Prevalence of Stillbirths during COVID-19 Pandemic at a Tertiary Referral Centre in Central Kerala, India: A Cross-sectional Study

Introduction: Stillbirth is defined as a baby born with no signs of life after a given threshold. It is a sensitive indicator of quality of care received by the mother during antepartum and intrapartum period. There has been a renewed focus on stillbirth in the backdrop of COVID-19 pandemic, as pregnant women are at an increased risk for severe form of COVID-19 and are associated with adverse perinatal outcomes.

Aim: To estimate the prevalence of stillbirths and its characteristics during the pandemic and also, to classify the causes of stillbirths according to the International Classification of Diseases for use in Perinatal Mortality (ICD-PM) classification.

Materials and Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at Government Medical College, Thrissur, Kerala, India, during the COVID-19 pandemic from 1st August 2021 to 30th July 2022. A total of 106 mothers, who gave birth to stillbirths after 28 weeks of gestation were included in the study. When gestational age was not sure, stillbirth weighing more than 500 grams was considered as the inclusion criteria. Foetus, placenta, cord and membranes were examined after the delivery. The parameters studied were age, domicile, income, gestational age, order of pregnancy, mode of delivery, timing of foetal death, baby weight, gender, presence of anomalies and maternal medical complications. The causes were classified according to International Classification of Diseases-10-to Perinatal Mortality (ICD-PM) classification system. Categorical variables were assessed by Chi-square test and continuous variables were assessed by unpaired Student’s t-test.

Results: There were 106 stillbirths with a Stillbirth Rate (SBR) of 38.78 per 1000 births. Major proportions of stillbirths were antepartum. Mean maternal age was 28.7±4.7 years. There were 73 (68.86) rural women and 33 (31.1%) urban women with stillbirths. A total of 90 (84.9%) cases were referral, while 16 (15.1%) were registered in the Institute for antenatal care. A total of 67 (63.2%) stillborns were male babies, but there was no significant difference in SBR, according to the order of pregnancy. Causes were classified according to the ICD-PM classification system. Hypertensive disorders in pregnancy (36.79%) and the foetal growth restriction (39.62%) were the common maternal and foetal condition identified among the cases. There were 22 COVID-19 positive cases, but they were also having hypertension as co-morbidity.

Conclusion: In present study, antepartum stillbirth was the commonest type and occurred mostly in referral cases from periphery. Hypertensive diseases in pregnancy and foetal growth restriction were the leading causes. Early detection of high-risk conditions and timely referral, may reduce the rate of stillbirth.