Targeted Patient Education—A Critical Step Toward Reducing Stillbirth Rates

Jonathan Youxiang Han, Eugene Youjin Huang, Kok Hian Tan

Abstract

Aim: To review all cases of stillbirths that occurred in KK Women’s and Children’s Hospital between January 2004 and December 2008, and conduct a critical analysis of epidemiologic factors, possible causes, and suboptimal factors relating to stillbirths.

Materials and Methods: Case records of 216 stillbirths were peer reviewed and assessed for the level of care, causative factors of stillbirths, and whether any case was preventable. The stillbirths were then classified using the KK Hospital Stillbirth Classification.

Results: The incidence rate of stillbirths was 3.5 per 1000 births. A total of 52 patients (24.1% of the stillbirth cases) had not received antenatal care at our hospital and 55 (25.5%) of the total stillbirth cases were unexplained. Of the 216 cases, 123 (56.9%) had suboptimal factors in their management—52 cases (24.1%) were classified as suboptimal factor grade 2 (regarded as may be preventable) and 48 cases (22.2 %) were suboptimal factor grade 3 (regarded as could have been prevented). Patients themselves were responsible for the suboptimal management of their pregnancies in 113 (52.3%) cases. The medical team was responsible in 10 (4.6%) cases. Preventable causes include uncontrolled diabetes (10 [4.6%]) and severe hypertensive disease (18 [8.3%]).

Conclusions: A significant proportion (46.3%) of stillbirths, about half of which (22.2%) had a clearly avoidable factor, could have been prevented. Patient factors that led to suboptimal management contributed to another significant proportion (52.3%) of stillbirths. Thus, patient education and motivation are critical to lowering the stillbirth rate.

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