Cause of death and associated conditions of stillbirths


  • Naveen Prasanna Department of Obstetrics and Gynecology, Karnataka Institute of Medical Sciences, Hubli - 580021, Karnataka, India
  • Kavita Mahadevappa Department of Obstetrics and Gynecology, Karnataka Institute of Medical Sciences, Hubli - 580021, Karnataka, India
  • Ramalingappa C. Antaratani Department of Obstetrics and Gynecology, Karnataka Institute of Medical Sciences, Hubli - 580021, Karnataka, India
  • Laxmikant Lokare Department of Community Medicine, Karnataka Institute of Medical Sciences, Hubli - 580021, Karnataka, India



CODAC simplified, Stillbirths rate, Intrauterine fetal death, Cause of stillbirth


Background: Fetal death is a psychological trauma for the expecting mother and their family. Most of the countries worldwide lack data on stillbirths. Simply counting stillbirths is the first step in analysis and prevention and hence stillbirths need to count. Purpose of the study is to know the incidence, cause of stillbirths and to plan cause specific interventions to reduce stillbirths.

Methods: This is a prospective cross-sectional study of patients with stillbirths from September 2014 to August 2015 in Karnataka Institute of Medical Sciences, Karnataka.  All the cases who delivered stillbirths  of  weight more than 1kg, were  grouped into  the following CODAC (causes of death and associated conditions)  simplified classification and were analysed.

Results: The total number of births during the study period was 9,863.  Total number of stillbirths in our study period was 563. In the study period, the stillbirth rate was 57.9 per 1000 births, out of which 56.3% were in preterm pregnancy and 43.69% in term pregnancies. The three common causes of stillbirths were hypertensive disorders (34.63%), intrapartum fetal loss (27.17%) and abruptio placenta (11.54%).  In 7.9% of cases the cause of stillbirth was unknown. Nutritional anaemia, teenage pregnancy and intrauterine growth restriction were the most common associated conditions of stillbirths.

Conclusions: Anaemia and teenage pregnancy are the two important risk factors associated with stillbirths. Adolescent health education, folic acid and iron supplementation in schools has to be planned as a primary prevention of stillbirth. Early detection and treatment of hypertensive disorders and good intrapartum care, will help us in reducing the stillbirth rate to a large extent, as these are the two important causes of stillbirth.


Cousens S, Blencowe H, Stanton C, Chou D, Ahmed S, Steinhardt L, et al. National, regional, and worldwide estimates of stillbirth rates in 2009 with trends since 1995:a systematic analysis. Lancet. 2011;377(9774):1319–30.

Lawn JE, Blencowe H, Pattinson R, Cousens S, Kumar R, Ibiebele I. Stillbirths: Where? When? Why? How tomake the data count? Lancet. 2011;377(9775):1448–63.

World Health Organization: ICD-10: International Statistical Classification of Diseases and Related Health Problems - Instruction Manual. 2nd edition. Geneva, Switzerland: World Health Organization; 2004. September 2015.

Frøen JF, Pinar H, Flenady V, Bahrin S, Charles A, Chauke L. Causes of death and associated conditions (CODAC) - a utilitarian approach to the classification of perinatal deaths. BMC Pregnancy Childbirth. 2009;9:22.

Choudhary A, Gupta V. Epidemiology of Intrauterine Fetal Deaths: A Study In Tertiary Referral Centre In Uttarakhand IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861. Volume 13, Issue 3 Ver. II. (Mar. 2014), PP 035b.

World Health Organization (WHO). Perinatal and neonatal mortality for the year 2000: Country, regional and global estimates. Geneva, 2006. September 2015.

Census of India. Estimates of mortality indicators 2010. September 2015.

Registrar General of India. Sample Registration System (SRS) statistical report 2012. September 2015.

PHFI, AIIMS, and SC- State of India’s Newborns (SOIN) 2014- a report. (Eds) Zodpey S and Paul VK. Public Health Foundation of India, All India Institute of Medical Sciences and Save the Children. New Delhi, India.

Frøen JF, Gordijn SJ, Abdel-Aleem H, Bergsjø P, Betran A, Duke CW. Making stillbirths count, making numbers talk - issues in data collection for stillbirths. BMC PregnancyChildbirth. 2009.

Wilkins A, Earnest J, Mccarthy EA, Shub A. A retrospective review of stillbirths at the national hospital in Timor-Leste. Aust N Z J Obstet Gynaecol. 2015.

Bukowski R, Carpenter M, Conway D, Coustan D, Dudley DJ, Goldenberg RL. Causes of death among stillbirths. JAMA. 2011.

Yakoob MY, Lawn JE, Darmstadt GL, Bhutta ZA. Stillbirths: epidemiology, evidence, and priorities for action. Seminars in Perinatology 2010;34(6):387–94.

Silver RM, Varner MW, Reddy U, Goldenberg R, Pinar H, Conway D. Work-up of stillbirth: a review of the evidence. American Journal of Obstetrics and Gynecology. 2007;196(5):433–44.

McClure EM, Nalubamba-Phiri M, Goldenberg RL. Stillbirth in developing countries. International Journal of Gynecology & Obstetrics. 2006;94(2):82–90.

Dimitrov G, Frandeva B, Garnizov T, Zlatkov V, Dimitrov A. Causes of stillbirths according to the period of pregnancy. Akush Ginekol (Sofiia). 2014;53(3):3-7.

Helgadóttir LB, Turowski G, Skjeldestad FE, Jacobsen AF, Sandset PM, Roald B et al. Classification of stillbirths and risk factors by cause of death - a case-control study. Acta Obstet Gynecol Scand. 2013;92(3):325-33.

Flenady V, Koopmans L, Middleton P, Frøen JF, Smith GC, Gibbons K. Major risk factors for stillbirth in high-income countries: a systematic review and metaanalysis. Lancet. 2011;377(9774):1331–40.

Bhutta ZA, Yakoob MY, Lawn JE, Rizvi A, Friberg IK, Weissman E. Stillbirths: what difference can we make and at what cost? Lancet. 2011;377(9776):1523–38.






Original Research Articles