Original Research

Preventing antenatal stillbirths: An innovative approach for primary health care

Tsakane M. Hlongwane, Tanita Botha, Bongani S. Nkosi, Robert C. Pattinson
South African Family Practice | Vol 64, No 1 : Part 3| a5487 | DOI: https://doi.org/10.4102/safp.v64i1.5487 | © 2022 Tsakane M. Hlongwane, Tanita Botha, Bongani S. Nkosi, Robert C. Pattinson | This work is licensed under CC Attribution 4.0
Submitted: 04 January 2022 | Published: 25 August 2022

About the author(s)

Tsakane M. Hlongwane, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; and, Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; and, Maternal and Infant Health Care Strategies Research Unit, South African Medical Research Council, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
Tanita Botha, Department of Statistics, Faculty of Natural Sciences and Agricultural Sciences, University of Pretoria, Pretoria, South Africa
Bongani S. Nkosi, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; and, Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; and, Maternal and Infant Health Care Strategies Research Unit, South African Medical Research Council, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
Robert C. Pattinson, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; and, Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; and, Maternal and Infant Health Care Strategies Research Unit, South African Medical Research Council, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa

Abstract

Background: In South Africa (SA), approximately 16 000 stillbirths occur annually. Most are classified as unexplained and occur in district hospitals. Many of these deaths may be caused by undetected foetal growth restriction. Continuous wave Doppler ultrasound of the umbilical artery (CWDU-UmA) is a simple method for assessing placental function. This screening method may detect the foetus at risk of dying and growth-restricted foetuses, allowing for appropriate management.

Methods: A cohort study was conducted across South Africa. Pregnant women attending primary health care clinics at 28–34 weeks gestation were screened using CWDU-UmA. Women not screened at those antenatal clinics served as control group 1. Control group 2 consisted of the subset of control group 1 with women detected with antenatal complications excluded. Women with foetuses identified with an abnormal CWDU-UmA test were referred and managed according to a standardised protocol. A comparison between the study and control groups was performed.

Results: The study group consisted of 6536 pregnancies, and there were 66 stillbirths (stillbirth rate [SBR]: 10.1/1000 births). In control group 1, there were 193 stillbirths in 10 832 women (SBR: 17.8/1000 births), and in control group 2, 152 stillbirths in 9811 women (SBR: 15.5/1000 births) (risk ratio: 0.57, 95% confidence intervals: 0.29–0.85 and 0.65, 0.36–0.94, respectively).

Conclusion: Screening a low-risk pregnant population identified the low-risk mother with a high-risk foetus, and acting on the information as described was associated with a significant reduction (35% – 43%) in stillbirths. This demonstrates a step-change reduction in stillbirths and warrants screening in SA.


Keywords

antenatal care; pregnancy; primary healthcare clinics; stillbirths; Doppler; umbilical artery blood flow; foetal growth restriction

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