Stillbirth in a Tertiary Care Referral Hospital in North Bengal - A Review of Causes, Risk Factors and Prevention Strategies

Background and Aims: Stillbirth is one of the most common adverse outcomes of pregnancy, accounting for half of all perinatal mortality. Each year approximately 4 million stillbirths are reported, with 97% occurring in developing countries. The objective of the present study was to evaluate the stillbirth rate, exploring the risk factors and causes of stillbirth and suggest policies to reduce it. Settings and Design: A retrospective study of stillbirth among all deliveries over 5 years at North Bengal Medical College, a referral tertiary care teaching hospital in a rural background. The stillbirth rate and its trend were defined and the probable causes and risk factors were identified. Results: Stillbirth rate is 59.76/1000 live births, and Perinatal Mortality 98.65/1000 births. Of the still births, 59.72% were fresh and 40.27% were macerated. Among the causes of stillbirths, poor antenatal attendance and low socioeconomic status were important; other risk factors included prematurity, PIH, birth asphyxia, poor intrapartum care including prolonged and obstructed labour. In 23% cases, the cause remained unexplained. Conclusion: In addition to poor antenatal care, low socioeconomic condition, poor referral service, suboptimal intrapartum care in health facilities including tertiary centre were mainly responsible for majority of still births which could have been prevented. We speculate that upgrading the existing health system performance, particularly high quality intrapartum care by skilled health personnel, will reduce stillbirths substantially in our institut

A randomized trial of intravenous labetalol & oral nifedipine in severe pregnancy induced hypertension

Background: Hypertension is the most frequently encountered medical disorder in obstetrics practice & remain a major cause of maternal, fetal & neonatal morbidity & mortality. The present study was undertaken to compare the time taken to reach the therapeutic goal blood pressure after using intravenous labetalol & oral nifedipine in severe pregnancy induced hypertension.Methods: Randomly allocated patients received labetalol 20 mg initially, followed by escalating doses of 40, 80, 80 & 80 mg & a placebo tablet every 20 minutes or initially nifedipine tablet 10 mg orally with repeated doses of 20 mg every 20 minutes up to 5 doses & intravenous placebo 0.9% isotonic saline until the therapeutic goal blood pressure, Systolic ≤ 150 mmHg & diastolic ≤ 100 mmHg was achieved. Primary and secondary outcomes like the time interval required to achieve a blood pressure of ≤150/100 mmHg and urinary output, agent failure & adverse effects respectively were reported.Results: Patients received oral nifedipine achieved the goal therapeutic blood pressure more rapidly in 28.2±11.7 minutes (mean±SD) as compared with 48.4±23.5 minutes in those received intravenous labetalol (p=0.001). The nifedipine group also required significantly fewer doses (3.5±0.5 vs 4.5±1.5; p=0.001) to reach the goal blood pressure. Urine output was significantly increased (p<0.001) at one hour after nifedipine therapy (95.6±1.2) compared with labetalol (41.9±1.6 ml) & remained significantly increased at 4,8,16&24 hours after initial therapy. Few adverse effects were reported but not significant. No patients required cross over therapy.Conclusions: Oral nifedipine & intravenous labetalol regimens are effective in the management of severe hypertension in pregnancy; however nifedipine controls hypertension more rapidly & is associated with a significant increase in urinary output