Stillbirths increase amid pandemic

An expectant mother Rabeya, 22, having very low oxygen saturation (60-70 per cent), was admitted to a Covid unit under the gynaecology department of Dhaka Medical College and Hospital (DMCH) on 27 July.

Despite the emergency, there was no vacancy in the hospital’s ICU for the critical patient. While undergoing treatment at a Covid dedicated general ward of DMCH, Rabeya delivered a stillborn child. Unfortunately, the mother too passed away two hours after being admitted to the hospital.

Tamanna Rahman, a consultant at DMCH, told Prothom Alo that a fetus gets less oxygen if the pregnant mother’s oxygen saturation falls. The situation poses life risk both to the mother and the infant. Tamanna observed several stillbirths at the Covid and non-Covid units of the hospital during the pandemic.

According to the health service directorate (DGHS)’s data on delivery cases at upazila health complexes, general hospitals and public medical college hospitals, the rate of stillbirths increased in the pandemic compared to the year 2019.

In 2019, the rate of stillbirth was 3.73 per cent while the percentage was 4.14 the next year. In first six months of the current year, stillbirth rate stood at 3.82 per cent. During the pandemic time, however, the number of deliveries in government facilities also decreased at a significant rate.

Physicians think that stillbirth has been increasing as coronavirus is infecting the pregnant mothers and the pandemic is overburdening the health services. However, the Covid bulletin by the DGHS does not mention stillbirths.

On 2 August, the National Immunization Technical Advisory Group (NITAG) recommended vaccinating expectant and lactating mothers. Earlier, the Obstetrical and Gynecological Society of Bangladesh (OGSB) highlighted the necessity during a discussion with NITAG.

OGSB president Fedousi Begum, also a senior consultant at obstetrical and gynecology department under BIRDEM General Hospital, said, “The percentage of Covid cases among vaccinated persons is lower. The risk of death too is very low. If pregnant mothers were brought under vaccinations earlier, the rate of maternal death, stillbirth and neonatal death would have been lower.”

She added that the limited health services, economic downfall and mental depression amid the pandemic have an effect on mothers’ health.

A pregnant mother suffering from high blood pressure, malnutrition, diabetes, infection and congenial disabilities may deliver a still born child while premature delivery causes neonatal death. A Covid-infected expectant mother has a higher risk of stillbirth and premature delivery, said Ferdousi Begum.

The family planning directorate (DGFP) operates 3,364 field offices at a union level across the country. Besides, there are maternal and child health centres: 183 at union level, 12 at upazila level and 60 at district level, along with three specialised hospitals at national level.

According to DGFP, lesser people avail service from its health facilities compared to the year 2019. Similarly, the rate of stillbirths, neonatal deaths and maternal deaths has come down.

In 2019, DGFP recorded 1,202 stillbirths, 239 neonatal deaths and 2,480 maternal deaths among 188,962 delivery cases at its health facilities. Of the 174,263 deliveries in 2020, DGFP saw 889 stillbirths, 126 neonatal deaths and 1,212 maternal deaths.

During the first half of this year, 351 stillbirths, 29 neonatal deaths and 299 maternal deaths among 83,764 deliveries happened at DGFP facilities.

DGFP director (maternal and child health services) Mohammad Sharif told Prothom Alo, “Expectant mothers in critical condition and Covid symptoms visiting the maternal and child health centres have been referred to specialised public hospitals for better treatment. That was why the mortality rate at our facilities seemed lower than the previous years.”

He added that patients as well as the physicians feared virus transmission at the centres when the coronavirus hit the country initially. During the pandemic, deliveries at home were more common.

Currently, the centres are providing health services in an organised way. Covid-infected pregnant mothers can get caesarean section at the centres, Mohammad Sharif said, adding that lessons from the Covid situation would help deal with the maternal and child mortality within the shortest possible time.

*This report appeared in the print and online editions of Prothom Alo, has been rewritten in English by Sadiqur Rahman.