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The burden of misclassification of antepartum stillbirth in Nepal
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration. Department of Global Health, Karolinska Institutet.ORCID iD: 0000-0001-7164-598X
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2019 (English)In: BMJ Global Health, E-ISSN 2059-7908, Vol. 4, no 6, article id e001936Article in journal (Refereed) Published
Abstract [en]

Background Globally, every year 1.1 million antepartum stillbirths occur with 98% of these deaths taking place in countries where the health system is poor. In this paper we examine the burden of misclassification of antepartum stillbirth in hospitals of Nepal and factors associated with misclassification.

Method A prospective observational study was conducted in 12 hospitals of Nepal for a period of 6 months. If fetal heart sounds (FHS) were detected at admission and during the intrapartum period, the antepartum stillbirth (fetal death ≥22 weeks prior labour) recorded in patient’s case note was recategorised as misclassified antepartum stillbirth. We further compared sociodemographic, obstetric and neonatal characteristics of misclassified and correctly classified antepartum stillbirths using bivariate and multivariate analysis.

Result A total of 41 061 women were enrolled in the study and 39 562 of the participants’ FHS were taken at admission. Of the total participants whose FHS were taken at admission, 94.8% had normal FHS, 4.7% had abnormal FHS and 0.6% had no FHS at admission. Of the total 119 recorded antepartum stillbirths, 29 (24.4%) had FHS at admission and during labour and therefore categorised as misclassified antepartum stillbirths. Multivariate analysis performed to adjust the risk of association revealed that complications during pregnancy resulted in a threefold risk of misclassification (adjusted OR-3.35, 95% CI 1.95 to 5.76).

Conclusion Almost 25% of the recorded antepartum stillbirths were misclassified. Improving quality of data is crucial to improving accountability and quality of care. As the interventions to reduce antepartum stillbirth differ, accurate measurement of antepartum stillbirth is critical.

Place, publisher, year, edition, pages
2019. Vol. 4, no 6, article id e001936
National Category
Public Health, Global Health, Social Medicine and Epidemiology
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URN: urn:nbn:se:uu:diva-399600DOI: 10.1136/bmjgh-2019-001936ISI: 000505580600048PubMedID: 31908870OAI: oai:DiVA.org:uu-399600DiVA, id: diva2:1378551
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Swedish Research CouncilAvailable from: 2019-12-13 Created: 2019-12-13 Last updated: 2020-03-23Bibliographically approved

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