The global network: a prospective study of stillbirths in developing countries

Objective Our goal was to determine stillbirth rates in a multisite population-based study in community settings in the developing world. Study Design Outcomes of all community deliveries in 5 resource-poor countries (Democratic Republic of Congo, Guatemala, India, Zambia, and Pakistan) and in 1 mid-level country (Argentina) were evaluated prospectively over an 18-month period. Births of >1000 g with no signs of life were defined as stillbirth. Results Outcomes of 60,324 deliveries were included. Stillbirth rates ranged from 34 per 1000 in Pakistan to 9 per 1000 births in Argentina. Increased stillbirth rates were associated significantly with lower skilled providers, out-of-hospital births, and low cesarean section rates. Maceration was present in 17.2% of stillbirths. Conclusion The stillbirth rates among births of ≥1000 g in these developing countries were substantially higher than reported stillbirth rates in developed countries (3-5/1000 births). Because most developed countries define stillbirth as ≥20 weeks of gestation or ≥500 g and because almost one-half of all stillbirths are