{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T17:55:25Z","timestamp":1786730125811,"version":"build-2736575974"},"reference-count":32,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2021,8,8]],"date-time":"2021-08-08T00:00:00Z","timestamp":1628380800000},"content-version":"unspecified","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,7,31]]},"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Stillbirth is one of the vital indicators of quality care. This study aimed to determine maternal-fetal characteristics and causes of stillbirth in Nepal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Secondary analysis of single-centred registry-based surveillance data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>The study was conducted at the Department of Obstetrics and Gynecology, Chitwan Medical College Teaching Hospital, a tertiary care hospital located in Bharatpur, Nepal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>All deliveries of intrauterine fetal death, at or beyond 22 weeks\u2019 period of gestation and\/or birth weight of 500 g or more, conducted between 16 July 2017 and 15 July 2019 were included in the study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>The primary outcome measure of this study was stillbirth, and the secondary outcome measures were maternal and fetal characteristics and cause of stillbirth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Out of 5282 institutional deliveries conducted over 2\u2009years, 79 (1.5%) were stillbirths, which gives the stillbirth rate of 15 per 1000 births. Of them, the majority (75; 94.9%) were vaginal delivery and only four (5.1%) were caesarean section (p&lt;0.0001). The proportion of the macerated type of stillbirth was more than that of the fresh type (58.2% vs 41.8%; p=0.13). Only half of the mothers who experienced stillbirth had received antenatal care. While the cause of fetal death was unknown in one-third of cases (31.6%; 25\/79), among likely causes, the most common was maternal hypertension (29.1%), followed by intrauterine infection (8.9%) and fetal malpresentation (7.6%). Four out of 79 stillbirths (5%) had a birth defect.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>High rate of stillbirths in Nepal could be due to the lack of quality antenatal care. The country\u2019s health systems should be strengthened so that pregnancy-related risks such as maternal hypertension and infections are identified early on. Upgrading mothers\u2019 hygiene and health awareness is equally crucial in reducing fetal deaths in low-resource settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-045012","type":"journal-article","created":{"date-parts":[[2021,8,9]],"date-time":"2021-08-09T13:59:32Z","timestamp":1628517572000},"page":"e045012","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Maternal and fetal characteristics and causes of stillbirth in a tertiary care hospital of Nepal: secondary analysis of registry-based surveillance data"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8317-5388","authenticated-orcid":false,"given":"Basant","family":"Sharma","sequence":"first","affiliation":[{"name":"Obstetrics and Gynecology, Chitwan Medical College, Bharatpur, Chitwan, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6843-6677","authenticated-orcid":false,"given":"Suraj","family":"Bhattarai","sequence":"additional","affiliation":[{"name":"Global Health, Global Institute for Interdisciplinary Studies, Kathmandu, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabita","family":"Shrestha","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, Chitwan Medical College, Bharatpur, Chitwan, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rakshya","family":"Joshi","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, Chitwan Medical College, Bharatpur, Chitwan, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renuka","family":"Tamrakar","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, Chitwan Medical College, Bharatpur, Chitwan, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prekshya","family":"Singh","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, Chitwan Medical College, Bharatpur, Chitwan, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jully","family":"Chaudhary","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, Chitwan Medical College, Bharatpur, Chitwan, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Upendra","family":"Pandit","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, Chitwan Medical College, Bharatpur, Chitwan, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,8,9]]},"reference":[{"key":"2025121604544895000_11.8.e045012.1","unstructured":"World Health Organization . Making every baby count: audit and review of stillbirths and neonatal deaths, 2016. Available: https:\/\/www.who.int\/publications\/i\/item\/9789241511223"},{"key":"2025121604544895000_11.8.e045012.2","unstructured":"World Health Organization . Stillbirths, 2020. Available: https:\/\/www.who.int\/maternal_child_adolescent\/epidemiology\/stillbirth\/en\/"},{"key":"2025121604544895000_11.8.e045012.3","doi-asserted-by":"crossref","first-page":"1448","DOI":"10.1016\/S0140-6736(10)62187-3","article-title":"Stillbirths: where? When? Why? How to make the data count?","volume":"377","author":"Lawn","year":"2011","journal-title":"The Lancet"},{"key":"2025121604544895000_11.8.e045012.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2016.03.044"},{"key":"2025121604544895000_11.8.e045012.