Maternal and Placental Factors Associated with Stillbirth: Evidence from Selected Hospitals in Lusaka, Zambia

Maternal and Placental Factors Associated with Stillbirth: Evidence from Selected Hospitals in Lusaka, Zambia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Maternal and Placental Factors Associated with Stillbirth: Evidence from Selected Hospitals in Lusaka, Zambia Makasa Musonda, Shibemba Lunda Aaron, Zulu Mathias Zulu, Kaonga Patrick, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7425494/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: An estimated 3.04 million stillbirths were recorded in 2021 with a global stillbirth rate decline from 21.4 to 13.9/1000 live births from 2000 to 2019. Despite this decline south Asia and sub-Saharan Africa recorded the least progress with an estimated decrease of 24.9%. The region accounts for 77.3% (2.35 million) of the global stillbirths’ total. To have a stillbirth is a devasting experience such that victims desire to understand the cause of death. This study aimed to evaluate the association between maternal and placental factors with stillbirth. Methods : This was a prospective unmatched case-control study conducted from September 2023 to February 2024 in selected hospitals in Lusaka, Zambia. Eligible participants were mothers with pregnancies beyond 28 weeks' gestation who experienced a stillbirth (cases) or a live birth (controls), enrolled at a 1:4 ratio. A purposive sampling technique was employed. Placental specimens were preserved in formaldehyde and sent for histopathological examination. Data were collected using a structured Google Sheets form. Statistical analysis included Chi-square and Fisher’s exact tests to assess associations with stillbirth. Univariate and stepwise multivariable logistic regression models were applied to identify risk factors associated with stillbirth. Results: The 180 participants analysed comprised of 36 stillbirths (cases) and 144 live births (controls). The maternal mean age was 27.6 (SD±6.5: range 18-43). Unmarried participants had lower odds of stillbirth (COR=0.18; 95% CI: 0.05-0.62; p = 0.01). Above ≥5km residence from the hospital had higher odds (2.33; 95% CI: 1.11-4.91; p = 0.03). Early antenatal booking was protective (COR=4.28; 95% CI: 1.96-9.38; p < 0.00), as was early start of iron and folate (COR=2.62; 95% CI: 1.15-5.99; p = 0.02). History of stillbirth (COR=3.17; 95% CI: 1.21-8.28; p = 0.02) or abortion (COR=4.60; 95% CI: 1.39-15.25; p = 0.01) higher risk. Abnormal placental pathology had a strong association with stillbirth (AOR=4.53; 95% CI: 1.13-18.12; p < 0.03). Cord length umbilical cord was protective had lower odds (AOR = 0.07, 95% CI: 0.02–0.35, p = 0.00). Conclusion: Several maternal, obstetric, and placental factors were associated with stillbirth, including late initiation of antenatal care, a history of abortion, and previous stillbirth. Among placental findings, umbilical cord length remained significantly associated in adjusted models, while other abnormalities—such as marginal cord insertion, villous maturation disorders, and chorioamnionitis—showed strong associations only in univariable analyses. Collectively, placental pathologies demonstrated a significant contribution, underscoring the value of exploring the use of Doppler ultrasound for targeted surveillance in high-risk pregnancies. Maternal Placenta pathology Stillbirth Case-control study Figures Figure 1 Figure 2 Figure 3 Introduction Experiencing stillbirth is an overwhelming event that can result in profound psychosocial challenges and significant economic burdens for mothers, their immediate families, caregivers, and society at large ( 1 , 2 ). Stillbirth is defined in the International Classification of Diseases, 10th revision (ICD-10) as foetal death occurring before or during delivery after 20 weeks of gestation, according to). However, the World Health Organization (WHO) recommends a threshold of 28 weeks of gestation or more – or, where gestation age is not known, a birthweight of 1000g or more – for purposes of international comparison ( 3 ). Globally, an estimated 3.04 million stillbirths occurring after 20 weeks of gestation were reported in 2021, with nearly two-third occurring after 28 weeks of gestation ( 4 ). Between 2000 and 2019, the global stillbirth rate declined by 35.1% from 21.4 to 13.9 per 1000 live births ( 5 ). Despite this progress, the absolute number of stillbirths remain unacceptably high. South Asia and sub-Saharan Africa (SSA) stillbirths accounted for 77.3% (2.35 of the 3.04 million) of the global total, with SSA showing the least progress – a reduction of 24.9% ( 4 , 5 ). In addition to the slow progress in SSA, global monitoring of stillbirth trend has been inconsistent, partly because stillbirth has not received the same level of attention as maternal and child mortality within the global health agenda ( 6 ). Notably, stillbirth is not included as a specific target within the Sustainable Development Goals (SDG) agenda ( 7 ). In response, the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME), in collaboration with its Technical Advisory Group and Core Stillbirth Estimation Group, developed annual stillbirths estimates for 2000 to 2019 to strengthen administrative data systems ( 8 ). Furthermore, the Every Newborn Action Plan (ENAP) spearheaded by the United Nations Children’s Emergency Fund (UNICEF), WHO, and the UN Global Strategy for Women’s, Children’s and Adolescents’ Health 2016–2030 - set a target to reduce stillbirth rates to 12 per 1000 live births by 2030 ( 9 , 10 ). However, challenges remain, particularly with regards to data availability, quality, and accurate determination of causes of death ( 11 ). Furthermore, the authors reported that poor-quality data captured in many surveys has been cited as a key barrier to reliable trend tracking. Stillbirth remains surrounded by stigma and cultural taboos in many societies, which can influence how women and their family members respond to surveys, thereby affecting the accuracy of reported information ( 2 ). Despite these barriers, most women and their partners express a desire to understand the cause of their baby’s death, with many showing a positive attitude toward investigations - particularly non-invasive methods such as placental pathology ( 12 ). The placenta plays a crucial role in sustaining the foetus, meeting essential nutritional needs, and providing protection through its ability to mount an inflammatory response to external insults ( 13 ). Some of the known common causes of stillbirth include obstetrical complications, placental abnormalities, foetal malformations, infections, umbilical cord abnormalities, hypertensive disorders, medical complications, and undetermined ( 14 ). In the Zambian, there is limited published evidence on the role of the placental pathology in stillbirths. This study therefore aimed to assess maternal and placental factors association with stillbirth. Methods Study design, and period This was a prospective, unmatched case-control study conducted between September 2023 and February 2024 at seven major hospitals of Lusaka, Zambia. These included the five first-level hospital (Chawama, Chilenje, Chipata, Kanyama, and Matero), as well as Levy Mwanawasa University Teaching Hospital and the Women and Newborn Hospital. Cases were women who experienced stillbirth, while controls were women with live births, selected at a ratio of 1:2. In addition, placenta specimens were collected from all the of the study participants. Eligibility criteria The study included mothers with a gestation age above 28 weeks or more who delivered at the participating hospitals (study sites). Cases were defined as stillbirths at ≥ 28 weeks of gestation, while controls were defined as live births at ≥ 28 weeks. Given the relative rarity of stillbirths, cases were recruited consecutively from the facility which the event occurred, provided they met the inclusion criteria. Controls were selected from the next eligible live birth at the same facility that met the inclusion criteria within 24 hours of case recruitment. Sample size calculation The required sample size was estimated using Epi Info™ version 7.2.6.0 for an unmatched case–control study. Parameters included a hypothetical case-to-control ratio of 1:4, 95% confidence interval (CI), 80% power, and an assumed odds ratio of 3 based on findings from a previous study ( 15 ). This yielded a minimum of 34 cases and 134 controls, giving a total of 168 participants. To account for potential data losses, a 10% contingency was added, resulting in a final target sample size of 184. Data Collection The dependent variable was stillbirth. The independent variables comprised of the mothers’ demographic characteristics. These included maternal age, parity and gravidity, mode of delivery, foetal anomalies, marital status, educational level, employment status, and residence. Other independent variables included antenatal history, medical conditions, and obstetrics history and placenta pathologies. They included history of smoking, alcohol use during pregnancy, malaria, malaria presumptive treatment during pregnancy, anaemia, and antepartum haemorrhage, hypertensive disorders of pregnancy, diabetes mellitus, tuberculosis, HIV status and syphilis. Others involved were antenatal care booking and number of visits, inter-pregnancy interval, history of preterm delivery, low birthweight, previous history of pregnancy loss or newborn with seven days of life, and mode of transport to health facility. Review of maternal medical records, interviewer-administered questionnaire, and then placentas were collected from both groups underwent detailed histopathological examination by the pathologist. Placentas were stored in diluted formaldehyde then transported to the pathology department for further processing and histopathological examination. The pathology department of the University Teaching Hospital (UTH) produced pathology reports. Placenta Preservation To preserve placental specimens for histopathology examination, 10% neutral buffered formaldehyde was prepared. The preparation involved diluting 100ml of commercially available 37% formaldehyde stock solution in 900mls of phosphate- buffered saline to obtain a final volume of 1 litre. The phosphate buffer was required to maintain a neutral pH of 7.0, minimizing tissue distortion and ensuring optimal preservation of histological structure. The formaldehyde was prepared under standard biosafety precautions and stored in clearly labelled, tightly sealed containers at room temperature. All specimens were immersed in this solution immediately after gross examination to maintain integrity of tissues prior to laboratory processing and analysis. Sampling Strategy and Site Allocation Cases where recruited using the purposive sampling technique due to the rarity of the outcome of interest. To recruit controls, convenient sampling technique was used by recruiting participants who had delivered a live baby within 24 hours before or after recruitment of a case and if inclusion criteria was met. The same principles were applied to recruit and collect placenta specimens as these were embedded in the main sample population. To ensure that the sample distribution was reflective across all selected facilities, sample size per facility was determined using Probability Proportional to Size sampling. This was arrived at after review of records for each facility from the previous year and estimated the volumes per site. Therefore, facilities with higher volumes were assigned greater probability of selection compared to the ones with lower volumes. Although Levy Mwanawasa University Teaching Hospital was originally included due to its high delivery and perinatal death volumes, it was excluded from the final sample. This was because the data collection team at Levy mishandled the placental preservation process, compromising the integrity of