Factors Associated with Macerated Stillbirths at Ndola Teaching Hospital, Ndola, Copperbelt, Zambia

Abstract

Purpose: Macerated stillbirths remain a significant public health concern, particularly in low-resource settings such as Zambia. This study investigates the factors contributing to macerated stillbirths. Methodology: A cross-sectional study design was employed, utilizing secondary data extracted from delivery registers at Ndola Teaching Hospital for the period January to December 2023. A total of 169 case notes of macerated stillbirths were analyzed. Descriptive statistics, chi-square tests, and logistic regression analyses were conducted using Stata version 15 to determine associations between macerated stillbirths and maternal factors, socioeconomic status, and health system-related factors. Significance was set at p < 0.05. Findings: Among the study participants, 31% (n=53) were nulliparous, 21.6% (n=37) were primiparous, 38.6% (n=66) were multiparous, and 8.8% (n=15) were grand multiparas. The majority (84.71%, n=144) had underlying health conditions. Macerated stillbirths were more common in full-term pregnancies (52.4%, n=55) and preterm births (40.0%, n=42). Labor complications were reported in 24.56% (n=42) of cases and were significantly associated with macerated stillbirths (p = 0.035). However, maternal age (p = 0.765), parity (p = 0.465), and residential area (p = 0.514) were not significantly associated with maceration. Logistic regression indicated that the duration of pregnancy was a borderline significant predictor (p = 0.06), while underlying health conditions and labor complications did not reach statistical significance in adjusted models. The prevalence findings indicated that more than half (61.4%) reviewed case files were macerated still births. Unique Contribution to Theory, Policy and Practice: The study highlights the critical importance of targeted improvements in maternal healthcare to address the high prevalence of macerated stillbirths at Ndola Teaching Hospital. By implementing the above recommendations, there is significant potential to enhance clinical practices, optimize resource allocation, and ultimately improve perinatal outcomes in Zambia. Future initiatives should focus on both reinforcing current practices and exploring innovative strategies to mitigate the risk factors identified in this study.