PubMed
    1. Lawn JE, Blencowe H, Waiswa P, et al. Stillbirths: rates, risk factors, and acceleration towards 2030. Lancet. 2016;387(10018):587–603. - PubMed
    1. Saleem S, Tikmani SS, McClure EM, et al. Trends and determinants of stillbirth in developing countries: results from the Global Network’s Population-Based Birth Registry. Reprod Health. 2018;15(Suppl 1):100. - PMC - PubMed
    1. McClure EM, Goldenberg RL. Improved data informs efforts to end preventable stillbirths. Lancet Glob Health. 2016;4(2):e70–71. - PubMed
    1. Copper RL, Goldenberg RL, DuBard MB, Davis RO. Risk factors for fetal death in white, black, and Hispanic women. Collaborative Group on Preterm Birth Prevention. Obstet Gynecol. 1994;84(4):490–495. - PubMed

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