biological specimens and their suitability for analysis. As a result, sample allocations were redistributed proportionally among the remaining six facilities. The following Table 1 illustrates the proportional allocation of samples. Table 1 Adjusted Proportional Allocation Table (Excluding Levy Mwanawasa Hospital) Facility Total Deliveries Perinatal Deaths % of Deaths (Excl. Levy) Adjusted Cases Adjusted Controls Total Sample WNH 6,797 363 36.1% 13 52 65 Kanyama 11,336 233 23.2% 8 33 41 Matero 4,939 192 19.1% 7 27 34 Chipata 9,117 169 16.8% 2 24 30 Chawama 7,590 52 5.2% 0 7 9 Chilenje 5,059 12 1.2% 0 1 1 TOTAL 44,838 1,021 100% 36 144 180 Data Analysis Data cleaning checking for completeness and validity was done in excel Microsoft software then exported to Stata Version 17 for analysis. Descriptive statistics was used to summarize frequency distributions and report central tendencies. Numerical data were summarized using appropriate measures of central tendency and dispersion, while categorical variables were presented as frequencies and percentages. To assess associations with stillbirth, Chi-square and Fisher’s exact tests (where applicable) were used to identify statistically significant variables. Univariate logistic regression analysis was conducted to explore the association between each potential risk factor and stillbirth. This was followed by investigator-led stepwise multivariable logistic regression analysis, adjusting for potential confounders to identify independent risk factors, reported as adjusted odds ratios (AORs). The model’s ability to correctly estimate risk was evaluated using the hosmer and lemeshow goodness-of-fit test, where a non-significant p - value (p > 0.05) indicated a good fit. To assess model’s stability and its ability to discriminate between participants with and without stillbirth, the area under the receiver operating characteristic (ROC) curve was calculated. An AUC value of 0.7 or higher was considered acceptable, as recommended by Kleinbaum and Klein ( 16 ). Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were adhered to ( 17 ). Results A total of 180 participants were included in the analysis, comprising 36 cases (stillbirths) and 144 controls (live births). Participants’ ages ranged from 18 to 43 years, with a mean age of 27.6 years (SD ± 6.5). Participants’ Socio-demographic, Maternal, and Placenta Characteristics In this study, several maternal, foetal, and placenta factors were significantly associated with stillbirth. Age 20–34 years had higher likelihood of stillbirth compared to the 35 years old age groups (32 of 36 [88.90%] compared to 3 of 36 [8.33%] and 1 of 36 [2.78], respectively; p = 0.01). Maternal weight between 60–69 kg was more significantly common among stillbirth cases than controls (14 [38.89%] against 22 of 144 [15.28%]; (p = 0.01). Marital status also showed significant association with the outcome, with a greater proportion of stillbirths occurring among the married women (32 [86.89%] in contrast with the controls 96 [66.67%]; p < 0.00). Antenatal care (ANC) booking after 12 weeks of gestation (Late ANC booking), was more frequent among the stillbirths (24 [66.67%] in comparison with the controls (36 of 114 [31.58%]; p < 0.00), as was fewer ANC (contacts < 8) (36 [100.00%] compare to 108 [85.71%]; p = 0.02). Prior history of stillbirth was noted exclusively among stillbirths (8 [22.22%] in contrast with none from the controls (0/112; p < 0.00). Short interpregnancy intervals (≤ 2 years) were more frequent in the stillbirth group (15 of 24 [62.50%] against 12 of 37 [32.43%]; p = 0.02). Alcohol consumption during pregnancy and anaemia were noted among the stillbirths (6 of 33 [18.18%] and 5 of 26 [13.89%], respectively; and both had p < 0.00). Foetal congenital anomalies were more frequent in stillbirths (30 of 36 [83.33%] compare to none among controls; p < 0.00). Placental factors including central cord insertion (28 of 36 [77.78%] compared to 56 of 126 controls [44.44%]; p < 0.00). Acute chorioamnionitis (20 of 36 [55.56%] as opposed to 28 of 126 controls [22.22%]; p < 0.00). Women with immature placental parenchyma (8 of 36 [22.22%] compared to none of 126 controls; p < 0.00) were also strongly associated with stillbirth. Normal placental histology was more frequent in the live births (91 of 126 [72.22%] compared to stillbirths (8 of 36 [22.22%]; p < 0.00). The following Table 2 and 3 illustrate the findings in details: Table 2 Participants’ Socio-demographic Characteristics Variables Stillbirth ( 36 ) (%) Alive (144) (%) Total (180) (%) p-value Age 35 1 (2.78) 27 (18.75) 28 (15.56) Total 36 (100.00) 144 (100.00) 180 (100.00) Maternal Weight 70kg 14 (38.89) 79 (54.86) 93 (51.67) Total 36 (100.00) 144 (100.00) 180 (100.00) Marital Status Married 32 (86.89) 96 (66.67) 128 (71.11) 0.00 No Married 4 (11.11) 48 (33.33) 52 (28.89) 0.00* Total 36 (100.00) 144 (100.00) 180 (100.00) Parity 5 6 (16.67) 13 (9.03) 19 (10.56) 0.22* Total 36 (100.00) 144 (100.00) 180 (100.00) Employment Employed 9 (25.00) 55 (38.19) 64 (35.56) 0.14 Unemployed 27(75.00) 89 (61.81) 116 (64.44) 0.17* Total 36 (100.00) 144 (100.00) 180 (100.00) Education Primary 10 (27.78) 42 (29.17) 52 (28.89) 0.95 Secondary 20 (55.56) 76 (52.78) 96 (53.33) 1.00* Tertiary 6 (16.67) 26 (18.06) 32 (17.78) Total Distance to Hospital < 5km ≥ 5km Total 36 (100.00) 15 (41.67) 21 (58.33) 36 (100.00) 144 (100.000 90 (62.50) 54 (37.50) 144 (100.00) 180 (100.00) 105 (58.33) 75 (41.67) 180 (100.00) 0.02 0.04* * fisher’s exact test Table 3 Maternal and Placental Characteristics ANC Booking 12 Weeks 24 (66.67) 36 (31.58) 60 (40.00) Total 36 (100.00) 114 (100.00) 150 (100.00) ANC Contacts 8 Weeks 0 (0.000 18 (14.29) 18 (11.11) Total 36 (100.00) 126 (100.00) 162 (100.00) Folate/FeSo 4 12 Weeks 21 (63.64) 33 (45.83) 54 (51.43) Total 33 (100.00) 72 (100.00) 105 (100.00) History of Stillbirth Yes 8 (22.22) 0 (0.00) 8 (5.41) 0.00 No 28 (77.78) 112 (100.00) 140 (94.59) 0.00 Total 36 (100.00) 112 (100.00) 148 (100.00) Interpregnancy Interval Within 2 years 15 (62.50) 12 (32.43) 27 (44.26) 0.02 After 2 years 9 (37.50) 25 (67.57) 34 (55.74) 0.03* Total 24 (100.00) 37 (100.00) 61 (100.00) Planned Pregnancy No 9 (32.14) 60 (47.62) 69 (44.81) 0.14 Yes 19 (67.86) 66 (52.38) 85 (55.15) Total 28 (100.00) 126 (100.00) 154 (100.000 HIV Status Negative 29 (80.56) 114 (90.48) 143 (88.27) 0.10 Positive 7 (19.44) 12 (9.52) 19 (11.73) 0.14 Total 36 (100.00) 126 (100.00) 162 (100.00) Alcohol Consumption during Pregnancy No 27 (81.82) 119 (100.00) 146 (96.05) 0.00 Yes 6 (18.18) 0 (0.00) 6 (3.95) 0.00* Total 36 (100.00) 119 (100.00) 152 (100.00) Anaemia during Pregnancy No 31 (86.11) 126 (100.00) 157 (96.91) 0.00 Yes 5 (13.89) 0 (0.00) 5 (3.09) 0.00* Total 36 (100.00) 126 (100.00) 162 (100.00) Rhesus Factor Not sure 32 (88.89) 100 (79.37) 132 (81.48) 0.19 Rhesus + ve 4 (11.11) 26 (20.63) 30 ( 0.23* Total 36 (100.00) 126 (100.00) 162 (100.00) Preeclampsia No 32 (88.89) 119 (94.44) 151 (93.21) 0.24 Yes 4 (11.11) 7 (5.56) 11 (6.79) 0.26* Total 36 (100.00) 126 (100.00) 162 (100.00) Hypertensive No 33 (91.67) 112 (88.89) 145 (89.51) 0.63 Yes 3 (8.33) 14 (11.11) 17 (10.49) 0.77 Total 36 (100.00) 126 (100.00) 162 (100.00) Congenital Anomalies Absent 6 (16.67) 0 (0.00) 6 (6.00) 0.00 Present 30 (83.33) 64 (100.00) 94 (94.00) 0.00* Total 36 (100.000 64 (100.000 100 (100.00) Cord Insertion Central 28 (77.78) 56 (44.44) 84 (51.85) 0.00 Marginal 8 (22.22) 70 (55.56) 78 (48.15) 0.00* Total 36 (100.00) 126 (100.00) 162 (100.00) Placenta Histopathology Normal Placenta 8 (22.22) 91 (72.22) 99 (61.11) 0.00 Acute Chorioamnionitis 20 (55.56) 28 (22.22) 48 (29.63) 0.00* Immature Parenchyma 8 (22.22) 0 (0.00) 8 (4.94) Retroplacental Haematoma 0 (0.00) 7 (5.56) 7 (4.32) Total 36 (100.00) 126 (100.00) 162 (100.00) * fisher’s exact test Summary of Findings using Univariable Logistic Regression Not being married was associated with lower odds of the adverse outcome compared to married women (COR = 0.18; 95% CI: 0.05–0.62; p = 0.01). Women living 5 kilometres or more from the hospital had increased odds of the outcome compared to those living closer (COR = 2.33; 95% CI: 1.11–4.91; p = 0.03). Attendance at antenatal care bookings was protective, with women who booked having over four times the odds of a favourable outcome (COR = 4.28; 95% CI: 1.96–9.38; p < 0.00). Early initiation of folate or iron supplementation was also associated with reduced odds of the outcome (COR = 2.62; 95% CI: 1.15–5.99; p = 0.02). A history of stillbirth (COR = 3.17; 95% CI: 1.21–8.28; p = 0.02) and abortion (COR = 4.60; 95% CI: 1.39–15.25; p = 0.01) increased the risk of the adverse outcome. Among clinical factors, a shorter umbilical cord length was associated with a markedly reduced risk (COR = 0.12; 95% CI: 0.05–0.30; p < 0.00), while abnormal placental pathology was linked to a nearly fivefold increase in odds (COR = 4.86; 95% CI: 2.22–10.60; p < 0.00). Other variables including age, parity, employment status, education, rhesus factor, hypertensive disorders, and preeclampsia were not significantly associated with the outcome. Hereafter is Table 4 illustrating the results after univariable logistic regression analysis: Table 4 Univariable Logistic Regression Variable COR 95% Confidence Interval P - Value Sociodemographic Factors Age 1.49 (0.77–2.87) 0.23 Parity 2.20 (0.76–6.33) 0.14 Marital Status 0.18 (0.05–0.62) 0.01 Employment Status 1.80 (0.79–4.11) 0.16 Educational Level 0.91 (0.53–1.57) 0.74 Distance to Hospital 2.33 (1.11–4.91) 0.03 Obstetric and Biological Factors ANC Booking 4.28 (1.96–9.38) 0.00 Delayed Time of Folate/FeSo₄ Start 2.62 (1.15–5.99) 0.02 Hypertensive Disorder 1.00 (0.27–3.75) 1.00 Preeclampsia 2.09 (0.50–8.80) 0.31 History of Stillbirth 3.17 (1.21–8.28) 0.02 History of Abortion 4.60 (1.39–15.25) 0.01 Rhesus Factor 0.45 (0.12–1.60) 0.22 Umbilical Cord Length 0.12 (0.05–0.30) 0.00 Abnormal Placenta Pathology 4.86 (2.22–10.60) 0.00 COR (Crude Odds Ratio) Summary of Findings using Multivariate Logistic Regression In the multivariable logistic regression model, abnormal cord length was associated with significantly lower odds of stillbirth (AOR = 0.07, 95% CI: 0.02–0.35, p = 0.00), while abnormal placenta was associated with significantly higher odds of stillbirth (AOR = 4.53, 95% CI: 1.13–18.12, p = 0.03). Other variables, including marital status, distance to facility, Rhesus factor, anaemia status, and history of stillbirth, were not statistically significant. The following is Table 5 showing the results following multivariable analysis: Table 5 Multivariable Logistic Regression Model Variable AOR 95% Confidence Interval P -value Marital Status 0.24 0.05–1.24 0.09 Distance to Facility 1.92 0.49–7.57 0.35 Rhesus Factor 0.41 0.05–3.24 0.40 Cord Length 0.07 0.02–0.35 0.00 Abnormal Placenta Pathology 4.53 1.13–18.12 0.03 AOR (Adjusted Odds Ratio) Placenta Histopathology The following Figs. 1.0 , 2.0, and 3.0 respectively, are photomicroscopes of selected placenta pathological lesions from the study participants demonstrating histopathology of various placenta pathologies. Discussion In this study, several maternal, obstetric, and placental factors were associated with stillbirth. However, using the multivariable logistic regression analysis, only short umbilical cord length and placental pathology remained independent predictors of stillbirth, while marital status, distance to the healthcare facility, and rhesus factor showed no significant statistical association after adjustment. Among the sociodemographic factors, age and parity in our study did not show significant association with stillbirth in either the univariable or multivariable models. In contrast, a systematic review and meta-analysis by Lean, Derricott ( 18 ), which used meta-regression to evaluate advanced maternal age as a continuous variable demonstrated an increased risk of adverse pregnancy outcomes including stillbirth with advancing age. Conversely, although our