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The burden of misclassification of antepartum stillbirth in Nepal.
Gurung, Rejina; Litorp, Helena; Berkelhamer, Sara; Zhou, Hong; Tinkari, Bhim Singh; Paudel, Prajwal; Malla, Honey; Sharma, Srijana; Kc, Ashish.
Afiliação
  • Gurung R; Research, Golden Community, Lalitpur, Nepal.
  • Litorp H; Department of Global Health, Karolinska Institutet, Stockholm, Sweden.
  • Berkelhamer S; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
  • Zhou H; Department of Pediatrics, University at Buffalo, Buffalo, New York, United States.
  • Tinkari BS; Department of Maternal and Child Health, Peking University of Health Sciences, Peking, China.
  • Paudel P; Ministry of Health and Population, Kathmandu, Nepal.
  • Malla H; Ministry of Health and Population, Kathmandu, Nepal.
  • Sharma S; Research, Golden Community, Lalitpur, Nepal.
  • Kc A; Research, Golden Community, Lalitpur, Nepal.
BMJ Glob Health ; 4(6): e001936, 2019.
Article em En | MEDLINE | ID: mdl-31908870
ABSTRACT

BACKGROUND:

Globally, every year 1.1 million antepartum stillbirths occur with 98% of these deaths taking place in countries where the health system is poor. In this paper we examine the burden of misclassification of antepartum stillbirth in hospitals of Nepal and factors associated with misclassification.

METHOD:

A prospective observational study was conducted in 12 hospitals of Nepal for a period of 6 months. If fetal heart sounds (FHS) were detected at admission and during the intrapartum period, the antepartum stillbirth (fetal death ≥22 weeks prior labour) recorded in patient's case note was recategorised as misclassified antepartum stillbirth. We further compared sociodemographic, obstetric and neonatal characteristics of misclassified and correctly classified antepartum stillbirths using bivariate and multivariate analysis.

RESULT:

A total of 41 061 women were enrolled in the study and 39 562 of the participants' FHS were taken at admission. Of the total participants whose FHS were taken at admission, 94.8% had normal FHS, 4.7% had abnormal FHS and 0.6% had no FHS at admission. Of the total 119 recorded antepartum stillbirths, 29 (24.4%) had FHS at admission and during labour and therefore categorised as misclassified antepartum stillbirths. Multivariate analysis performed to adjust the risk of association revealed that complications during pregnancy resulted in a threefold risk of misclassification (adjusted OR-3.35, 95% CI 1.95 to 5.76).

CONCLUSION:

Almost 25% of the recorded antepartum stillbirths were misclassified. Improving quality of data is crucial to improving accountability and quality of care. As the interventions to reduce antepartum stillbirth differ, accurate measurement of antepartum stillbirth is critical. TRIAL REGISTRATION NUMBER ISRCTN30829654.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Tipo de estudo: Observational_studies Idioma: En Revista: BMJ Glob Health Ano de publicação: 2019 Tipo de documento: Article País de afiliação: Nepal

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Tipo de estudo: Observational_studies Idioma: En Revista: BMJ Glob Health Ano de publicação: 2019 Tipo de documento: Article País de afiliação: Nepal