Background: Stillbirth is an important public health problem and a huge burden for countries and health systems, including Georgia, which is a lower-middle-income country, according to the World Bankâ€™s classification. Georgiaâ€™s population is 3.7 million people (2018), 54% of the population lives in urban areas. It is known, that countries have different rules about the lower limits for gestational age and birth weight for recording fetal deaths and this complicates international comparisons. According to Georgian legislation, the fetal mortality rate is defined, as the number of fetal deaths at or after 22 completed weeks of gestation in a given year, expressed per 1000 live births and stillbirths that same year.
Goals: The purpose of this study is to analyze trends in stillbirth rates in Georgia from 2000 to 2018 and to determine the various causes and risk factors leading to fetal death in order to formulate preventive strategies.
Methods: A retrospective analysis of risk factors leading to fetal mortality was carried out on the basis of hospital records from three main gynecological clinics in Kutaisi (west Georgia). We also investigated and analyzed the causes of all deaths for the period 2015-2018 using the verbal autopsy method. The odds ratio for risk factors with 95% confidence interval for stillbirths was calculated using the logistic regression model.
Results: According to official statistics, Stillbirth rate in Georgia, was reduced significantly from 14.7 (2000) and 16, 8 (2006) to 9,8 per 1000 deliveries in 2018 (p=0.001). However, it is still higher than the average rate of European region. The most common risk factors for stillbirths in Georgia include a low socioeconomic status and poor nutrition, poor literacy, increased basal metabolic index. Although the proportion of stillbirths was higher among mothers with history of abortion, previous stillbirth and maternal age of more than 35 years, the odds ratio was not statistically significant. Determining the direct causes of death is still problematic in Georgia. According to medical records, the majority of these stillbirths occurred in the antenatal period (82%), 14% in the intranatal period. A significant association was found between preterm delivery (p=0.001) and pre-eclampsia/eclampsia (p=0.01) with still births. A large proportion of causes of still births (21, 2% in 2017) was unexplained.
Conclusion: Improving the quality of obstetric services, in particular, early identification of risk factors, complications during pregnancy and childbirth, as well as adequate initial treatment, will significantly reduce the number of fetal deaths in the intranatal period.
Keywords: Trend; Stillbirth; Causes; Preterm delivery; Maternal age
Sheila G. has completed his Ph.D at the Georgia State Medical University and postdoctoral studies at St. Petersburg University. She was the first Deputy Chairperson of the Healthcare and Social Issues Committee of the Parliament of Georgia, She has over 25 years of experience as a teacher in various subjects and Masterâ€™s degree and a research career in Perinatal Medicine and Clinical Epidemiology. At present, she is professor of Tsereteli State University. Shelia G. has published more than 47 papers in reputed journals. She has participated in more than 21 international conferences and congresses (such as AMEE; FIGO; ESC; FIAPAC and etc.), as well as in several international projects.