INTRODUCTION Despite advances in antenatal and intrapartum care, stillbirth 1 continues to be a major burden. Currently, 98% of stillbirths 2 occur in low-to-middle-income countries. Estimated proportion is 10% in developed regions and WHO estimated rate is 22 per 1000 total births. Government of India has developed an Indian Newborn Action Plan which includes 3 efforts to reduce stillbirths to <10 per 1000 births by 2030. Stillbirth is dened as (WHO) baby born with no signs of life at or after 28 weeks of gestation. Risk factors are women with > 35 years of age, prolonged pregnancy, low socioeconomic status, smoking habit in pregnancy, women with certain medical conditions such as high blood pressure and diabetes, multifetal gestation like triplets or quadruplets. Stillbirth at term in an otherwise low risk pregnancy devastates parents with its unexpectedness. A modest reduction in India's SBR would translate into thousands of lives saved. The Indian government recognizes the need to improve pregnancy care and inst i tut ional del ivery among disadvantaged socioeconomic groups who have a higher risk of maternal and 4 fetal death. Since 2005, the government has made several efforts including cash assistance and dedicated services through community health workers with a stronger focus in the 4 states with poor health and development indicators. OBJECTIVES To study all the cases of stillbirths in last one year at tertiary care health center and to review its etiology, pregnancy complications & associated risk factors. MATERIALS & METHODS This is a retrospective observational study, conducted at a Government Medical College and Hospital over a period of one year (November 2018 to November 2019). Written informed consent from subjects was obtained for participation. Women who delivered at our labour room with stillborn baby over the study period were included. Antenatal history was recorded, clinical examination ndings, laboratory parameters, complications studied, obstetric managements as well as the managements of complications and fetal outcomes were recorded. RESULTS Total cases of stillbirth were 102 out of 9624 total births during study period. Stillbirth rate was 11 per 1000 total births. Table 1: Demographic Prole Of Cases Under Study Out of 102 cases 67% were >30 years of age, 57% were grandmultipara, 49 % were in between 36-42 weeks of gestation, 77% were from rural area and 59% belonged to lower socioeconomic group. Table 2: Associated Risk Factors For Stillbirth UNDERSTANDING STILLBIRTH: A RETROSPECTIVE STUDY Original Research Paper Dr. Gauri Nagnath Jagdale Assistant Professor, Department of Obstetrics &Gynaecology, B.J.G.M.C Pune. X 25GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS Obstetrics & Gynaecology INTRODUCTION- Stillbirth is an important global health problem affecting over 7000 families every day and is associated with emotional, social & economic consequences. OBJECTIVES- To study all the cases of stillbirths in last one year at tertiary care center in view of its etiology, pregnancy complications & associated risk factors. METHODS- Retrospective observational study of all cases in last one year (Nov. 2018 to Nov. 2019) at tertiary care center. All cases are assessed in aspect of history, clinical ndings, laboratory parameters, complications and outcome. RESULTS: Total cases of stillbirth were 102 out of 9624 total births during study period. Stillbirth rate was 11 per 1000 total births. CONCLUSION: Targeting at risk population groups, recording all stillbirths and improving quality of health care provided can reduce the rate further. ABSTRACT KEYWORDS : Stillbirth, complications, congenital anomalies. VOLUME-9, ISSUE-1, JANUARY-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Dr. Pradip W. Sambarey* Professor & Head, Department of Obstetrics & Gynaecology, B.J.G.M.C Pune. *Corresponding Author Demographic variable Frequency Percentage Age <20 years 13 13 20-30 20 20 >30 years 69 67 Parity Primipara 12 12 Multipara 32 31 Grandmultipara 58 57 Gestational Age(weeks) 28-32 12 12 32-36 40 39 36-42 50 49 Place of residence Urban 23 23 Rural 79 77 Socioeconomic status Upper 12 12 Middle 30 29 Lower 60 59 Associated risk factor Frequency Percentage Number of ANC visits 4 or more 05 05 Less than 4 58 57 Missing 39 38 Timing of rst ANC visit < 3 months 38 37 3 months or later 64 63 Place of delivery Institution 31 30 Home 71 70 Sex of baby Female 43 42 Male 59 58 26 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS Stillbirth rate was 57% in women with less than 4 ANC visits and women who visits health care facility rst time in rdpregnancy after 3 month of gestation have stillbirth rate of 63%. Home delivery is an important factor contributing for 