Clinical epidemiology of intrapartum stillbirths in The Gambia and Burkina Faso: Descriptive cohort analysis from PregnAnZI-2 clinical trial

IntroductionWest Africa has the highest intrapartum stillbirth rate globally, yet there is limited understanding of regional clinical and epidemiological risk factors. Local data on intrapartum stillbirth rates and risk factors is urgently needed to address the knowledge gap, identify vulnerable sub-groups, and inform policy to reduce stillbirth rates in West Africa. MethodsThis descriptive cohort study is a secondary analysis of data collected in the framework of a randomised clinical trial, conducted between 2017 and 2021 in The Gambia and Burkina Faso. Pregnant women considered to be low-risk for intrapartum complications and their offspring were enrolled during labour at ten primary and secondary health facilities in The Gambia and Burkina Faso. Intrapartum stillbirth was detected prospectively. Associations between independent clinical and socio-demographic factors and intrapartum stillbirth were determined using logistic regression models, informed by a novel conceptual framework. Results11,983 women and their 12,198 offspring were included in this analysis. We identified 93 intrapartum stillbirths, representing a rate of 7.6/1000 total births. Pre-conception and antepartum risk factors for intrapartum stillbirth were identified as: parity (p=0.02), with highest risk for primiparous women compared to parity of 2 (aOR 4.16, 95% CI 1.71-10.14); history of previous stillbirth (aOR 8.75, 95% CI 4.88 - 15.67) or previous caesarean section (aOR 4.52, 95% CI 1.53 - 13.33); maternal antibiotics before labour (aOR 4.67, 95% CI 1.10-19.86); twin births (aOR 3.53, 95% CI 1.73 - 7.21); and extremes of birth weight, for both macrosomia (aOR 4.97, 95% CI 1.74-14.17) and low birth weight (LBW)(aOR 1.91, 95% CI 1.07-3.40). ConclusionThis study confirms that intrapartum stillbirths are a major public health problem in rural and urban West Africa. Early identification of at-risk women and pregnancies (e.g., history of previous stillbirth or caesarean section, twins, foetal macrosomia, or LBW) with enhanced antenatal monitoring and planning for safe delivery could reduce intrapartum stillbirth rates in the region.