What is the True Fresh Stillbirth Rate and How Can Fresh Stillbirths Be Prevented?

Session: New Horizons in Measurement for Maternal and Newborn Health

Presenter: Hege Langli Ersdal, Stavanger University Hospital
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Background: Annually, an estimated 1.2 million fresh stillbirths (FSB) and 1 million early neonatal deaths (END) occur on the birthday. The progression to FSB and/or END after intrapartum hypoxia is likely part of the same end process. This presentation will address the misclassification of FSB and END, how these deaths can be prevented, and how misclassifications influence resuscitation measurement and NMR, often used as key coverage indicators.

Methodology: This abstract summarizes findings from several studies in Tanzania: 1) The Safer Births project, at two referral hospitals (Muhimbili and Haydom) to evaluate new equipment for better fetal heart rate (FHR) monitoring (a multi-crystal automatic Doppler versus hand-held devices) and Helping Babies Breathe (HBB) practice (dry-electrode sensors for immediate HR detection). 2) The HBB multicenter study, led by the Ministry of Health; a) phase I, to evaluate the impact of HBB training and b) phase II, to evaluate the importance of FHR monitoring and timely obstetrical actions.

Results: 1) Among 349 babies receiving resuscitation at Haydom, providers classified 15 END within 2 hours and 16 FSB. However, 12/15 END and 10/16 FSB had HR at birth, recorded by the HR-sensor. 2a) Following HBB training, END was reduced by 47% and FSB by 26%.1 2b) The risk of FSB increases significantly with FHR abnormalities, labor complications, and transfer.2 For FHR measurements, a multi-crystal Doppler is easier and faster than hand-held devices.

Conclusions: The true FSB and END rates are probably not known. Correct classification of FSB and END in the delivery room is very difficult, and misclassifications are likely to influence NMR. This is a crucial issue to address when measuring coverage of resuscitation and monitoring progress toward global targets. Prevention of FSB and END is possible through a combined strategy of clinical risk identification, early detection of FHR abnormalities and expedited delivery.