70% of total stillbirths. Out of all stillborn babies 58% were male babies. There was higher rate of stillbirth in spontaneous vaginal deliveries (74%) than cesarean section (18%). Table 3: Complications In Pregnancy Associated With Stillbirth Preeclampsia, eclampsia & other hypertensive disorders in pregnancy contribute for 21%, child birth complications for 18% of total stillbirths. Out of total stillborn babies 11% were having congenital anomalies. Maternal diabetes contribute for 10% of total stillbirths and remaining 10% were due to abnormal fetal presentation and position. DISCUSSION The overall rate of stillbirth was found to be 11 per 1000 total births. The above ndings show the impact of inequality on stillbirth, as women in the most deprived groups were at highest risk. This was identied across a number of variables which capture different aspects of deprivation; for example, poorer women, those with little education, those living in rural areas were at increased risk of stillbirth compared to more afuent and advantaged women. Pregnancy complications, including anemia, eclampsia, other hypertensive disorders, antepartum hemorrhage, abnormal fetal position and obstructed labour signicantly increased the risk of stillbirth. We found a signicant disparity in the risk of stillbirth by socioeconomic status which is consistent with previous research. A systematic review of studies from developing countries showed that low socioeconomic status was signicantly associated with stillbirth with a population 5 attributable fraction ranging between 2% and 75%. Maternal education and employment may act through promoting high self- esteem and empowering women to make decisions about 6 healthcare utilization. Our ndings related to timing and number of ANC visits conforms to the results of other studies. Improving the quality of pregnancy care with specic measures to prevent stillbirth are important in addition to increasing coverage of antenatal care. Male sex of fetus to be 7 associated with higher risk of stillbirth. Abnormal fetal presentation and obstructed labour operate through similar 8 mechanisms causing fetal hypoxia and stillbirth. However, a stillbirth could be prevented if these complications are detected timely and managed appropriately. CONCLUSION Our study showed that targeting at risk population groups, recording all stillbirths and improving quality of health care provided can reduce the rate further. Improving uptake of ANC and timely identication and effective management of maternal and fetal complications could reduce preventable stillbirths. ASHA's and Anganwadi workers could play an important role in timely identication of danger signs through frequent interactions with pregnant women. Progress towards goals of poverty eradication and female education could help to reduce stillbirths. LIMITATIONS- There may be possibility of misclassication of stillbirth as miscarriage/ abortion or neonatal death as stillbirth. CONFLICT OF INTEREST-NIL FUNDING SOURCE-NIL REFERENCES 1. Flenady V, Wojcieszek AM, Middleton P, Ellwood D , Erwich JJ, Coory M, et al. Stillbirth: recall to action in high income countries. Lancet 2016; 387:691-702. 2. Lawn JE, Blencowe H, Waiswa P, et al. Stillbirths: rates, risk factors and acceleration towards 2030. Lancet 2016; 387: 587-603. 3. Sharma D. India newborn action plan. J Res Med Sci 2015; 2:58. 4. Ministry of Health and Family Welfare (MoHFW) Gol. National health portal: Janani Suraksha Yojana (JSY) New Delhi: National Institute of Health and Family Welfare (NIHFW), MoHFW. (cited 18 Dec 2018). 5. McClure EM, Saleem S, Pasha O, et al. Stillbirth in developing countries: a review of causes, risk factors and prevention strategies. J Matern Fetal Neonatal Med 2 009; 22:183-90. 6. Pincus T, Callahan LF. Associations of low formal education and poor health status: behavioral, in addition to demographic and medical explanations. J Clin Epidemiol 1994; 47: 355-61. 7. Mondal D, Galloway TS, Bailey TC, et al. Elevated risk of stillbirth in males: systematic review and meta- analysis of more than 30 million births. BMC Med 2014; 12:220. 8. Lawn J, Shibuya K, Stein C. No cry at birth: global estimates of intrapartum stillbirths and intrapartum-related neonatal deaths. Bull World Health Organ 2005; 83: 409-17. VOLUME-9, ISSUE-1, JANUARY-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Mode of Delivery Spontaneous vaginal 76 74 Assisted vaginal 08 08 Cesarean section 18 18 Complications in pregnancy Prevalence Percentage Preeclampsia & other hypertensive disorders in pregnancy 22 21 Child birth complications 18 18 Fetal growth restriction 31 30 Congenital anomalies of baby 11 11 Maternal diabetes 10 10 Abnormal fetal presentation and position 10 10