study did not find an association between teenage pregnancy and stillbirth, adolescent pregnancy remains a critical public health concern, as stillbirth rates are significantly higher among the 10-19-year-old compared to adults ( 19 ). With regard to parity, our findings of no association with stillbirth are consistent with earlier evidence from the same setting over a decade ago ( 20 ). This is further supported by a more recent population-based, multi-country study conducted across seven sites in low-resource settings, including Zambia, which also found no significant association between high parity and stillbirth ( 21 ). Marital status showed a strong association with stillbirth in the unadjusted regression model but only a borderline association in the adjusted model (p = 0.09). This trend suggests that being married may have a protective effect in reducing the risk of stillbirth. However, contrasting evidence from a cross-sectional analysis of Demographic Health Surveys (DHS) data across 27 sub-Saharan African countries reported that married women had higher odds of experiencing stillbirth compared to their unmarried counterparts ( 22 ). Similarly, distance to the hospital (≥ 5 km) demonstrated a strong association with stillbirth in the unadjusted model but did not retain statistical significance after adjustment for confounders. This aligns with findings from a facility-based study in Lagos, Nigeria, which also reported an unadjusted association between longer distance to hospital and stillbirth that was not significant in adjusted models ( 23 ). The lack of significance may be explained by the interplay of other factors such as delays in accessing comprehensive obstetric care and mode of transport, which was not directly assessed in our study. Nonetheless, prior evidence has shown that mode of transport is strongly linked to perinatal mortality, including stillbirth. Women who walked or relied on public transport faced significantly higher risks compared to those who used personal transport. A study conducted in Uganda and Zambia found that women with motorized transport were more likely to access Comprehensive Emergency Obstetric and Neonatal Care (CEmONC) facilities, whereas those who walked were often restricted to Basic Emergency Obstetric and Neonatal Care (BEmONC) facilities ( 24 , 25 ). Among the obstetric and biological factors, late antenatal care (ANC) booking and delayed initiation of folate and iron (FeSO₄) supplementation were both significantly associated with stillbirth in the unadjusted regression model but not after adjustment for confounders. These variables were assessed independently in the univariable analysis and subsequently included in the stepwise multivariable regression model. Late ANC booking has frequently been reported as a strong predictor of adverse perinatal outcomes, including stillbirth, as complications are often identified too late for timely intervention ( 26 ). This is has been linked with delayed or missed opportunities for preventive measures such as early screening for conditions such as anaemia, rhesus factor, preeclampsia and timely administration of Folate and FeSo 4, which are more effectively managed with early detection ( 27 ). Our study found that a previous history of stillbirth and abortion were both strongly associated with stillbirth in the unadjusted model; however, these associations did not remain significant after adjusting for potential confounders. Although our findings did not show a statistically significant relationship, other studies have reported that a history of abortion is associated with an increased risk of stillbirth compared to women without such a history. This has been attributed to heightened susceptibility to infections or other complications in subsequent pregnancies, which may increase the likelihood of stillbirth ( 28 , 29 ). Similarly, unlike our study where a history of stillbirth showed no significant association in the adjusted model, other studies have reported it as a significant risk factor for subsequent stillbirth ( 30 , 31 ). Most previous studies have reported that stillbirths are commonly attributable to obstetric complications, hypertensive disorders, infections, congenital anomalies, and placental problems. In low-resource settings, intrapartum events are the predominant causes, whereas in high-income countries maternal medical conditions and congenital anomalies are more frequently implicated ( 2 , 5 , 32 ). As for our study, most of these factors such ANC contacts, interpregnancy interval, alcohol consumption during pregnancy, anaemia during pregnancy, and congenital anomalies only showed strong association with stillbirth using chi-square and fisher’s exact test but not in the regression analysis. With regard to placental characteristics, our study found that cord insertion and certain abnormal placental pathologies (including acute chorioamnionitis and immature parenchyma) were strongly associated with stillbirth in chi-square and Fisher’s exact tests. However, these associations did not persist after regression analysis, except for umbilical cord length and abnormal placental pathology, which remained significantly associated with stillbirth in the adjusted model. In this study, umbilical cord length demonstrated a strong association with stillbirth in the adjusted logistic regression model. This finding aligns with other studies that have reported a statistical association between cord complications and increased cord length, noting that the incidence of cord-related complications rises as cord length increases. However, some authors have suggested that stillbirth may not be directly attributable to cord length itself, but rather to complications secondary to excessive cord length. The observed association between parenchymal maturity and stillbirth is consistent with previous research, which has demonstrated that the most prevalent histopathological lesions in stillbirths compared to live births include disorders of villous maturation. Such patterns are suggestive of intrauterine hypoxia, foetal vascular malperfusion, and chronic placental inflammation ( 33 – 35 ). Specifically, Jaiman and colleagues reported that delayed villous maturation was significantly more common in stillbirths than in live births. The role of chorioamnionitis in stillbirth is also supported by prior studies, which reported significantly higher rates of chorioamnionitis among stillbirths compared to controls ( 33 , 36 ). In our study, however, chorioamnionitis was also observed among live births. This suggests that while chorioamnionitis may be an important risk factor for stillbirth, its effect could be influenced by confounding factors such as the higher prevalence of preterm birth among stillbirth cases. Study strengths and limitations One of the key strengths of this study lies in its use of a robust case-control design combined with appropriate statistical techniques to analyse associations across three outcome variables. This approach allowed for the investigation of a broad range of maternal, foetal, and placental pathological characteristics. Notably, the inclusion of placental histopathology is a significant strength, particularly in low-resource settings such as Zambia, where such analyses are seldom performed due to high financial costs, logistical barriers, and a shortage of trained pathology personnel. The limited demand for placental histopathology in routine clinical or research practice may further contribute to its underutilization. By incorporating this component, the study adds valuable data to the limited body of knowledge on placental pathology in stillbirths, particularly within Zambia and other similar resource-constrained settings. At the same time, the study faced important limitations. Financial and logistical constraints restricted the scope of investigations. The robustness of the findings could have been further enhanced by incorporating genetic and molecular testing for congenital anomalies, which may have contributed to some of the stillbirths and would have provided greater context to the placental pathology results. Additionally, cord blood aspiration for screening infections—including TORCH infections (Toxoplasmosis, Other agents, Rubella, Cytomegalovirus, and Herpes simplex virus)—was not performed. Such analyses might have yielded insights into infectious causes of placental changes that are not always detectable through gross or histological examination alone. Despite these constraints, the study provides novel insights and highlights the feasibility and utility of incorporating placental pathology into stillbirth investigations in low-resource contexts. It lays a foundation for future research and policy dialogue on strengthening diagnostic capacity and surveillance in maternal and perinatal health. Conclusion This study identified several maternal, obstetric, and placental factors significantly associated with stillbirth, including late initiation of antenatal care (ANC), a history of abortion, and previous stillbirth. With respect to placental pathology, umbilical cord length remained significantly associated with stillbirth in the adjusted model. Although marginal cord insertion, parenchymal maturity, and chorioamnionitis demonstrated strong associations in univariable analyses, these did not persist after adjusting for confounders. Interestingly, placental pathologies showed significant association only when considered collectively, highlighting the complex and multifactorial nature of placental contributions to stillbirth. These findings underscore the importance of strengthening post-delivery screening for placental pathology as part of routine perinatal audits. Furthermore, integrating point-of-care tools such as Doppler ultrasound for targeted assessment of placental function in high-risk pregnancies may provide earlier opportunities for intervention and prevention of adverse outcomes Recommendations Based on these study findings, we recommend the following actions to strengthen maternal and newborn health in Zambia: Promotion of early and sustained ANC attendance Strengthening community-level awareness is critical to encourage early ANC booking (before 12 weeks of gestation). Early initiation of ANC enhances opportunities for timely screening, risk stratification, and detection of high-risk pregnancies, ultimately improving pregnancy outcomes. Enhancement of clinical capacity for placenta and foetal surveillance Our findings provide a foundation for larger-scale and more advanced research into the role of placental pathology in perinatal mortality, particularly in low-resource settings. Building clinical and research capacity in placental histopathology and integrating point-of-care tools such as Doppler ultrasound for foetal and placental assessment should be prioritized. Further investigation into infection-related factors The prevalence of chorioamnionitis in both cases and controls suggests the role of pre-existing infections. We therefore recommend incorporating additional investigations, such as vaginal swabbing and microbial culture, particularly among high-risk or clinically suspicious cases, to better understand and address infection-related contributions to adverse pregnancy outcomes. Linking placental pathology to neonatal outcomes Further surveys are needed to establish the relationship between placental pathological findings (such as chorioamnionitis) and early neonatal outcomes, including sepsis. Such research would strengthen understanding of the continuum between stillbirth and neonatal morbidity and mortality, and guide more comprehensive interventions. The above recommendations are aligned with the objective of the Zambia National Health Strategic Plan 2022 – 2026 and the WHO ANC model (37, 38). These strategies call for integrated, evidence-based, and quality-driven maternal health services to avoid preventable stillbirths and foster positive