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.