Setting Up the Stillbirth Registration System and Investigating the Related Causes in Iran in Selected Hospitals: Observational Cohort Study

Background One of the major causes of perinatal mortality is stillbirth. In many cases, the cause of stillbirth is difficult to identify, and the cause of many cases remain unexplained. Because of the lack of registration stillbirth system in our country we developed protocol and instructions for stillbirth and setting up a stillbirth registration system in selected hospitals around country. Methods Iranian Maternal and Neonatal Network (IMaN) registers information about almost all births (live & dead) around the country, but this network does not collect data about stillbirth causes. In this study, we developed the stillbirth evaluation protocol with experts' cooperation, and we designed forms for the stillbirth registration system electronically. Then we trained related individuals in 14 selected hospital from 12 provinces (14 cities) of Iran. After a year, we extracted, analyzed, and, based on the Relevant Condition of Death Classification (ReCoDe), interpreted the collected data. Results A total of 105,562 births and 762 stillbirths registered. In 742 registered stillbirth cases in 14 selected hospitals, the relevant causes were identified in 65.4% of cases, while 34.6% of cases remained unclassified. The most frequent relevant conditions were fetal (33.2%), maternal (9.1%), amniotic fluid (8.8%), placenta (7.7%), and umbilical cord (6.2%). Conclusions Our registration decreased the percentage of stillbirth with an unexplained cause from about 70–34.6%.