pregnancy experience. Abbreviations ANC Antenatal Care AOR Adjusted Odds Ratio BEmONC Basic Emergency Obstetric and Neonatal Care CEmONC Comprehensive Emergency Obstetric and Neonatal Care CI Confidence Interval DHS Demographic Health Surveys ENAP Every Newborn Action Plan FeSo4 Ferrous Sulphate HIV Human Immunodeficiency Syndrome ICD-10 International Classification of Diseases, 10th revision NHRA National Health Research Authority ROC Receiver Operating Characteristic SDG Sustainable Development Goals SSA Sub-Saharan Africa STROBE Strengthening the Reporting of Observational Studies in Epidemiology TORCH Toxoplasmosis, Other agents, Rubella, Cytomegalovirus, and Herpes Simplex Virus UNFPA United Nations Population Fund UNICEF United Nations Children’s Emergency Fund UN IGME United Nations Inter-Agency Group for Child Mortality Estimation UTH University Teaching Hospital WHO World Health Organization WNH Women and Newborn Hospital Declarations Ethical Oversight Ethical approval was obtained through the University of Zambia Biomedical Research Ethics Committee (Unzabrec) (reference number 3718-2023). This was followed by the National Health Research Authority (NHRA) clearance with reference number 000012/16/03/2023. There was Confidentiality and privacy for study participants. A comprehensive brief on the study aim, procedures, potential risks, and benefits were conducted using the participants’ information sheet and then obtaining informed consent before recruitment. Participants were also informed on their right to withdrawal from participating. Participants’ personal data was anonymized. Data was collected and kept on a password-protected device that was only accessible by the principle investigator. Encrypted backup was used with restricted access. Consent for publication All authors have read and approved the final version of the manuscript. Availability of data and materials Due to ethical restrictions which prevent public sharing of minimal data for this study which contains potentially identifiable patient information. Data used are available from the corresponding author and the University of Zambia School of Public Health representative, Joseph Zulu, professor of Community Health Medicine (via email [email protected] ) on reasonable request. Conflict of Interest We hereby declare that there are no actual or potential conflicts of interest—financial, professional, or personal—that could have influenced the conduct, analysis, or reporting of this study. Funding Not applicable as this was not a funded project. References Heazell AE, Siassakos D, Blencowe H, Bhutta ZA, Cacciatore J, Dang N, et al. Ending preventable stillbirths 3 Stillbirth: Why invest? 2015. Heazell AE, Siassakos D, Blencowe H, Burden C, Bhutta ZA, Cacciatore J, et al. Stillbirths: economic and psychosocial consequences. The Lancet. 2016;387(10018):604-16. Blencowe H, Hug L, Moller AB, You D, Moran AC. Definitions, terminology and standards for reporting of births and deaths in the perinatal period: International Classification of Diseases (ICD‐11). International Journal of Gynecology & Obstetrics. 2024. Comfort H, McHugh TA, Schumacher AE, Harris A, May EA, Paulson KR, et al. Global, regional, and national stillbirths at 20 weeks' gestation or longer in 204 countries and territories, 1990–2021: findings from the Global Burden of Disease Study 2021. The Lancet. 2024;404(10466):1955-88. 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;398(10302):772-85. De Bernis L, Kinney MV, Stones W, ten Hoope-Bender P, Vivio D, Leisher SH, et al. Stillbirths: ending preventable deaths by 2030. The lancet. 2016;387(10019):703-16. Nations U. Department of Economic and Social Affairs, Sustainable Development. Ensure Access to Affordable, Reliable, Sustainable and Modern Energy for All. 2022. Hug L, Mishra A, Lee S, You D, Moran A, Strong KL, et al. A neglected tragedy the global burden of stillbirths: report of the UN inter-agency group for child mortality estimation, 2020. 2020. WHO U, UNFPA BT. Trends in maternal mortality: World Bank; 2014. Child EWE. The global strategy for women's, children's and adolescents' health (2016-2030): Every Woman Every Child; 2015. Blencowe H, Cousens S, Jassir FB, Say L, Chou D, Mathers C, et al. National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis. The Lancet Global Health. 2016;4(2):e98-e108. Bedwell C, Danna VA, Lyangenda K, Tuwele K, Kuzenza F, Kimaro D, et al. ‘Moving towards understanding’, acceptability of investigations following stillbirth in sub‐Saharan Africa: A grounded theory study. BJOG: An International Journal of Obstetrics & Gynaecology. 2023;130(1):59-67. Kulkarni AD, Palaniappan N, Evans MJ. Placental Pathology and Stillbirth: A review of the literature and guidelines for the less experienced. Journal of Fetal Medicine. 2017;4(04):177-85. Patel O, Pradhan P, Das P, Mishra SK, Das Jr P. Placental Pathology and Maternal Risk Factors for Stillbirth: A Case-Control Study. Cureus. 2023;15(5). Patel O, Pradhan P, Das P, Mishra SK. Placental Pathology and Maternal Risk Factors for Stillbirth: A Case-Control Study. Cureus. 2023;15(5):e39339. Kleinbaum DG, Klein M. Survival analysis a self-learning text: Springer; 1996. Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. The lancet. 2007;370(9596):1453-7. Lean SC, Derricott H, Jones RL, Heazell AEP. Advanced maternal age and adverse pregnancy outcomes: A systematic review and meta-analysis. PLOS ONE. 2017;12(10):e0186287. Zhang T, Wang H, Wang X, Yang Y, Zhang Y, Tang Z, et al. The adverse maternal and perinatal outcomes of adolescent pregnancy: a cross sectional study in Hebei, China. BMC pregnancy and childbirth. 2020;20(1):339. Stringer EM, Vwalika B, Killam WP, Giganti MJ, Mbewe R, Chi BH, et al. Determinants of stillbirth in Zambia. Obstet Gynecol. 2011;117(5):1151-9. McClure EM, Saleem S, Goudar SS, Garces A, Whitworth R, Esamai F, et al. Stillbirth 2010–2018: a prospective, population-based, multi-country study from the Global Network. Reproductive Health. 2020;17(2):146. Terefe B, Jembere MM, Abrha NN, Asgedom DK, Assefa SK, Assimamaw NT. Pooled prevalence and multilevel determinants of stillbirths in sub-Saharan African countries: implications for achieving sustainable development goal. Global Health Research and Policy. 2025;10(1):11. Aduragbemi B-T, Cephas Ke-on A, Uchenna G-A, Lenka B. Influence of travel time and distance to the hospital of care on stillbirths: a retrospective facility-based cross-sectional study in Lagos, Nigeria. BMJ Global Health. 2021;6(10):e007052. Yusrawati Y, Respati T, Sekarwana N. Factors to improve the quality of comprehensive emergency obstetric and newborn care. International Journal of Public Health. 2023;12(3):1030-9. Widyantari KY, Sulistyaningsih I, editors. The Effectiveness of Cemonc on Maternal Mortality: Systematic Literature Review. Proceeding International Conference; 2019. Elrasheed FE, Abdelwahid A, Omer S, Abdelmageed MM, Elwali T, Elzein AM, et al. Booked vs. Unbooked Pregnancy Outcomes: Implications for Maternal and Fetal Health in a Resource-Limited Setting. Cjebm. 2025. Mansoor J, Hafeez U, Khan NU, Ali A, Zubair R, Swathi N, et al. Fetal and Neonatal Outcomes in Booked vs. UnBooked Deliveries: A Systematic Review and Meta-analysis of the Global Literature. 2024. Feleke BE, Feleke TE. A longitudinal study on the effects of previous stillbirth or abortion on subsequent pregnancies and infants. European journal of public health. 2021;31(6):1237-41. Suleiman MB, Mokuolu OA. Perinatal mortality in a Northwestern Nigerian city: a wake up call. Frontiers in Pediatrics. 2014;2:105. Makasa M, Mutale W, Lubeya MK, Mpetemoya T, Chinayi M, Mangala B, et al. Determinants of stillbirth in the Five General Hospitals of Lusaka, Zambia: A Case-Control study. Medical Journal of Zambia. 2023;50(1):35-46. Dube K, Lavender T, Blaikie K, Sutton CJ, Heazell AE, Smyth RM. Identification of factors associated with stillbirth in Zimbabwe–a cross sectional study. BMC pregnancy and childbirth. 2021;21:1-14. Lawn JE, Blencowe H, Waiswa P, Amouzou A, Mathers C, Hogan D, et al. Stillbirths: rates, risk factors, and acceleration towards 2030. The Lancet. 2016;387(10018):587-603. Jaiman S, Romero R, Pacora P, Jung E, Bhatti G, Yeo L, et al. Disorders of placental villous maturation in fetal death. Journal of perinatal medicine. 2020;48(4):345-68. Khong TY, Mooney EE, Ariel I, Balmus NC, Boyd TK, Brundler M-A, et al. Sampling and definitions of placental lesions: Amsterdam placental workshop group consensus statement. Archives of pathology & laboratory medicine. 2016;140(7):698-713. Clark A, Jackson T, Nagahawatte N, Poologasundarampillai G, Brownbill P, Evangelinos A, et al. Development of integrated models of the fetal and placental circulations to improve prediction of stillbirth. Placenta. 2024;154:e46. Lahra MM, Gordon A, Jeffery HE. Chorioamnionitis and fetal response in stillbirth. Am J Obstet Gynecol. 2007;196(3):229.e1-4. Organization WH. WHO antenatal care recommendations for a positive pregnancy experience: nutritional interventions update: multiple micronutrient supplements during pregnancy. 2020. Ministry of Health - MOH. National-Health-Stratergic-Plan-for-Zambia-2022-to-2026-revised-February-2023-lower-resolution.pdf. Lusaka, Zambia: MoH; 2022. p. 150. Additional Declarations No competing interests reported. Supplementary Files ParticpantInformationSheet.docx MaternalandPlacentalFactorsQuestionnaire.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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1","display":"","copyAsset":false,"role":"figure","size":272149,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003e1.0\u003c/strong\u003e Pathology number ZUH 2305561 at ×4, ×10, and ×40 magnification, respectively, demonstrate features of a \u003cstrong\u003enormal mature placenta\u003c/strong\u003e, including well-formed parenchymal villi with dense capillarization, uniform trophoblastic layers, and normal villous vasculature indicative of appropriate placental development.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7425494/v1/34b23b676f0f6cdd3171768e.png"},{"id":92574886,"identity":"143d4882-e3e8-47ce-8b03-e7418f0f4e1e","added_by":"auto","created_at":"2025-10-01 08:14:13","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":276374,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003e2.0 \u003c/strong\u003ePathology number ZUH 2305557 at X 4,10 and 40 magnification photomicrographs, respectively, demonstrate features of an \u003cstrong\u003eimmature placental parenchyma\u003c/strong\u003e with avascular villi. Some villi also show thickened trophoblastic layers and increased stromal cellularity, consistent with delayed villous maturation.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7425494/v1/55de2d0beddedcdf84d67df0.png"},{"id":92573098,"identity":"fa5785ed-4f8a-4d91-946f-c5ba15679e2b","added_by":"auto","created_at":"2025-10-01 08:06:13","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":242081,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003e3.0 \u003c/strong\u003ePathology number ZUH 2305558 at X 4, 10, and 40 magnification respectively, demonstrate histological features consistent with chorioamnionitis, characterized by dense infiltration of neutrophils into the chorionic plate and amniotic membranes.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7425494/v1/1ed889bb881f817eaeee0ff0.png"},{"id":100237272,"identity":"692d51aa-f7ce-47d0-bca5-b54b40c66aa2","added_by":"auto","created_at":"2026-01-14 12:41:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2382315,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7425494/v1/22aab063-6796-41cb-9cb4-d1bac2ec4e36.pdf"},{"id":92573091,"identity":"fc599fa1-2ed5-4d39-8b6b-33ca59fe6c42","added_by":"auto","created_at":"2025-10-01 08:06:13","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":20101,"visible":true,"origin":"","legend":"","description":"","filename":"ParticpantInformationSheet.docx","url":"https://assets-eu.researchsquare.com/files/rs-7425494/v1/8bd6e3b87e004c4c56a2f54c.docx"},{"id":92574885,"identity":"53b49581-a6f8-4f3c-bf9f-5a16fa3772aa","added_by":"auto","created_at":"2025-10-01 08:14:13","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":13785,"visible":true,"origin":"","legend":"","description":"","filename":"MaternalandPlacentalFactorsQuestionnaire.docx","url":"https://assets-eu.researchsquare.com/files/rs-7425494/v1/7f7b6060300224172c82d6ab.