Stillbirths by maternal-obstetric characteristics and Robson classification system: a cross-sectional study from eight district hospitals in Bangladesh

TL;DR

This study examines stillbirth causes in Bangladesh hospitals, finding most deaths occur during labor and highlighting preventable gaps in care.

Contribution

The study applies the Robson classification system to identify high-risk groups and preventable factors for stillbirth in district hospitals in Bangladesh.

Findings

Stillbirth prevalence varied across facilities (0.9–6.6%) with 56.6% occurring intrapartum.

Advanced maternal age, preterm birth, and lack of antenatal care were significantly associated with stillbirth.

Intrapartum stillbirths were most common in specific Robson groups, indicating targeted intervention opportunities.

Abstract

Understanding maternal-obstetric determinants is key to stillbirth prevention. The Robson classification system enables monitoring and identification of high-risk groups. This study examined the prevalence and distribution of antepartum and intrapartum stillbirths by maternal-obstetric characteristics and Robson groups in district hospitals of Bangladesh.

We conducted a cross-sectional analysis using prospectively collected data from Phases 4 and 5 (August 2022–June 2023) of a multi-phase implementation research study on the Robson classification system in eight district hospitals. All deliveries at ≥ 28 weeks of gestation were included, classified as live births, antepartum stillbirths (death before onset of labour), and intrapartum stillbirths (death after onset of labour). Descriptive analyses estimated stillbirth prevalence by timing, maternal and obstetric factors, and Robson groups. Associations were assessed using χ2 tests.

Out of 15 529 deliveries, 3.9% were stillbirths (56.6% intrapartum and 43.4% antepartum). Stillbirth prevalence varied across facilities (0.9–6.6%). A higher stillbirth burden was significantly associated (P < 0.05) with advanced maternal age (>34 years), preterm birth, lack of antenatal care, non-use of the partograph, and low birthweight. Breech presentation, induced labour, and vaginal delivery had the highest stillbirth percentage. Timing of stillbirth differed significantly by foetal presentation, onset of labour, and mode of delivery (P < 0.05). Stillbirth prevalence varied across Robson groups (0–17.5%). Intrapartum stillbirths predominated in Groups 1, 3, 6 and 8, while Group 10 was largely antepartum-dominated.

Stillbirth remains a substantial burden in district-level hospitals in Bangladesh, with most deaths occurring during the intrapartum period and marked variation across facilities and Robson groups. The findings highlight preventable gaps in antenatal screening, labour monitoring, and timely emergency obstetric care. Application of the Robson classification system enables precise identification of high-risk obstetric groups for targeted quality-improvement interventions to reduce preventable stillbirths and accelerate progress toward national and global stillbirth reduction targets.

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