{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T16:57:56Z","timestamp":1770137876032,"version":"3.49.0"},"reference-count":32,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2016,10,5]],"date-time":"2016-10-05T00:00:00Z","timestamp":1475625600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Stillbirths are among the most common adverse pregnancy outcomes, with 98% occurring in low\u2010income countries. More than one\u2010third occur in sub\u2010Saharan Africa (<jats:styled-content style=\"fixed-case\">SSA<\/jats:styled-content>). However, the medical conditions causing stillbirths and interventions to reduce stillbirths from these conditions are not well documented. We estimated the reductions in stillbirths possible with combinations of interventions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>We developed a computerised model to estimate the impact of various interventions on stillbirths caused by the most common conditions. The model considered the location of obstetric care (home, clinic or hospital) and each intervention's efficacy, penetration and utilisation. Maternal transfers were also considered.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting and population<\/jats:title><jats:p>Pregnancies in <jats:styled-content style=\"fixed-case\">SSA<\/jats:styled-content> in 2012.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>For each condition, we created a series of scenarios involving different combinations of interventions and modelled their impact on stillbirth rates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Stillbirths associated with various maternal and fetal conditions and the percentage reduction with various interventions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eight to ten maternal and fetal conditions were responsible for most stillbirths, but none for more than 15%. The most common conditions causing stillbirths in <jats:styled-content style=\"fixed-case\">SSA<\/jats:styled-content> include obstructed labour and uterine rupture, fetal distress and umbilical cord complications, fetal growth restriction, pre\u2010eclampsia\/eclampsia, and placental abruption\/placenta praevia. Syphilis and malaria contribute smaller numbers. Reducing stillbirths requires appropriate diagnosis and management of each condition, usually including hospital care for monitoring and delivery, often by caesarean section. Maternal syphilis and malaria were the only conditions for which outpatient management alone reduced stillbirth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Most stillbirths in low\u2010income countries occur at term and during labour and therefore are preventable by appropriate obstetric care. Management focused on the maternal and fetal conditions that cause stillbirths is necessary to achieve stillbirth rates approaching those found in high\u2010income countries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>Reducing stillbirth incidence requires appropriate management of each causative condition and often caesarean delivery.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.14304","type":"journal-article","created":{"date-parts":[[2016,10,12]],"date-time":"2016-10-12T18:29:23Z","timestamp":1476296963000},"page":"119-129","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Clinical interventions to reduce stillbirths in sub\u2010Saharan Africa: a mathematical model to estimate the potential reduction of stillbirths associated with specific obstetric conditions"],"prefix":"10.1111","volume":"125","author":[{"given":"RL","family":"Goldenberg","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Columbia University New York NY USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"JB","family":"Griffin","sequence":"additional","affiliation":[{"name":"Statistical, Social and Environmental Health Sciences RTI International Durham NC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"BD","family":"Kamath\u2010Rayne","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Cincinnati Cincinnati OH USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M","family":"Harrison","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Columbia University New York NY USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"DJ","family":"Rouse","sequence":"additional","affiliation":[{"name":"Statistical, Social and Environmental Health Sciences RTI International Durham NC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K","family":"Moran","sequence":"additional","affiliation":[{"name":"Statistical, Social and Environmental Health Sciences RTI International Durham NC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B","family":"Hepler","sequence":"additional","affiliation":[{"name":"Statistical, Social and Environmental Health Sciences RTI International Durham NC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"AH","family":"Jobe","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Cincinnati Cincinnati OH USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"EM","family":"McClure","sequence":"additional","affiliation":[{"name":"Statistical, Social and Environmental Health Sciences RTI International Durham NC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,10,5]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)62310-0"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)62187-3"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2013-305557"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0412.2011.01275.x"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.1823"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-9-24"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181e7d975"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)62269-6"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2012.10.030"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.328.7454.1490"},{"key":"e_1_2_7_12_1","unstructured":"[http:\/\/mnhtech.org\/]. 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