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Maternal and Placental Factors Associated with Stillbirth: Evidence from Selected Hospitals in Lusaka, Zambia","fulltext":[{"header":"Introduction","content":"\u003cp\u003eExperiencing stillbirth is an overwhelming event that can result in profound psychosocial challenges and significant economic burdens for mothers, their immediate families, caregivers, and society at large (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Stillbirth is defined in the International Classification of Diseases, 10th revision (ICD-10) as foetal death occurring before or during delivery after 20 weeks of gestation, according to). However, the World Health Organization (WHO) recommends a threshold of 28 weeks of gestation or more \u0026ndash; or, where gestation age is not known, a birthweight of 1000g or more \u0026ndash; for purposes of international comparison (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Globally, an estimated 3.04\u0026nbsp;million stillbirths occurring after 20 weeks of gestation were reported in 2021, with nearly two-third occurring after 28 weeks of gestation (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Between 2000 and 2019, the global stillbirth rate declined by 35.1% from 21.4 to 13.9 per 1000 live births (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Despite this progress, the absolute number of stillbirths remain unacceptably high. South Asia and sub-Saharan Africa (SSA) stillbirths accounted for 77.3% (2.35 of the 3.04\u0026nbsp;million) of the global total, with SSA showing the least progress \u0026ndash; a reduction of 24.9% (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn addition to the slow progress in SSA, global monitoring of stillbirth trend has been inconsistent, partly because stillbirth has not received the same level of attention as maternal and child mortality within the global health agenda (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Notably, stillbirth is not included as a specific target within the Sustainable Development Goals (SDG) agenda (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In response, the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME), in collaboration with its Technical Advisory Group and Core Stillbirth Estimation Group, developed annual stillbirths estimates for 2000 to 2019 to strengthen administrative data systems (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Furthermore, the Every Newborn Action Plan (ENAP) spearheaded by the United Nations Children\u0026rsquo;s Emergency Fund (UNICEF), WHO, and the UN Global Strategy for Women\u0026rsquo;s, Children\u0026rsquo;s and Adolescents\u0026rsquo; Health 2016\u0026ndash;2030 - set a target to reduce stillbirth rates to 12 per 1000 live births by 2030 (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). However, challenges remain, particularly with regards to data availability, quality, and accurate determination of causes of death (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Furthermore, the authors reported that poor-quality data captured in many surveys has been cited as a key barrier to reliable trend tracking.\u003c/p\u003e\u003cp\u003eStillbirth remains surrounded by stigma and cultural taboos in many societies, which can influence how women and their family members respond to surveys, thereby affecting the accuracy of reported information (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Despite these barriers, most women and their partners express a desire to understand the cause of their baby\u0026rsquo;s death, with many showing a positive attitude toward investigations - particularly non-invasive methods such as placental pathology (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). The placenta plays a crucial role in sustaining the foetus, meeting essential nutritional needs, and providing protection through its ability to mount an inflammatory response to external insults (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Some of the known common causes of stillbirth include obstetrical complications, placental abnormalities, foetal malformations, infections, umbilical cord abnormalities, hypertensive disorders, medical complications, and undetermined (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). In the Zambian, there is limited published evidence on the role of the placental pathology in stillbirths. This study therefore aimed to assess maternal and placental factors association with stillbirth.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design, and period\u003c/h2\u003e\u003cp\u003eThis was a prospective, unmatched case-control study conducted between September 2023 and February 2024 at seven major hospitals of Lusaka, Zambia. These included the five first-level hospital (Chawama, Chilenje, Chipata, Kanyama, and Matero), as well as Levy Mwanawasa University Teaching Hospital and the Women and Newborn Hospital. Cases were women who experienced stillbirth, while controls were women with live births, selected at a ratio of 1:2. In addition, placenta specimens were collected from all the of the study participants.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEligibility criteria\u003c/h3\u003e\n\u003cp\u003eThe study included mothers with a gestation age above 28 weeks or more who delivered at the participating hospitals (study sites). Cases were defined as stillbirths at \u0026ge;\u0026thinsp;28 weeks of gestation, while controls were defined as live births at \u0026ge;\u0026thinsp;28 weeks. Given the relative rarity of stillbirths, cases were recruited consecutively from the facility which the event occurred, provided they met the inclusion criteria. Controls were selected from the next eligible live birth at the same facility that met the inclusion criteria within 24 hours of case recruitment.\u003c/p\u003e\n\u003ch3\u003eSample size calculation\u003c/h3\u003e\n\u003cp\u003eThe required sample size was estimated using Epi Info\u0026trade; version 7.2.6.0 for an unmatched case\u0026ndash;control study. Parameters included a hypothetical case-to-control ratio of 1:4, 95% confidence interval (CI), 80% power, and an assumed odds ratio of 3 based on findings from a previous study (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). This yielded a minimum of 34 cases and 134 controls, giving a total of 168 participants. To account for potential data losses, a 10% contingency was added, resulting in a final target sample size of 184.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eThe dependent variable was stillbirth. The independent variables comprised of the mothers\u0026rsquo; demographic characteristics. These included maternal age, parity and gravidity, mode of delivery, foetal anomalies, marital status, educational level, employment status, and residence. Other independent variables included antenatal history, medical conditions, and obstetrics history and placenta pathologies. They included history of smoking, alcohol use during pregnancy, malaria, malaria presumptive treatment during pregnancy, anaemia, and antepartum haemorrhage, hypertensive disorders of pregnancy, diabetes mellitus, tuberculosis, HIV status and syphilis. Others involved were antenatal care booking and number of visits, inter-pregnancy interval, history of preterm delivery, low birthweight, previous history of pregnancy loss or newborn with seven days of life, and mode of transport to health facility.\u003c/p\u003e\u003cp\u003eReview of maternal medical records, interviewer-administered questionnaire, and then placentas were collected from both groups underwent detailed histopathological examination by the pathologist. Placentas were stored in diluted formaldehyde then transported to the pathology department for further processing and histopathological examination. The pathology department of the University Teaching Hospital (UTH) produced pathology reports.\u003c/p\u003e\n\u003ch3\u003ePlacenta Preservation\u003c/h3\u003e\n\u003cp\u003eTo preserve placental specimens for histopathology examination, 10% neutral buffered formaldehyde was prepared. The preparation involved diluting 100ml of commercially available 37% formaldehyde stock solution in 900mls of phosphate- buffered saline to obtain a final volume of 1 litre. The phosphate buffer was required to maintain a neutral pH of 7.0, minimizing tissue distortion and ensuring optimal preservation of histological structure. The formaldehyde was prepared under standard biosafety precautions and stored in clearly labelled, tightly sealed containers at room temperature. All specimens were immersed in this solution immediately after gross examination to maintain integrity of tissues prior to laboratory processing and analysis.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eSampling Strategy and Site Allocation\u003c/h2\u003e\u003cp\u003eCases where recruited using the purposive sampling technique due to the rarity of the outcome of interest. To recruit controls, convenient sampling technique was used by recruiting participants who had delivered a live baby within 24 hours before or after recruitment of a case and if inclusion criteria was met. The same principles were applied to recruit and collect placenta specimens as these were embedded in the main sample population.\u003c/p\u003e\u003cp\u003eTo ensure that the sample distribution was reflective across all selected facilities, sample size per facility was determined using Probability Proportional to Size sampling. This was arrived at after review of records for each facility from the previous year and estimated the volumes per site. Therefore, facilities with higher volumes were assigned greater probability of selection compared to the ones with lower volumes.\u003c/p\u003e\u003cp\u003eAlthough Levy Mwanawasa University Teaching Hospital was originally included due to its high delivery and perinatal death volumes, it was excluded from the final sample. This was because the data collection team at Levy mishandled the placental preservation process, compromising the integrity of biological specimens and their suitability for analysis. As a result, sample allocations were redistributed proportionally among the remaining six facilities. The following Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates the proportional allocation of samples.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAdjusted Proportional Allocation Table (Excluding Levy Mwanawasa Hospital)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFacility\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal Deliveries\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePerinatal Deaths\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e% of Deaths (Excl. Levy)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAdjusted Cases\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eAdjusted Controls\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eTotal Sample\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWNH\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6,797\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e363\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eKanyama\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11,336\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e233\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMatero\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4,939\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e192\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eChipata\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9,117\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e169\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eChawama\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7,590\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eChilenje\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5,059\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTOTAL\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e44,838\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1,021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e144\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e180\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eData cleaning checking for completeness and validity was done in excel Microsoft software then exported to Stata Version 17 for analysis. Descriptive statistics was used to summarize frequency distributions and report central tendencies.