What is stillbirth?

• A stillbirth is a baby born with no signs of life. Different countries use different cut-offs for the minimum number of weeks the pregnancy must have lasted to be classified as a stillbirth, with earlier pregnancy losses considered ‘miscarriages’. The World Health Organization (WHO) defines a stillbirth as a baby born with no signs of life at or after 22 weeks of pregnancy, but recommends that a 28-week cut-off be used for international comparison.
• In Kenya, a stillbirth is defined as a baby who is born without any signs of life after 28 weeks of pregnancy or in the 3rd trimester.
• Any baby who is born without any signs of life before 28 weeks is considered to be a miscarriage. A late miscarriage is one that happens after the first 12 weeks of pregnancy, but before 28 weeks. The impact of these losses can be just as significant as the impact of stillbirths, and may also lead to intense psychological pain for the affected families.
• In high-income countries, pregnancy losses from 20 or 22 weeks are frequently counted as stillbirths. This lower cutoff period is related to the more advanced technology and healthcare provided to many women in these countries before and during pregnancy, which helps to ensure that babies born at lower gestational ages might survive birth in some cases even though unlikely.

• Using the WHO international comparison definition of stillbirth, there were two million stillbirths globally in 2019 alone.
• In comparison, there are also about 2.4 million babies who died during the first month of their life in 2019, of whom 1 million died on their day of birth.

Source: A neglected Tragedy: The global burden of stillbirths; Report of the UN Inter-agency Group for Child Mortality Estimation, 2020/UNICEF, WHO, WB, UN

• In sub-Saharan Africa, the stillbirth rate is 21 per 1,000 total births. This is seven times higher than the stillbirth rate in high-income countries in Europe, Northern America, Australia and New Zealand, where it is just 3 per 1,000 total births.
• In Kenya, the stillbirth rate is 19 per 1,000 total births. This represents a huge burden for bereaved families.
  

Adapted Source: https://www.who.int/images/default-source/infographics/stillbirth/stillbirth-vulnerable-populations.jpg?sfvrsn=6b919f76_4

• It is devastating to experience a stillbirth. It’s okay to want to understand why the baby died. Stillbirths are caused by various factors; some are known while others are unknown. Approximately 1 in 3 stillbirths do not have known causes, even in high-income settings with advanced technology and comprehensive investigation.
• Globally, an estimated 42% of all stillbirths are intrapartum (i.e. baby born with no signs of life who was alive at the start of labor).
• An estimated 729,000 babies died during labor in 2019 in sub-Saharan
• Africa and Southern Asia, accounting for 88% of all intrapartum stillbirths worldwide.
• In Kenya, 53% of stillbirths occurred during labor and birth, while 47% occurred during pregnancy.
• Many stillbirths are potentially preventable. For example, stillbirths that occur during labor and birth are among the most preventable stillbirths, as long as proven interventions that improve the health of mothers and their babies are available and accessed.
• The causes of stillbirths in Kenya are similar to global causes of stillbirth.

Stillbirth can occur during pregnancy and prior to birth, before labor begins (antepartum stillbirth)

It can also occur during labor and birth (intrapartum stillbirth)

• Obstetric complications, such as problems with placental development leading to vaginal bleeding or failure of transmission of nutrients to the baby.
• Hypertensive disorders, commonly known as pre-eclampsia and eclampsia, conditions in pregnancy characterized by high blood pressure.
• Medical complications such as HIV, anemia, chronic hypertension, malaria, gestational diabetes mellitus, sexually transmitted infections and bacterial infections.
• Other causes include but are not limited to:
  • Problems with the womb.
  • Preterm labor complications.
  • Problems with the umbilical cord.
  • Birth defects that occur as the baby develops in the womb.
  • IUGR (intrauterine growth restriction, also known as fetal growth restriction), which is when a baby does not grow as expected.

   

Causes of 229 stillbirths in four tertiary hospitals in Nairobi, Kenya (2018-2019)

Source: Gwako GN, Were F, Obimbo MM, Kinuthia J, Gachuno OW, Gichangi PB. Association between utilization and quality of antenatal care with stillbirths in four tertiary hospitals in a low-income urban setting. Acta obstetricia et gynecologica Scandinavica. 2021;100(4):676-83.

Source: McClure EM, Saleem S, Goudar SS, Garces A, Whitworth R, Esamai F, et al. Stillbirth 2010-2018: a prospective, population-based, multi-country study from the Global Network. Reproductive health. 2020;17(Suppl 2):146.

• Risk factors are characteristics associated with, but not direct causes of, stillbirth. Risk factors for stillbirth are described below.
• Lack of access to skilled care at birth and emergency obstetrical care such as Caesarean section if needed.
  • In Kenya, over 1/3 of all women are not attended by a skilled birth attendant. Since complications associated with birth are one of the main causes of stillbirth, the presence of a skilled birth attendant is often important to provide effective care and prevent stillbirth.
• Socio-demographic factors, including rural residence, low socioeconomic status, lack of education, and poor nutrition.
  • Socio-economic status can affect a mother’s access to quality healthcare
  • Level of education may affect parents’ knowledge of pregnancy health and danger signs
• Inadequate support from her partner may affect the health of the mother, leading to psychological challenges which can ultimately affect her physiological health.
• Short inter-pregnancy intervals and prior stillbirths have also been associated with increased risk of stillbirth.

The most common risk factors for stillbirths in Kenya include:

• The lack of a skilled birth attendant
• Multiple pregnancies such as twins
• Low socioeconomic status
• Poor nutrition
• Advanced maternal age (typically considered to be greater than 35 years of age)
• Poor infrastructure for maternity care

Source: Froen JF, Cacciatore J, McClure EM, Kuti O, Jokhio AH, Islam M, et al. Stillbirths: why they matter. Lancet. 2011;377 (9774): 1353-66.

Talking about stillbirth:

• What are some of the common causes of stillbirths?
• After your stillbirth experience, were you able to understand the cause(s) or possible risk factors?
• If so, has this changed how you think about or experience any subsequent pregnancies?
• How can some stillbirths be prevented?