Physical and Psychological Maternal Morbidity After Stillbirth: Findings from a Tertiary Care Centre in Eastern India
DOI:
https://doi.org/10.55489/njmr.160320261362Keywords:
Still birth, Maternal Morbidity, Puerperal Infection, Postpartum Hemorrhage, Edinburgh Postnatal Depression Scale, Severe Maternal MorbidityAbstract
Background: World Health Organisation International ICD 10th revision defines stillborn as death of a fetus with a birthweight of ≥ 1000 grams or a gestational age of ≥ 28 weeks. After or during delivery of stillborn baby, maternal morbidity needs to be evaluated. The objective was to evaluate the various adverse clinical outcomes of mother who had stillbirths.
Methods: A prospective observational study was done at Department of Obstetrics and Gynaecology, Jalpaiguri Government Medical College, India from February 2024 to December 2024 among 95 mothers who underwent stillbirth delivery.
Results: The majority of study participants belonged to age group below 20 years followed by the age group of 21-25 years. Only 54 mothers had their pregnancies booked. Out of 95 study population the study demonstrated most common adverse physical outcome as infectious complications (47) followed by uterine (30), haemorrhagic (27) & renal complications (23). 39 mothers developed mild depression & 13 mothers developed moderate depression. Operative and conservative specific medical management were required for 7 & 48 mothers respectively. 40 mothers had no complications and required no specific management.
Conclusions: This present study showed significant rise of physical & psychological complications among study population (total 55 mothers out of 95) after stillbirth. Reporting of maternal morbidity after stillborn should be done from institutional to national level using the ICD code (9 or 10) for SMM (severe maternal morbidity) to assess the magnitude.
References
1. MacDorman MF, Gregory EC. Fetal and Perinatal Mortality: United States, 2013. Natl Vital Stat Rep. 2015 Jul 23;64(8):1-24. PMID: 26222771.
2. World Health Organization: International Classification of Diseases (ICD-11). Geneva: World Health Organization; [cited 2026 Jun 14]. Available from: https://www.who.int/standards/classifications/classification-of-diseases
3. Hug L, You D, Blencowe H, Mishra A, Wang Z, Fix MJ, et al. Global, regional, and national estimates and trends in stillbirths from 2000 to 2019: a systematic assessment. Lancet. 2021 Aug 28;398(10302):772-785. DOI: https://doi.org/10.1016/S0140-6736(21)01112-0 PMid:34454675 PMCid:PMC8417352
4. Datta V, Ghosh S, Aquino LD. Progressing towards SDG 2030 goals with system changes: the India Newborn Action Plan. BMJ Open Qual. 2022 May;11(Suppl 1):e001971. DOI: https://doi.org/10.1136/bmjoq-2022-001971 PMid:35545276 PMCid:PMC9092168
5. Gold KJ, Mozurkewich EL, Puder KS, Treadwell MC. Maternal complications associated with stillbirth delivery: A cross-sectional analysis. J Obstet Gynaecol. 2016;36(2):208-212. DOI: https://doi.org/10.3109/01443615.2015.1050646 PMid:26479679 PMCid:PMC5035705
6. Wall-Wieler E, Carmichael SL, Gibbs RS, Lyell DJ, Girsen AI, El-Sayed YY, et al. Severe Maternal Morbidity Among Stillbirth and Live Birth Deliveries in California. Obstet Gynecol. 2019 Aug;134(2):310-317. DOI: https://doi.org/10.1097/AOG.0000000000003370 PMid:31306335 PMCid:PMC6921936
7. World Health Organization. The prevention and management of puerperal infections: report of a technical working group. Geneva: World Health Organization; 1995. Available from: https://iris.who.int/handle/10665/59429
8. Perlman NC, Carusi DA. Retained placenta after vaginal delivery: risk factors and management. Int J Womens Health. 2019 Oct 7;11:527-534. DOI: https://doi.org/10.2147/IJWH.S218933 PMid:31632157 PMCid:PMC6789409
9. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY, editors. Williams Obstetrics. 23rd ed. New York (NY): McGraw-Hill Medical; 2010. p. 654, 765-767.
