A retrospective review of stillbirths at the national hospital in Dili, Timor-Leste

Abstract

Background - Timor-Leste has high maternal and infant mortality rates. Estimates of stillbirths are unreliable and limited by poor collection of vital health statistics. Lack of accurate data impedes the development of interventions to address local determinants of stillbirth. Aims - This study aimed to identify the rate, timing and causes of stillbirths at National Hospital Guido Valadares in Dili, Timor-Leste, between November 2009 and December 2010, during which data were available. Methods - Hospital birth registry and maternal records were retrospectively reviewed to identify stillbirths during the study period. The simplified Cause of Death and Associated Conditions system was utilised to classify stillbirths. Results - One hundred and fifty-three stillbirths were identified, producing a stillbirth rate of 29 per 1000 births. Of stillbirths with known timing, 70 (66.7%) occurred antepartum and 35 (33.3%) intrapartum. Cause of death could not be ascertained in 62.7% of cases due to poor or missing records. Where identified, the three most commonly classified causes of death were intrapartum fetal asphyxia, maternal infection and maternal hypertensive disorder. Conclusion - This study highlights the need for standardised recording and coding of perinatal deaths at HNGV. The high proportion of antenatal death transfers from community health centres demonstrates the need for community and hospital staff training to improve the quality of antenatal and intrapartum obstetric care. A prospective study of stillbirths is recommended to obtain reliable data on the determinants of stillbirths in Timor-Leste. These data would inform evidence-based interventions for the improvement of maternity and obstetric care in community and hospital settings.