\u003c/p\u003e\u003cp\u003eNumerical data were summarized using appropriate measures of central tendency and dispersion, while categorical variables were presented as frequencies and percentages. To assess associations with stillbirth, Chi-square and Fisher\u0026rsquo;s exact tests (where applicable) were used to identify statistically significant variables. Univariate logistic regression analysis was conducted to explore the association between each potential risk factor and stillbirth. This was followed by investigator-led stepwise multivariable logistic regression analysis, adjusting for potential confounders to identify independent risk factors, reported as adjusted odds ratios (AORs). The model\u0026rsquo;s ability to correctly estimate risk was evaluated using the hosmer and lemeshow goodness-of-fit test, where a non-significant p\u003cem\u003e-\u003c/em\u003evalue (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) indicated a good fit. To assess model\u0026rsquo;s stability and its ability to discriminate between participants with and without stillbirth, the area under the receiver operating characteristic (ROC) curve was calculated. An AUC value of 0.7 or higher was considered acceptable, as recommended by Kleinbaum and Klein (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were adhered to (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 180 participants were included in the analysis, comprising 36 cases (stillbirths) and 144 controls (live births). Participants\u0026rsquo; ages ranged from 18 to 43 years, with a mean age of 27.6 years (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;6.5).\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eParticipants\u0026rsquo; Socio-demographic, Maternal, and Placenta Characteristics\u003c/h2\u003e\u003cp\u003eIn this study, several maternal, foetal, and placenta factors were significantly associated with stillbirth. Age 20\u0026ndash;34 years had higher likelihood of stillbirth compared to the \u0026lt;\u0026thinsp;20 and \u0026gt;\u0026thinsp;35 years old age groups (32 of 36 [88.90%] compared to 3 of 36 [8.33%] and 1 of 36 [2.78], respectively; p\u0026thinsp;=\u0026thinsp;0.01). Maternal weight between 60\u0026ndash;69 kg was more significantly common among stillbirth cases than controls (14 [38.89%] against 22 of 144 [15.28%]; (p\u0026thinsp;=\u0026thinsp;0.01). Marital status also showed significant association with the outcome, with a greater proportion of stillbirths occurring among the married women (32 [86.89%] in contrast with the controls 96 [66.67%]; p\u0026thinsp;\u0026lt;\u0026thinsp;0.00). Antenatal care (ANC) booking after 12 weeks of gestation (Late ANC booking), was more frequent among the stillbirths (24 [66.67%] in comparison with the controls (36 of 114 [31.58%]; p\u0026thinsp;\u0026lt;\u0026thinsp;0.00), as was fewer ANC (contacts\u0026thinsp;\u0026lt;\u0026thinsp;8) (36 [100.00%] compare to 108 [85.71%]; p\u0026thinsp;=\u0026thinsp;0.02). Prior history of stillbirth was noted exclusively among stillbirths (8 [22.22%] in contrast with none from the controls (0/112; p\u0026thinsp;\u0026lt;\u0026thinsp;0.00). Short interpregnancy intervals (\u0026le;\u0026thinsp;2 years) were more frequent in the stillbirth group (15 of 24 [62.50%] against 12 of 37 [32.43%]; p\u0026thinsp;=\u0026thinsp;0.02). Alcohol consumption during pregnancy and anaemia were noted among the stillbirths (6 of 33 [18.18%] and 5 of 26 [13.89%], respectively; and both had p\u0026thinsp;\u0026lt;\u0026thinsp;0.00).\u003c/p\u003e\u003cp\u003eFoetal congenital anomalies were more frequent in stillbirths (30 of 36 [83.33%] compare to none among controls; p\u0026thinsp;\u0026lt;\u0026thinsp;0.00). Placental factors including central cord insertion (28 of 36 [77.78%] compared to 56 of 126 controls [44.44%]; p\u0026thinsp;\u0026lt;\u0026thinsp;0.00). Acute chorioamnionitis (20 of 36 [55.56%] as opposed to 28 of 126 controls [22.22%]; p\u0026thinsp;\u0026lt;\u0026thinsp;0.00). Women with immature placental parenchyma (8 of 36 [22.22%] compared to none of 126 controls; p\u0026thinsp;\u0026lt;\u0026thinsp;0.00) were also strongly associated with stillbirth. Normal placental histology was more frequent in the live births (91 of 126 [72.22%] compared to stillbirths (8 of 36 [22.22%]; p\u0026thinsp;\u0026lt;\u0026thinsp;0.00). The following Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e illustrate the findings in details:\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eParticipants\u0026rsquo; Socio-demographic Characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStillbirth (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e) (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAlive (144) (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTotal (180) (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (8.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28 (19.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31 (17.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e20\u0026ndash;34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32 (88.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e89 (61.81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e121 (67.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.01*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (2.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27 (18.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28 (15.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e144 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e180 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMaternal Weight\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;59kg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (22.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43 (29.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e51 (28.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e60\u0026ndash;69kg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (38.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22 (15.28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36 (20.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.01*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;70kg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (38.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e79 (54.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e93 (51.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e144 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e180 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32 (86.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e96 (66.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e128 (71.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.00\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo Married\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (11.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48 (33.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e52 (28.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.00*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e144 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e180 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eParity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30 (83.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e131 (90.97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e161 (89.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.18\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (16.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (9.03)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19 (10.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.22*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e144 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e180 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEmployment\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (25.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55 (38.19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e64 (35.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27(75.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e89 (61.81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e116 (64.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.17*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e144 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e180 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (27.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42 (29.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e52 (28.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 (55.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e76 (52.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e96 (53.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.00*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTertiary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (16.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26 (18.06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32 (17.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003eDistance to Hospital\u003c/p\u003e\u003cp\u003e\u0026lt;\u0026thinsp;5km\u003c/p\u003e \u003cp\u003e\u0026ge;\u0026thinsp;5km\u003c/p\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36 (100.00)\u003c/p\u003e\u003cp\u003e15 (41.67)\u003c/p\u003e\u003cp\u003e21 (58.33)\u003c/p\u003e\u003cp\u003e36 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e144 (100.000\u003c/p\u003e\u003cp\u003e90 (62.50)\u003c/p\u003e\u003cp\u003e54 (37.50)\u003c/p\u003e\u003cp\u003e144 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e180 (100.00)\u003c/p\u003e\u003cp\u003e105 (58.33)\u003c/p\u003e\u003cp\u003e75 (41.67)\u003c/p\u003e\u003cp\u003e180 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.02\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e0.04*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003e*\u003c/b\u003e\u003cem\u003efisher\u0026rsquo;s exact test\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMaternal and Placental Characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eANC Booking\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;12 Weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (33.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e78 (68.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e90 (60.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.00\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;12 Weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24 (66.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36 (31.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e60 (40.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e114 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e150 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eANC Contacts\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;8 Weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e108 (85.