Fetal outcome in severe maternal morbidity: too many stillbirths.

OBJECTIVE

We determined the stillbirth rates among singleton births in Gambian hospitals. Contribution of severe obstetric complications was given special attention.

DESIGN

A multi-center retrospective review.

SETTING

Three obstetric referral hospitals.

SAMPLE: Fetal outcomes in 826 women with severe maternal morbidity out of 3,280 singleton deliveries.

METHODS

All women with severe maternal morbidity reported in the investigated hospitals between January and June 2006 were identified and their cases reviewed. For each case, information about fetal outcome and the mother's age, parity, obstetric complications and delivery mode was abstracted from maternity records. Main outcome measures. Stillbirth rates and the impact of health service factors.

RESULTS

There were excessively high stillbirth rates with an eight-fold increased risk among women with severe obstetric complications (310/1,000 births), compared to women without complications (51/1,000 births). Hemorrhage, anemia, sepsis and hypertensive pregnancy disorders were associated with higher stillbirth rates. Dystocia cases had a relatively lower stillbirth rate. In women with severe obstetric complications, vaginal delivery was associated with a four-fold increased risk of stillbirth compared to cesarean section.

CONCLUSION

Severe maternal morbidity has significant impact on stillbirth rates. Better access to emergency obstetric care and improved intrapartum care will significantly reduce stillbirth rates in poor settings of the world, such as The Gambia.