Methods
We conducted a retrospective cohort study investigating all stillbirths
recorded at the National Referral Hospital in Honiara, Solomon Islands,
between January 2017 and December 2018. Ethical approval was obtained
from the Solomon Islands Ministry of Health and Medical Services Ethics
Board (HRE032/18).
Stillbirth was defined as the death of a fetus before birth at\(\geq\)20 estimated gestational weeks, or greater than 500g in
birthweight. Antepartum stillbirth was defined as a death occurring
before the onset of labour or “macerated” in appearance. Intrapartum
death was considered a death occurring after the onset of labour or
during birth which had a “fresh” appearance. Neonates were weighed at
birth and fetal weight cut-offs of <2500g and <1500g
were used to define low birth weight and extremely low birth weight,
respectively, as gestational uncertainty decreased the accuracy of
gestational centiles. The total numbers of live births and stillbirths
during the study period were obtained from an existing hospital birth
registry. Where available, case files were reviewed for details
regarding maternal risk factors, contributing factors, sociodemographic
and pregnancy details.
Available case files were reviewed for suspected cause of death and
contributing maternal conditions identified. In the Solomon Islands
verbal autopsy or detailed diagnostic tests are not available to confirm
cause of death. Deaths were deemed preventable if they were over 28
weeks estimated gestation, above 1500g birth weight and excluding those
with congenital anomalies.
There are several international classification systems that aim to
accurately determine the primary cause of stillbirths and risk factors
that may inform public health and policy interventions.11 In 2016 the World Health Organization (WHO)
developed the tenth revision of the International Classification of
Diseases (ICD-10) and applied it to the perinatal period (ICD-PM).11, 12 The ICD-PM first identifies the timing of
perinatal death (antepartum, intrapartum or unknown), then the assigns
the main cause of death, and links each stillbirth with the main
maternal condition contributing to the stillbirth (Table S1 in
appendix). In this study, we used the ICD-PM to classify causes of
stillbirth at the National Referral Hospital. Given there was no
comparison group, descriptive statistics were used to describe the data.
Statistical analyses were performed using STATS 15-IC.