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e144 (88.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.02\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;8 Weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (14.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18 (11.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e126 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e162 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFolate/FeSo\u003csub\u003e4\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;12 Weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (36.36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39 (54.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e51 (48.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;12 Weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21 (63.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33 (45.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e54 (51.43)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e72 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e105 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHistory of Stillbirth\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (22.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (5.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.00\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28 (77.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e112 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e140 (94.59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.00\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e112 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e148 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eInterpregnancy Interval\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 2 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 (62.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 (32.43)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27 (44.26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.02\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAfter 2 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (37.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25 (67.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34 (55.74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.03*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e61 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePlanned Pregnancy\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (32.14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60 (47.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e69 (44.81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19 (67.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66 (52.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e85 (55.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e126 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e154 (100.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHIV Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNegative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29 (80.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e114 (90.48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e143 (88.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePositive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (19.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 (9.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19 (11.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e126 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e162 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAlcohol Consumption during Pregnancy\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27 (81.82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e119 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e146 (96.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.00\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (18.18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (3.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.00*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e119 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e152 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAnaemia during Pregnancy\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31 (86.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e126 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e157 (96.91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.00\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (13.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (3.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.00*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e126 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e162 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRhesus Factor\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot sure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32 (88.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e100 (79.37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e132 (81.48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRhesus\u0026thinsp;+\u0026thinsp;ve\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (11.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26 (20.63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30 (\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.23*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e126 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e162 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePreeclampsia\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32 (88.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e119 (94.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e151 (93.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.24\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (11.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (5.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11 (6.79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.26*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e126 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e162 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHypertensive\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33 (91.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e112 (88.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e145 (89.51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.63\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (8.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (11.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17 (10.49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.77\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e126 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e162 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCongenital Anomalies\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbsent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (16.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.00\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePresent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30 (83.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e64 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e94 (94.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.00*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36 (100.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e64 (100.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCord Insertion\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCentral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28 (77.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56 (44.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e84 (51.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.00\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarginal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (22.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70 (55.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e78 (48.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.00*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e126 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e162 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePlacenta Histopathology\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNormal Placenta\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (22.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e91 (72.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e99 (61.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.00\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcute Chorioamnionitis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 (55.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28 (22.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48 (29.63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.00*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eImmature Parenchyma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (22.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (4.94)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRetroplacental Haematoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (5.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (4.32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e126 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e162 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003e*\u003c/b\u003e\u003cem\u003efisher\u0026rsquo;s exact test\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eSummary of Findings using Univariable Logistic Regression\u003c/h2\u003e\u003cp\u003eNot being married was associated with lower odds of the adverse outcome compared to married women (COR\u0026thinsp;=\u0026thinsp;0.18; 95% CI: 0.05\u0026ndash;0.62; p\u0026thinsp;=\u0026thinsp;0.01). Women living 5 kilometres or more from the hospital had increased odds of the outcome compared to those living closer (COR\u0026thinsp;=\u0026thinsp;2.33; 95% CI: 1.11\u0026ndash;4.91; p\u0026thinsp;=\u0026thinsp;0.03). Attendance at antenatal care bookings was protective, with women who booked having over four times the odds of a favourable outcome (COR\u0026thinsp;=\u0026thinsp;4.28; 95% CI: 1.96\u0026ndash;9.38; p\u0026thinsp;\u0026lt;\u0026thinsp;0.00). Early initiation of folate or iron supplementation was also associated with reduced odds of the outcome (COR\u0026thinsp;=\u0026thinsp;2.62; 95% CI: 1.15\u0026ndash;5.99; p\u0026thinsp;=\u0026thinsp;0.02). A history of stillbirth (COR\u0026thinsp;=\u0026thinsp;3.17; 95% CI: 1.21\u0026ndash;8.28; p\u0026thinsp;=\u0026thinsp;0.02) and abortion (COR\u0026thinsp;=\u0026thinsp;4.60; 95% CI: 1.39\u0026ndash;15.25; p\u0026thinsp;=\u0026thinsp;0.01) increased the risk of the adverse outcome. Among clinical factors, a shorter umbilical cord length was associated with a markedly reduced risk (COR\u0026thinsp;=\u0026thinsp;0.12; 95% CI: 0.05\u0026ndash;0.30; p\u0026thinsp;\u0026lt;\u0026thinsp;0.00), while abnormal placental pathology was linked to a nearly fivefold increase in odds (COR\u0026thinsp;=\u0026thinsp;4.86; 95% CI: 2.22\u0026ndash;10.60; p\u0026thinsp;\u0026lt;\u0026thinsp;0.00). Other variables including age, parity, employment status, education, rhesus factor, hypertensive disorders, and preeclampsia were not significantly associated with the outcome. Hereafter is Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e illustrating the results after univariable logistic regression analysis:\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eUnivariable Logistic Regression\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCOR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95% Confidence Interval\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP - Value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eSociodemographic Factors\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(0.77\u0026ndash;2.87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.23\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(0.76\u0026ndash;6.