MATERNAL SOCIO-DEMOGRAPHIC DETERMINANTS OF STILLBIRTH : A HOSPITAL BASED STUDY

RESULTS

In the present study, the overall proportion of stillbirth was found to be 13.7%. It was observed that stillbirth was more among mothers in the age group of <20 years (60.4%). [Table 1] The association between mother's age and stillbirth was found to be statistically significant (p<0.05). Education of mother came out to be a favorable factor for pregnancy outcome. Stillbirth was high among illiterate mothers (53.4%) and as the level of education increased the percentage of stillbirth decreased. This association came out to be significant (p<0.01). The statistical association between SLI of mother and stillbirth was also statistically significant (p<0.05). Among the total mothers whose pregnancy ended into stillbirth, nearly 63% belonged to low SLI group. Father's education showed no statistically significant association with the stillbirth. Tobacco consumption by the mothers during pregnancy had detrimental effect on pregnancy outcome, nearly 58% of stillbirths were among the mothers who consumed tobacco in any form during their ante natal period and this association came out to be statistically significant (p<0.05).
Nearly 63% of the pregnancy among primiparous mothers ended into stillbirth. [Table 2] this association between parity and stillbirth was statistically significant (P<0.05). Stillbirth was high (54%) among mothers delivering at <37 weeks of gestation and this association between gestational week at delivery and stillbirth came out to be statistically significant (p<0.05). Nearly (56%) of stillbirth were seen among mothers who had a previous history of stillbirth and this association was statistically significant (p<0.05). Our study revealed that maternal anaemia was an unfavorable factor for the pregnancy outcome. Almost 51% of mothers with haemoglobin level less than 7 gm% delivered stillbirth baby, this association between haemoglobin level and stillbirth was statistically significant (p<0.05). No statistically significant association was seen between inter pregnancy interval and stillbirth. Among the mothers who did not receive any ANC almost 66% of them delivered a stillbirth baby , this association between ANC visits received by mother and stillbirth was statistically significant (p<0.01).

DISCUSSION

Out of total 314 mothers delivered in our institutional hospital 271(86.3%) gave live births while the pregnancy of 43 (13.7%) mothers ended into still birth.
This high proportion of still birth in tertiary hospitals may be explained by late referrals or admission of the high risk birthing mothers from the community to the hospital. This indicates lack of awareness regarding risk factors of still birth and their grave outcome among the birth attendants and the community.
Mothers whose pregnancy ended into still birth, majority belonged to the age group of <20 years (60.47%) followed by mothers belonging to age group of >30 years, 10 (23.26%) and 7 (16.28%) mothers belonged to the age group of 20-30 years. Khandait et al, also found that still birth rate was high among mothers who

were teenagers.22 Rahman et al, McClure et al, Bhattacharya et al  found statistically significant association between advanced maternal age and still birth.18,17,14 still birth. 15 Bapat et al reported that age was not associated with The percentage of mothers whose pregnancy ended into still birth was more 58.14% among those who were consuming tobacco than who were not consuming tobacco (16.61%). Similar finding was reported by Gupta PC et al, while Mishra et al reported that there was no effect of tobacco on still birth. 25,26 The percentage of still birth was high 53.49% among mothers who were illiterate, this percentage decreased as level of education of mothers increased. Thus it was observed the percentage of still birth was high among illiterate mothers. This association came out to be statistically significant (P<0.05). These findings corroborate findings from other studies by Korde-Nayak et al, McClure et al, Rahman et al, Vidyadhar et al, while Kumar et al did not find parental literacy to have any influence on still birth. 19,17,18,16,27
The percentage of still birth was high 39.53 % among mothers who had low standard of living index followed by 34.88% among mothers who had medium standard of living index, while 25.58% of mothers who had still birth had high SLI. There was statistically significant association between economic status and still birth. Korde-Nayak et al, Bapat et al, Bhattacharya et al, Vidyadhar et al found statistically significant association between economic status and still birth. 19,15,14,16 Low family income acts as hindering factor for early decision to seek care and thereby delay to receive care.
Among the total 43 still births maximum number of mothers i.e. 27 (62.79%) were primipara followed by grand- multipara 11 (25.58%) and multipara 5 (11.63%). Thus it was observed that among mothers for whom it was first pregnancy and for mothers who had 4 or more children there was high percentage of still birth. There is statistically significant association between parity and still birth which was also found by study done

Among the still births majority were pre-term 23 (53.49%) while term and post-term were 17 (39.53%) and 3 (6.98%) respectively. It was observed that statistically significant association exists between prematurity and still birth. Similar findings were observed by Rahman et al, Vidyadhar et al. 18,16
In our study we found that there exists no association between inter-pregnancy interval and pregnancy outcome. William et al in their study found higher percentage of still birth when inter pregnancy interval was less than one year, while Kumar et al reported that, short inter pregnancy was not associated with still birth.21,27

History of still birth was present in 9 (56.25%) of mothers who gave still birth while mothers who gave live births this history of still birth was present only in 28.42% of them. There was statistically significant association between history of still birth in previous pregnancies and still birth in present pregnancy. Similar finding was observed by Korde-Nayak et al, Bapat et al in their studies. 19,15
It was observed that among the mothers who did not receive ante natal care, 31 (65.96%) had still births. While the mothers who had received ante natal care 12 (4.49%) had still birth. The present study revealed that infrequent or no ANC visits during pregnancy were associated with substantially increased risk of foetal death. These results are in agreement with studies done by Korde-Nayak et al, Rahman et al, Vidyadhar et al and Bapat et al. 19,18,16,15
Majority of mothers whose pregnancy ended into still birth 22 (51.16%) had haemoglobin <7 gm%, while Hb level of 7-10 gm%, 10-11 gm% and >11 gm% was found in 14 (32.56%), 6 (13.95%) and 1 (2.33%) respectively. Thus it was observed that still birth was high among anaemic mothers, and the finding was statistically significant. Vidyadhar et al found similar finding in their study. 16

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