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)62310-0"},{"key":"2025121604544895000_11.8.e045012.6","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-019-2234-6","article-title":"Factors associated with perinatal mortality in Nepal: evidence from Nepal demographic and health survey 2001-2016","volume":"19","author":"Ghimire","year":"2019","journal-title":"BMC Pregnancy Childbirth"},{"key":"2025121604544895000_11.8.e045012.7","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1111\/1471-0528.12995","article-title":"Causes of and factors associated with stillbirth in low- and middle-income countries: a systematic literature review","volume":"121 Suppl 4","author":"Aminu","year":"2014","journal-title":"BJOG"},{"key":"2025121604544895000_11.8.e045012.8","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f108"},{"key":"2025121604544895000_11.8.e045012.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2005.03.074"},{"key":"2025121604544895000_11.8.e045012.10","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-5-9"},{"key":"2025121604544895000_11.8.e045012.11","unstructured":"World Health Organization . Maternal death surveillance and response (MDSR); 2020."},{"key":"2025121604544895000_11.8.e045012.12","doi-asserted-by":"crossref","first-page":"S342","DOI":"10.1093\/cid\/ciz573","article-title":"An observational pilot study evaluating the utility of minimally invasive tissue sampling to determine the cause of stillbirths in South African women","volume":"69","author":"Madhi","year":"2019","journal-title":"Clin Infect Dis"},{"key":"2025121604544895000_11.8.e045012.13","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)60496-7"},{"key":"2025121604544895000_11.8.e045012.14","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00818-1"},{"key":"2025121604544895000_11.8.e045012.15","unstructured":"Family Health Division Ministry of Health . Country update Nepal- building on MPDRs to implement MPDSR, 2016. Available: http:\/\/mdsr-action.net\/updates\/nepal-building-on-mpdrs-to-implement-mpdsr\/"},{"key":"2025121604544895000_11.8.e045012.16","unstructured":"Government of Nepal Ministry of Health and Population . DoHS annual report FY 2075-76, 2020. Available: http:\/\/dohs.gov.np\/dohs-annual-report-fy-2076-77\/"},{"key":"2025121604544895000_11.8.e045012.17","doi-asserted-by":"crossref","unstructured":"Jindal A , Thakur R , Minhas S . Causes of stillbirth according to different gestational ages. Int J Reprod Contraception, Obstet Gynecol 2018.","DOI":"10.18203\/2320-1770.ijrcog20180886"},{"key":"2025121604544895000_11.8.e045012.18","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-018-1866-2"},{"key":"2025121604544895000_11.8.e045012.19","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.14971"},{"key":"2025121604544895000_11.8.e045012.20","doi-asserted-by":"crossref","first-page":"46","DOI":"10.33314\/jnhrc.v17i01.1534","article-title":"Risk factors related to intrauterine fetal death","volume":"17","author":"Thakur","year":"2019","journal-title":"J Nepal Health Res Counc"},{"key":"2025121604544895000_11.8.e045012.21","doi-asserted-by":"crossref","unstructured":"Kuti O , Owolabi AT , Orji EO , et al . Antepartum fetal death in a Nigerian teaching hospital: aetiology and risk factors. Trop J Obstet Gynaecol 2004;20.doi:10.4314\/tjog.v20i2.14419","DOI":"10.4314\/tjog.v20i2.14419"},{"key":"2025121604544895000_11.8.e045012.22","unstructured":"Audu . Risk factors for stillbirths at universty of Maiduguri teaching Hospital, Maiduguri, Nigeria: a cross-sectional retrospective analysis. Nigerian Medical Journal 2009."},{"key":"2025121604544895000_11.8.e045012.23","unstructured":"Rehan N . Still births in a Hausa community. J Pak Med Assoc 1982."},{"key":"2025121604544895000_11.8.e045012.24","doi-asserted-by":"crossref","unstructured":"Singh N , Pandey K , Gupta N , et al . A retrospective study of 296 cases of intra uterine fetal deaths at a tertiary care centre. Int J Reprod Contracept Obstet Gynecol 2013:141\u20136.doi:10.5455\/2320-1770.ijrcog20130606","DOI":"10.5455\/2320-1770.ijrcog20130606"},{"key":"2025121604544895000_11.8.e045012.25","first-page":"76","article-title":"Associated risk factors with ante-partum intra-uterine fetal death","volume":"27","author":"Shaaban","year":"2006","journal-title":"Saudi Med J"},{"key":"2025121604544895000_11.8.e045012.26","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2018-rcpch.284"},{"key":"2025121604544895000_11.8.e045012.27","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2018-024324","article-title":"Modelling the effect of the introduction of antenatal screening for group B Streptococcus (GBS) carriage in the UK","volume":"9","author":"Bevan","year":"2019","journal-title":"BMJ Open"},{"key":"2025121604544895000_11.8.e045012.28","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0182874"},{"key":"2025121604544895000_11.8.e045012.29","doi-asserted-by":"crossref","first-page":"257.e1","DOI":"10.1016\/j.ajog.2007.07.012","article-title":"Stillbirths in an urban community in Pakistan","volume":"197","author":"Jehan","year":"2007","journal-title":"Am J Obstet Gynecol"},{"key":"2025121604544895000_11.8.e045012.30","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002838"},{"key":"2025121604544895000_11.8.e045012.31","doi-asserted-by":"crossref","first-page":"44","DOI":"10.3126\/kumj.v10i4.10994","article-title":"Intrauterine foetal death and its probable causes: two years experience in Dhulikhel Hospital-Kathmandu university hospital","volume":"10","author":"Tamrakar","year":"2012","journal-title":"Kathmandu Univ Med J"},{"key":"2025121604544895000_11.8.e045012.32","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h3080"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2020-045012","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T12:54:54Z","timestamp":1765889694000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2020-045012"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8]]},"references-count":32,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,8,9]]},"published-print":{"date-parts":[[2021,8]]}},"alternative-id":["10.1136\/bmjopen-2020-045012"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2020-045012","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8]]}}}