Stillbirth refers to all pregnancy losses after 22 weeks of gestation. WHO defines stillbirth as birth weight of at least 1000 grams or a gestational age of at least 28 weeks (third-trimester stillbirth). Pakistan ranks second amongst countries that account for 66 per cent of the world’s stillbirths with 46 stillbirths per 1000 births.
Speaking at a dissemination seminar organized by Aga Khan University in collaboration with Save the Children, Dr Zulifar Bhutta, Founding Chair, Division of Women and Child Health, shared the results of a systematic review of randomised trails and observational studies on stillbirths published in The Lancet which suggest that up to 45 per cent of these deaths can be prevented globally by adopting 10 health care interventions which includes Periconceptional folic acid fortification, Insecticide-treated bed nets, Intermittent preventive treatment for malaria prevention during pregnancy, Syphilis detection and treatment, Detection and management of hypertensive disease of pregnancy, Detection and management of diabetes in pregnancy, Detection and management of fetal growth restriction, Identification and induction for pregnant women with more than or equal to 41 weeks of gestation and Comprehensive basic obstetric care Comprehensive emergency obstetric care.
He highlighted that every day more than 7,300 babies are stillborn globally, and every year millions of stillbirths remain unaccounted for. Until now, the United Nations data collation system has not included stillbirths and even the Millennium Development Goals omit discussion and targets on stillbirth. The global health care community seems to have neglected this important aspect of maternal and child health.
Further elaborating on the interventions, Dr Bhutta stated that these interventions are most cost-effective when provided through integrated packages that are tailored to suit existing health care systems. If combined with another five maternal and neonatal death interventions (tetanus toxoid, antibiotics for preterm prelabour rupture of membrane, antenatal steroids, active management of the third stage of labour, and nenonatal resuscitation), 1.6 million women and newborn babies can be saved and 1.1 million stillbirths prevented annually throughout the world. Dr Bhutta stressed the need of providing care at all levels of the health system and implementing proven techniques that target key health interfaces.
At the community level, AKU is involved in a feasibility study aimed to redesign strategies for better management of women-related health care issues as well as for the wider acceptability of the community-level intervention package (CLIP). Dr Rahat Qureshi, Chair, Department of Obstetrics and Gynaecology, AKU, stressed that to achieve this coordinated action by national and local governments, health authorities and organizations is required.
Other speakers included Dr Nabeela Ali, Chief of Party, John Snow Inc. Islamabad, Drs Razia Korejo, Professor and Shireen Bhutta, Head, Department of Obstetrics and Gynaecology, JPMC, Dr Aftab Munir, Professor, Obstetrics and Gynaecology, Isra University, Hyderabad and Professor Sadiqa N. Jafarey, President, National Committee for Maternal Health.