Preventing antenatal stillbirths: An innovative approach for primary health care

South African Family Practice

Field Value
Title Preventing antenatal stillbirths: An innovative approach for primary health care
Creator Hlongwane, Tsakane M. Botha, Tanita Nkosi, Bongani S. Pattinson, Robert C.
Subject Primary health care; Antenatal care; Obstetrics; Primary care; Family medicine antenatal care; pregnancy; primary healthcare clinics; stillbirths; Doppler; umbilical artery blood flow; foetal growth restriction
Description Background: In South Africa (SA), approximately 16 000 stillbirths occur annually. Most are classified as unexplained and occur in district hospitals. Many of these deaths may be caused by undetected foetal growth restriction. Continuous wave Doppler ultrasound of the umbilical artery (CWDU-UmA) is a simple method for assessing placental function. This screening method may detect the foetus at risk of dying and growth-restricted foetuses, allowing for appropriate management.Methods: A cohort study was conducted across South Africa. Pregnant women attending primary health care clinics at 28–34 weeks gestation were screened using CWDU-UmA. Women not screened at those antenatal clinics served as control group 1. Control group 2 consisted of the subset of control group 1 with women detected with antenatal complications excluded. Women with foetuses identified with an abnormal CWDU-UmA test were referred and managed according to a standardised protocol. A comparison between the study and control groups was performed.Results: The study group consisted of 6536 pregnancies, and there were 66 stillbirths (stillbirth rate [SBR]: 10.1/1000 births). In control group 1, there were 193 stillbirths in 10 832 women (SBR: 17.8/1000 births), and in control group 2, 152 stillbirths in 9811 women (SBR: 15.5/1000 births) (risk ratio: 0.57, 95% confidence intervals: 0.29–0.85 and 0.65, 0.36–0.94, respectively).Conclusion: Screening a low-risk pregnant population identified the low-risk mother with a high-risk foetus, and acting on the information as described was associated with a significant reduction (35% – 43%) in stillbirths. This demonstrates a step-change reduction in stillbirths and warrants screening in SA.
Publisher AOSIS
Contributor This study was co-funded by the South African Medical Research Council (SAMRC) and the Council for Scientific and Industrial Research (CSIR). The CSIR developed the UmbiflowTM device and provided technical support.
Date 2022-08-25
Type info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Peer-reviewed Article Research; Cohort
Format text/html application/epub+zip text/xml application/pdf
Identifier 10.4102/safp.v64i1.5487
Source South African Family Practice; Vol 64, No 1 (2022): Part 3; 7 pages 2078-6204 2078-6190
Language eng
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Coverage South Africa; Africa September 2017-Decemeber 2020 antenatal care; primary health care; women; pregnancy
Rights Copyright (c) 2022 Tsakane M. Hlongwane, Tanita Botha, Bongani S. Nkosi, Robert C. Pattinson