Stillbirth in cases of severe acute maternal morbidity

Objective: To determine the incidence and correlates of stillbirths among women with severe acute maternal morbidity (SAMM). Methods: In an observational study of 728 women who had SAMM between January 2007 and December 2010 at a referral tertiary health facility in Benin, Nigeria, the incidence of stillbirth, and the clinical and demographic correlates of stillbirth were evaluated. Results: The rate of stillbirth among women with SAMM was 210 per 1000 deliveries. The rate among women who had uterine rupture (643 per 1000 deliveries) far exceeded other cause-specific rates of stillbirth. Unbooked status (odds ratio [OR], 2.2; 95% confidence interval [Cl], 1.3-3.8), low maternal education (OR, 2.1; 95% Cl, 1.2-4.0), vaginal delivery (OR, 8.1; 95% Cl, 5.1-13.0), and maternal comorbidity (OR, 12.9; 95% Cl, 6.2-26.9) were factors associated with stillbirth after adjusting for confounding variables. Conclusion: In Nigeria, SAMM was found to be associated with an unacceptably high rate of stillbirth. Strategies to improve fetal surveillance among women with SAMM are necessary to address the excessively high incidence of stillbirth among these patients. (c) 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.