Epidemiological Profile, Histopathological Causes, and Modifiable Risk Factors of Stillbirth in Secondary Obstetric Care

Abstract

Background:
Antenatal fetal death remains a major obstetric tragedy requiring rigorous etiology analysis to refine preventive protocols in secondary healthcare facilities.
Objectives: To evaluate the epidemiological profile, cause structure, and independent risk factors of stillbirth in an urban secondary care obstetric hospital.
Materials and methods: A case-control study was performed including 65 cases of antenatal fetal death (case group) and 195 uncomplicated full-term deliveries (control group). Maternal medical and obstetric history, pregnancy course, and placental histopathological findings were evaluated.
Results: The stillbirth rate was 8.2 per 1,000 total births. Primary histopathological causes were severe placental insufficiency with fetal hypoxia (41.5%), placental abruption (23.1%), and major congenital malformations (12.3%). Multivariable analysis identified independent risk factors for fetal death: lack of regular antenatal care (OR = 4.25; 95% CI: 1.82–9.91; p < 0.001), fetal growth restriction (FGR) (OR = 3.84; p = 0.002), preeclampsia (OR = 3.12; p = 0.008), and a history of chromosomal abnormalities (OR = 2.75; p = 0.024).
Conclusions: Suboptimal antenatal care and unrecognized fetal growth restriction are principal modifiable risk factors for stillbirth, highlighting the need for enhanced ultrasonographic and clinical surveillance in the second and third trimesters.

Keywords:
Stillbirth, Antenatal Fetal Death, Placental Insufficiency, Fetal Growth Restriction, Secondary Care.