Lancet Journal On Stillbirths

Social Issues Status of Children

Main Highlights:

An estimated 2.6 million third trimester stillbirths occurred in 2015 across the world. Most stillbirths (98%) occur in low and middle income countries.
India continues to be at the top of the table in the rank for number of stillbirths in 2015, recording 5,92,100, followed by Nigeria, Pakistan, China and Ethiopia. Cultural taboos and superstitions often take the blame in the case of stillbirth.
Many disorders associated with stillbirths are potentially modifiable and often coexist — maternal infections, non-communicable diseases, nutrition, lifestyle factors and maternal age older than 35 years.
Five priority areas to change the stillbirth trend include intentional leadership; increased voice, especially of women; implementation of integrated interventions with commensurate investment; indicators to measure effect of interventions and especially to monitor progress; and investigation into crucial knowledge gaps. The post-2015 agenda represents opportunities for all stakeholders to act together to end all preventable deaths, including stillbirths.

Stillbirth:The birth of an infant that has died in the womb (strictly, after having survived through at least the first 28 weeks of pregnancy).

Main Causes of Stillbirth:

Bleeding (haemorrhage) before or during labour
Placental abruption –where the placenta separates from the womb before the baby is born (this may be associated with bleeding or abdominal pain)
Pre-eclampsia – a condition that causes high blood pressure in the mother
A problem with the umbilical cord, which attaches the placenta to the baby's tummy button – the cord can slip down through the entrance of the womb before the baby is born (cord prolapse), or it can be wrapped around the baby and become knotted
Intrahepatic cholestasis of pregnancy (ICP) or obstetric cholestasis – a liver disorder during pregnancy characterised by severe itching
A genetic physical defect in the baby
Pre-existing diabetes
Infection in the mother that also affects the baby

Analysis:

There is a need of maintaining meticulous records of all births and deaths (maternal and foetal) in order to increase the availability of data, rationalising that while data alone will not help save lives
Causal pathways for stillbirth frequently involve impaired placental function, either with growth restriction, or preterm labour or both.
Prenatal health is a crucial biological foundation to life-long health. A key priority is to integrate action for prenatal health within the continuum of care for maternal and newborn health.
Still, specific actions for stillbirths are needed for advocacy, policy formulation, monitoring, and research, including improvement in the dearth of data for effective coverage of proven interventions for prenatal survival.
Indirect and intangible costs of stillbirth are extensive and are usually met by families alone. This issue is particularly onerous for those with few resources. Negative effects, particularly on parental mental health, might be moderated by empathic attitudes of care providers and tailored interventions. The value of the baby, as well as the associated costs for parents, families, care providers, communities, and society, should be considered to prevent stillbirths and reduce associated morbidity.
Strong leadership is needed worldwide and in countries. Institutions with a mandate to lead global efforts for mothers and their babies must assert their leadership to reduce stillbirths by promoting healthy and safe pregnancies.

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