Stillbirths by maternal-obstetric characteristics and Robson classification system: a cross-sectional study from eight district hospitals in Bangladesh.

BACKGROUND

Understanding maternal-obstetric determinants is key to stillbirth prevention. The Robson classification system enables monitoring and identification of high-risk groups. This study examined the prevalence and distribution of antepartum and intrapartum stillbirths by maternal-obstetric characteristics and Robson groups in district hospitals of Bangladesh.

METHODS

We conducted a cross-sectional analysis using prospectively collected data from Phases 4 and 5 (August 2022-June 2023) of a multi-phase implementation research study on the Robson classification system in eight district hospitals. All deliveries at ≥ 28 weeks of gestation were included, classified as live births, antepartum stillbirths (death before onset of labour), and intrapartum stillbirths (death after onset of labour). Descriptive analyses estimated stillbirth prevalence by timing, maternal and obstetric factors, and Robson groups. Associations were assessed using χ2 tests.

RESULTS

Out of 15 529 deliveries, 3.9% were stillbirths (56.6% intrapartum and 43.4% antepartum). Stillbirth prevalence varied across facilities (0.9-6.6%). A higher stillbirth burden was significantly associated (P < 0.05) with advanced maternal age (>34 years), preterm birth, lack of antenatal care, non-use of the partograph, and low birthweight. Breech presentation, induced labour, and vaginal delivery had the highest stillbirth percentage. Timing of stillbirth differed significantly by foetal presentation, onset of labour, and mode of delivery (P < 0.05). Stillbirth prevalence varied across Robson groups (0-17.5%). Intrapartum stillbirths predominated in Groups 1, 3, 6 and 8, while Group 10 was largely antepartum-dominated.

CONCLUSIONS

Stillbirth remains a substantial burden in district-level hospitals in Bangladesh, with most deaths occurring during the intrapartum period and marked variation across facilities and Robson groups. The findings highlight preventable gaps in antenatal screening, labour monitoring, and timely emergency obstetric care. Application of the Robson classification system enables precise identification of high-risk obstetric groups for targeted quality-improvement interventions to reduce preventable stillbirths and accelerate progress toward national and global stillbirth reduction targets.