An Analysis of Cause of Stillbirth in a Tertiary Care Hospital of Delhi: A Contribution to the WHO SEARO Project

  • Abha Singh
  • Manisha KumarEmail author
Original Article



Over 98% of the world’s total stillbirths are believed to occur in developing countries and still have received very little research, programmatic or policy attention.

Aims and Objective

To collect data on epidemiological profile of cases experiencing stillbirths, to assess the associated antenatal high risk factors present and to find out the probable cause of stillbirth.

Materials and Methods

This was a cross-sectional, observational study, which was done as part of WHO SEARO project after ethical clearance. The study included all stillbirths which occurred in the hospital during the study period August 2015–February 2017. Antenatal records were reviewed; maternal investigations were done. Baby was examined after delivery. Pre-structured pro forma was filled for every case. Finally, the relevant condition found was classified under CODAC system of stillbirth classification.


Out of 20,580 deliveries, 600 (2.9%) were stillborn. Maternal cause was noted in 145/600 (24.2%) cases, fetal cause was noted in 181/600 (30.2%), and placental and cord origins were suspected in 128/600 (21.3%) and 12/600 (2%) cases, respectively. In 72/600 (12.0%) cases the reason for stillbirth was unknown and unclassifiable. Among the maternal causes the most common was hypertension (89/600, 14.8%) followed by infection including fever (5.7%); the most common infection was hepatitis. Among the fetal causes birth defect was the most common (106/600, 17.7%) followed by extreme prematurity in 42/600 (7.0%).


Birth defects were the most important fetal cause of stillbirth; hypertension in pregnancy and fetal growth restriction were important associated factors.


Causes of stillbirth CODAC classification Birth defect Fetal growth restriction 



The funding was provided by WHO SEARO (Grand No. PDS_DOCS/B5226).

Compliance with Ethical Standards

Conflict of interest

There is no conflict of interest among authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Liu L-C, Wang Y-C, Mu-Hsien Yu, et al. Major risk factors for stillbirth in different trimesters of pregnancy: a systematic review. Taiwan J Obstet Gynecol. 2014;53:141–5.CrossRefGoogle Scholar
  2. 2.
    McClure EM, Goldenberg RL. Stillbirth in developing countries: a review of causes, risk factors and prevention strategies. J Matern Fetal Neonatal Med. 2009;22(3):183–90.CrossRefPubMedCentralGoogle Scholar
  3. 3.
    Kumbhare SA, Maitra NK. Aetiological classification of stillbirths: a case control study. J Obstet Gynaecol India. 2016;66(6):420–5.CrossRefGoogle Scholar
  4. 4.
    DiMario S, Say L, Lincetto O. Risk factors for stillbirth in developing countries: a systematic review of the literature. Sex Transm Dis. 2007;34(7 Suppl):S11–21.CrossRefGoogle Scholar
  5. 5.
    McClure EM, Wright LL, Goldenberg RL, et al. The global network: a prospective study of stillbirths in developing countries. Am J Obstet Gynecol. 2007;197(3):247.e1-5.CrossRefGoogle Scholar
  6. 6.
    Korde-Nayak VN, Gaikwad PR. Causes of stillbirth. J Obstet Gynecol India. 2018;58(4):314–8.Google Scholar
  7. 7.
    Kochar PS, Dandona R, Kumar GA, et al. Population-based estimates of still birth, induced abortion and miscarriage in the Indian state of Bihar. BMC Pregnancy Childbirth. 2014;14:413.CrossRefPubMedCentralGoogle Scholar
  8. 8.
    Frøen JF, Pinar H, Flenady V, et al. Causes of death and associated conditions (Codac): a utilitarian approach to the classification of perinatal deaths. BMC Pregnancy Childbirth. 2009;10(9):22.CrossRefGoogle Scholar
  9. 9.
    Korejo R, Bhutta S, Noorani KJ, et al. An audit and trends of perinatal mortality at the Jinnah Postgraduate Medical Centre, Karachi. J Pak Med Assoc. 2007;57(4):168–72.Google Scholar
  10. 10.
    Prassana N, Mahadevappa K, Antaratani RC, et al. Cause of death and associated conditions of stillbirths. Int J Reprod Contracept Obstet Gynecol. 2015;4(6):1970–4.CrossRefGoogle Scholar
  11. 11.
    Goldenberg RL, McClure EM, Saleem S, et al. Infection-related stillbirths. Lancet. 2010;6736(09):61712–8.Google Scholar
  12. 12.
    Goldenberg RL, McClure EM, Bann CM. The relationship of intrapartum and antepartum stillbirth rates to measures of obstetric care in developed and developing countries. Acta Obstet Gynecol Scand. 2007;86(11):1303–9.CrossRefGoogle Scholar
  13. 13.
    Fauveau V. New indicator of quality of emergency obstetric and newborn care. Lancet. 2007;307:1310.CrossRefGoogle Scholar
  14. 14.
    Dandona R, Kumar GA, Kumar A, et al. Identification of factors associated with stillbirth in the Indian state of Bihar using verbal autopsy: a population-based study. PLoS Med. 2017;14(8):e1002363.CrossRefPubMedCentralGoogle Scholar
  15. 15.
    Newtonraj A, Kaur M, Gupta M, et al. Level, causes, and risk factors of stillbirth: a population-based case control study from Chandigarh, India. BMC Pregnancy Childbirth. 2017;17(1):371.CrossRefPubMedCentralGoogle Scholar

Copyright information

© Federation of Obstetric & Gynecological Societies of India 2018

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyLady Hardinge Medical CollegeNew DelhiIndia

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