Abstract:
BACKGROUND : In South Africa (SA), approximately 16 000 stillbirths occur annually. Most are
classified as unexplained and occur in district hospitals. Many of these deaths may be caused
by undetected foetal growth restriction. Continuous wave Doppler ultrasound of the umbilical
artery (CWDU-UmA) is a simple method for assessing placental function. This screening
method may detect the foetus at risk of dying and growth-restricted foetuses, allowing for
appropriate management.
METHODS : A cohort study was conducted across South Africa. Pregnant women attending
primary health care clinics at 28–34 weeks gestation were screened using CWDU-UmA.
Women not screened at those antenatal clinics served as control group 1. Control group 2
consisted of the subset of control group 1 with women detected with antenatal complications
excluded. Women with foetuses identified with an abnormal CWDU-UmA test were referred
and managed according to a standardised protocol. A comparison between the study and
control groups was performed.
RESULTS : The study group consisted of 6536 pregnancies, and there were 66 stillbirths
(stillbirth rate [SBR]: 10.1/1000 births). In control group 1, there were 193 stillbirths in 10 832
women (SBR: 17.8/1000 births), and in control group 2, 152 stillbirths in 9811 women
(SBR: 15.5/1000 births) (risk ratio: 0.57, 95% confidence intervals: 0.29–0.85 and 0.65,
0.36–0.94, respectively).
CONCLUSION : Screening a low-risk pregnant population identified the low-risk mother with a
high-risk foetus, and acting on the information as described was associated with a significant
reduction (35% – 43%) in stillbirths. This demonstrates a step-change reduction in stillbirths
and warrants screening in SA.