10. Weinmann EE, Salzman EW. Deep-vein thrombosis. New Engl J Med. 1994;331:1630-1641. DOI: https://doi.org/10.1056/NEJM199412153312407 PMid:7772110
11. Czysz A, Higbee SL. Superficial Thrombophlebitis. [Updated 2023 Jan 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556017/
12. Sethi S, De Vriese AS, Fervenza FC. Acute glomerulonephritis. Lancet. 2022 Apr 23;399(10335):1646-1663. DOI: https://doi.org/10.1016/S0140-6736(22)00461-5 PMid:35461559
13. Votavová R, Linhartová A, Korinek J, Marek J, Linhart A. Echocardiography in coronary artery disease. Cor et Vasa. 2015;57(6):e408-e418. DOI: https://doi.org/10.1016/j.crvasa.2015.09.006
14. Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 183: Postpartum hemorrhage. Obstet Gynecol 2017;130(4):e168-e186. DOI: https://doi.org/10.1097/AOG.0000000000002351 PMid:28937571
15. Le Bas A, Chandraharan E, Addei A, Arulkumaran S. Use of the "obstetric shock index" as an adjunct in identifying significant blood loss in patients with massive postpartum hemorrhage. Int J Gynaecol Obstet. 2014 Mar;124(3):253-255. DOI: https://doi.org/10.1016/j.ijgo.2013.08.020 PMid:24373705
16. Toh CH, Hoots WK. SSC on Disseminated Intravascular Coagulation of the ISTH. The scoring system of the Scientific and Standardisation Committee on Disseminated Intravascular Coagulation of the International Society on Thrombosis and Haemostasis: a 5-year overview. J Thromb Haemost. 2007 Mar;5(3):604-606. DOI: https://doi.org/10.1111/j.1538-7836.2007.02313.x PMid:17096704
17. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987 Jun;150:782-786. DOI: https://doi.org/10.1192/bjp.150.6.782 PMid:3651732 PMCid:PMC11713845
18. Joshi U, Lyngdoh T, Shidhaye R. Validation of hindi version of Edinburgh postnatal depression scale as a screening tool for antenatal depression. Asian J Psychiatr. 2020 Feb;48:101919. DOI: https://doi.org/10.1016/j.ajp.2019.101919 PMid:31927197
19. Wani RT. Socioeconomic status scales-modified Kuppuswamy and Udai Pareekh's scale updated for 2019. J Family Med Prim Care. 2019 Jun;8(6):1846-1849. DOI: https://doi.org/10.4103/jfmpc.jfmpc_288_19 PMid:31334143 PMCid:PMC6618222
20. Mandal A, Patra KK, Chattopadhyay S, Biswas A, Bari BB. A retrospective study on etiological aspects of intrauterine foetal demise after 28 weeks of gestation in a tertiary care hospital in Eastern India. Int J Health Clin Res. 2021;4(5):95-99.
21. Saha D, Kurude VN, Mundhe S. A study of intrauterine fetal death in a tertiary care hospital. Int J Reprod Contracept Obstet Gynecol. 2019 Jul;8(7):2647-2651. DOI: https://doi.org/10.18203/2320-1770.ijrcog20193019
22. Kanavi JV, Shobha G, Kavita G. Incidence and risk factors for intrauterine foetal demise: a retrospective study in a tertiary care centre in India. Int J Pregn & Chi Birth. 2017;2(2):33-36. DOI:https://doi.org/10.15406/ipcb.2017.02.00013
23. Varotsis D, Beacham J, Gomez J, Hannan Z, Boelig RC, Berghella V. Stillbirth is associated with postpartum severe maternal morbidity compared with gestational age matched and term live births. Am J Obstet Gynecol MFM. 2025 Sep;7(9):101725. DOI: https://doi.org/10.1016/j.ajogmf.2025.101725 PMid:40516786
24. Biswas DK, Sau A, Deb LM, Mandal O, Chakraborty B. Thalassemia-an untoward situation among the pregnant women in North Bengal district, West Bengal, India. Int J Community Med Public Health 2025; 12:1332-1336. DOI: https://doi.org/10.18203/2394-6040.ijcmph20250617
25. Ambedkar D, Mishra C, Sharma R, Kumar V, Yadav YK. Puerperal complications: it's association with anemia. Int J Pharm Clin Res. 2021;13(6):683-687.
26. Nyarko SH, Greenberg LT, Phibbs CS, Buzas JS, Lorch SA, Rogowski J, Saade GR, Passarella M, Boghossian NS. Association between stillbirth and severe maternal morbidity. Am J Obstet Gynecol. 2024 Mar;230(3):364.e1-364.e14. DOI: https://doi.org/10.1016/j.ajog.2023.08.029 PMid:37659745 PMCid:PMC10904670
27. Lewkowitz AK, Rosenbloom JI, López JD, Keller M, Macones GA, Olsen MA, et al. Association Between Stillbirth at 23 Weeks of Gestation or Greater and Severe Maternal Morbidity. Obstet Gynecol. 2019 Nov;134(5):964-973. DOI: https://doi.org/10.1097/AOG.0000000000003528 PMid:31599829 PMCid:PMC6814564
28. Gravensteen IK, Jacobsen EM, Sandset PM, Helgadottir LB, Rådestad I, Sandvik L, et al. Anxiety, depression and relationship satisfaction in the pregnancy following stillbirth and after the birth of a live-born baby: a prospective study. BMC Pregnancy Childbirth. 2018 Jan 24;18(1):41. DOI: https://doi.org/10.1186/s12884-018-1666-8 PMid:29361916 PMCid:PMC5781321
29. Marwah S, Gaikwad HS, Mittal P. Psychosocial Implications of Stillborn Babies on Mother and Family: A Review from Tertiary Care Infirmary in India. J Obstet Gynaecol India. 2018 Jun;69(3):232-238. DOI: https://doi.org/10.1007/s13224-018-1173-x PMid:31178638 PMCid:PMC6531591
30. Snowden JM, Lyndon A, Kan P, El Ayadi A, Main E, Carmichael SL. Severe Maternal Morbidity: A Comparison of Definitions and Data Sources. Am J Epidemiol. 2021 Sep 1;190(9):1890-1897. DOI: https://doi.org/10.1093/aje/kwab077 PMid:33755046 PMCid:PMC8579027
31. Nair M, Choudhury MK, Choudhury SS, Kakoty SD, Sarma UC, Webster P, Knight M. IndOSS-Assam: investigating the feasibility of introducing a simple maternal morbidity surveillance and research system in Assam, India. BMJ Glob Health. 2016 Apr 7;1(1):e000024. DOI: https://doi.org/10.1136/bmjgh-2015-000024 PMid:28588919 PMCid:PMC5321309
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