Stillbirth is an adverse pregnancy outcome of public health importance causing considerable psychosocial burden for parents and their family (1-3). In 2015, the global stillbirth rate (SBR) was approximately 18·4 per 1000 births, 25.5% reduction from what was in 2000. Two-third of the world’s total stillbirths occurred in . Globally, the Every Newborn Action Plan advocates the target of achieving 12 or fewer stillbirths per 1000 births in every country by 2030 (5). In resource poor settings, stillbirths are under studied and under reported despite their high burden and low reduction rates over years. This is because of various factors such as less attention given to the problem by health systems, inadequate reporting and poor access to quality obstetric care services (6). Most stillbirths can be prevented by existing public health measures. However, the prevalence of stillbirths remains unacceptably high in resource poor settings despite the presence of high impact interventions. Stillbirths are classified as ante partum stillbirths and intra partum stillbirths depending on the time of the incident. Ante partum stillbirth occurs before the onset of labour, whereas intra partum stillbirth is the death of fetus after the onset of labour but before birth (7).
In resource-constrained settings, about half of stillbirths occur during labour or birth (1), and intra partum stillbirths are a commonly reported adverse birth outcome. Reports show that about 1.3 million intra partum stillbirths occurred in 2015 (8). Intra partum stillbirths represent poor access to maternal care services and delays in getting appropriate obstetric care, particularly at health facilities. Intra partum stillbirth can be diagnosed with careful measurement of fetal heartbeat at onset of labour. In settings with poor access to skilled attendant during labour and poor practice of monitoring the fetal heartbeat, clinical indicators such as the skin appearance of the fetus (being macerated or unmacerated) help to identify intra partum stillbirths (5). Thus, the unmacerated or fresh skin appearance can be used as an indicator of intra partum fetal death, while the macerated skin appearance could indicate stillbirths that occur before the onset of labour. Evidence shows that signs of skin maceration begin at 6-12 hours after fetal death although this measure could miss deaths occur at home and those who come after 12 hours due to delays in getting care and access to skilled attendance (9).
The burden of stillbirths varies between and within countries and the variations could be because of differences in the distribution of risk factors such as socio-demographic characteristics, fetal medical conditions, environmental exposures and psychosocial stressors (5, 10-12). Maternal factors, for example, older age (above 35 years), obesity and smoking increase the risk of fetal death (3, 11). Null parity, grand multiparity, obstructed labor, prolonged labour, placental abruption, placenta previa, preterm labor, premature rupture of membrane, and intrauterine growth restriction are common obstetric factors associated with an increased risk of stillbirths, particularly in resource poor settings (12-15).
Other maternal medical conditions such as thyroid diseases, cardiovascular disorders, asthma, kidney diseases, and diabetes also increase the risk of stillbirths (15-18). Congenital anomalies of fetus (12), fetal-maternal hemorrhage (15, 19), and maternal infections such as malaria and syphilis also contribute to the risk of stillbirths in high burden areas (15).
In Ethiopia, the proportion of births attended by skilled attendants was only 28% (20), and the country was in the 5th place in number of stillbirths in the world in 2015 (5). Moreover, the rate of stillbirth in Ethiopia was stable over decades without being declined with the average annual reduction rate (ARR) of three percent (21, 22). The ARR of stillbirth in Ethiopia is lower than the reduction rate of some sub-Saharan African countries and the global ARR (5). There are also variations in proportions of stillbirth and perinatal mortality within the country (20). Studies from Ethiopia reported that the stillbirth rates ranged from 25/1000 births in Addis Ababa (21) to 85/1000 births in Amhara region (23). A disproportionate burden of stillbirths in the country could be attributed to a poorly-equipped maternal health care services, poor access to and coverage of skilled attendance at birth, late referral, long distance to referral facilities, poor transport facility and poor quality of obstetric care services. Moreover, modifiable risk factors such as sever pre-eclampsia, maternal convulsion, placental abruption, cord accidents, lack of antenatal follow-up and low birth weight were also reported (3, 21).
Studies on stillbirth are scarce in southern Ethiopia and existing evidence focuses on neonatal and perinatal mortalities though stillbirths account for about half of perinatal deaths (6). An assessment of the burden of stillbirths and associated factors in health care settings helps in devising strategies for tailored interventions in order to improve pregnancy outcomes (5). In this study, we aimed to assess the magnitude of stillbirths and associated socio-demographic and obstetric factors in Yirgalem Hospital, southern Ethiopia.