ABSTRACT
SCOPE OF THE PROBLEM Worldwide, there are between three and four million stillbirths delivered each year, 98% of these deaths occur in the developing world. The majority of these deaths could be potentially preventable if women had access to a skilled birth attendant and emergency services (such as having access to cesarean section and antibiotics).(1)
The Uncounted It is clear that stillbirths are universally undercounted, especially at lower ages of gestation. This is particularly true in developing countries where a substantial proportion of births occur at home. With the low literacy rates, the babies that are eventually registered represent only a fraction of those who were born, with those born dead or those that died soon after birth being uncounted. In many developing countries, there are no national requirements to register stillbirths so estimates are made, either from surveys or by extrapolating from neonatal or infant death. Typically, the stillbirth rate in developing countries is greater than the neonatal death rate. As advances in obstetrics occur, both the neonatal and stillbirth rates decrease but the stillbirths less so, leaving this the largest contributor to perinatal mortality.(2, 3)
The estimates of the global burden of stillbirth are significantly hampered by the lack of a uniform definition. While a moderate proportion of countries have adopted the WHO’s definition of the stillbirth (≥ 500 grams, or if the weight is not known, with a gestational age >22 completed weeks [154 days]), the gestational age that divides a miscarriage from a stillbirth is often legally defined within a country.(4) Most developing countries do not collect data from fetal losses before 28 weeks or babies weighing < 1,000 grams because whether born alive or dead, a premature baby is unlikely to survive in a setting of very limited resources. Even within the United States, there are significant variations about what is defined as a stillbirth from State to State and these definitions can substantially change the reported stillbirth rate by as much as 50%.(5) So for these reasons, international comparison of stillbirth rates must be done with caution. Given these limitations however, the estimated stillbirth rates from some developing on average are five times that of developed countries (6) (Table 6.1). The maternal mortality rates vary with the stillbirth rate, and depend largely if a woman has access to antenatal care, a skilled birth attendant and to the availability to cesarean section.