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital Status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(0.05\u0026ndash;0.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmployment Status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(0.79\u0026ndash;4.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducational Level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(0.53\u0026ndash;1.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.74\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDistance to Hospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(1.11\u0026ndash;4.91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.03\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eObstetric and Biological Factors\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eANC Booking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(1.96\u0026ndash;9.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.00\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDelayed Time of Folate/FeSo₄ Start\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(1.15\u0026ndash;5.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.02\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertensive Disorder\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(0.27\u0026ndash;3.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreeclampsia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(0.50\u0026ndash;8.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.31\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHistory of Stillbirth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(1.21\u0026ndash;8.28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.02\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHistory of Abortion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(1.39\u0026ndash;15.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRhesus Factor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(0.12\u0026ndash;1.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.22\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUmbilical Cord Length\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(0.05\u0026ndash;0.30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.00\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbnormal Placenta Pathology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(2.22\u0026ndash;10.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.00\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eCOR (Crude Odds Ratio)\u003c/h2\u003e\u003cdiv id=\"Sec14\" class=\"Section3\"\u003e\u003ch2\u003eSummary of Findings using Multivariate Logistic Regression\u003c/h2\u003e\u003cp\u003eIn the multivariable logistic regression model, abnormal cord length was associated with significantly lower odds of stillbirth (AOR\u0026thinsp;=\u0026thinsp;0.07, 95% CI: 0.02\u0026ndash;0.35, p\u0026thinsp;=\u0026thinsp;0.00), while abnormal placenta was associated with significantly higher odds of stillbirth (AOR\u0026thinsp;=\u0026thinsp;4.53, 95% CI: 1.13\u0026ndash;18.12, p\u0026thinsp;=\u0026thinsp;0.03). Other variables, including marital status, distance to facility, Rhesus factor, anaemia status, and history of stillbirth, were not statistically significant. The following is Table \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e showing the results following multivariable analysis:\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultivariable Logistic Regression Model\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAOR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95% Confidence Interval\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP -value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.05\u0026ndash;1.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDistance to Facility\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.49\u0026ndash;7.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.35\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRhesus Factor\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.05\u0026ndash;3.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCord Length\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.02\u0026ndash;0.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.00\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAbnormal Placenta Pathology\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.13\u0026ndash;18.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.03\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eAOR (Adjusted Odds Ratio)\u003c/h2\u003e\u003cdiv id=\"Sec16\" class=\"Section3\"\u003e\u003ch2\u003ePlacenta Histopathology\u003c/h2\u003e\u003cp\u003eThe following Figs.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1.0\u003c/span\u003e, 2.0, and 3.0 respectively, are photomicroscopes of selected placenta pathological lesions from the study participants demonstrating histopathology of various placenta pathologies.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, several maternal, obstetric, and placental factors were associated with stillbirth. However, using the multivariable logistic regression analysis, only short umbilical cord length and placental pathology remained independent predictors of stillbirth, while marital status, distance to the healthcare facility, and rhesus factor showed no significant statistical association after adjustment.\u003c/p\u003e\u003cp\u003eAmong the sociodemographic factors, age and parity in our study did not show significant association with stillbirth in either the univariable or multivariable models. In contrast, a systematic review and meta-analysis by Lean, Derricott (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), which used meta-regression to evaluate advanced maternal age as a continuous variable demonstrated an increased risk of adverse pregnancy outcomes including stillbirth with advancing age. Conversely, although our study did not find an association between teenage pregnancy and stillbirth, adolescent pregnancy remains a critical public health concern, as stillbirth rates are significantly higher among the 10-19-year-old compared to adults (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). With regard to parity, our findings of no association with stillbirth are consistent with earlier evidence from the same setting over a decade ago (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). This is further supported by a more recent population-based, multi-country study conducted across seven sites in low-resource settings, including Zambia, which also found no significant association between high parity and stillbirth (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMarital status showed a strong association with stillbirth in the unadjusted regression model but only a borderline association in the adjusted model (p\u0026thinsp;=\u0026thinsp;0.09). This trend suggests that being married may have a protective effect in reducing the risk of stillbirth. However, contrasting evidence from a cross-sectional analysis of Demographic Health Surveys (DHS) data across 27 sub-Saharan African countries reported that married women had higher odds of experiencing stillbirth compared to their unmarried counterparts (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Similarly, distance to the hospital (\u0026ge;\u0026thinsp;5 km) demonstrated a strong association with stillbirth in the unadjusted model but did not retain statistical significance after adjustment for confounders. This aligns with findings from a facility-based study in Lagos, Nigeria, which also reported an unadjusted association between longer distance to hospital and stillbirth that was not significant in adjusted models (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). The lack of significance may be explained by the interplay of other factors such as delays in accessing comprehensive obstetric care and mode of transport, which was not directly assessed in our study. Nonetheless, prior evidence has shown that mode of transport is strongly linked to perinatal mortality, including stillbirth. Women who walked or relied on public transport faced significantly higher risks compared to those who used personal transport. A study conducted in Uganda and Zambia found that women with motorized transport were more likely to access Comprehensive Emergency Obstetric and Neonatal Care (CEmONC) facilities, whereas those who walked were often restricted to Basic Emergency Obstetric and Neonatal Care (BEmONC) facilities (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAmong the obstetric and biological factors, late antenatal care (ANC) booking and delayed initiation of folate and iron (FeSO₄) supplementation were both significantly associated with stillbirth in the unadjusted regression model but not after adjustment for confounders. These variables were assessed independently in the univariable analysis and subsequently included in the stepwise multivariable regression model. Late ANC booking has frequently been reported as a strong predictor of adverse perinatal outcomes, including stillbirth, as complications are often identified too late for timely intervention (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). This is has been linked with delayed or missed opportunities for preventive measures such as early screening for conditions such as anaemia, rhesus factor, preeclampsia and timely administration of Folate and FeSo\u003csub\u003e4,\u003c/sub\u003e which are more effectively managed with early detection (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Our study found that a previous history of stillbirth and abortion were both strongly associated with stillbirth in the unadjusted model; however, these associations did not remain significant after adjusting for potential confounders. Although our findings did not show a statistically significant relationship, other studies have reported that a history of abortion is associated with an increased risk of stillbirth compared to women without such a history. This has been attributed to heightened susceptibility to infections or other complications in subsequent pregnancies, which may increase the likelihood of stillbirth (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Similarly, unlike our study where a history of stillbirth showed no significant association in the adjusted model, other studies have reported it as a significant risk factor for subsequent stillbirth (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Most previous studies have reported that stillbirths are commonly attributable to obstetric complications, hypertensive disorders, infections, congenital anomalies, and placental problems. In low-resource settings, intrapartum events are the predominant causes, whereas in high-income countries maternal medical conditions and congenital anomalies are more frequently implicated (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). As for our study, most of these factors such ANC contacts, interpregnancy interval, alcohol consumption during pregnancy, anaemia during pregnancy, and congenital anomalies only showed strong association with stillbirth using chi-square and fisher\u0026rsquo;s exact test but not in the regression analysis.\u003c/p\u003e\u003cp\u003eWith regard to placental characteristics, our study found that cord insertion and certain abnormal placental pathologies (including acute chorioamnionitis and immature parenchyma) were strongly associated with stillbirth in chi-square and Fisher\u0026rsquo;s exact tests. However, these associations did not persist after regression analysis, except for umbilical cord length and abnormal placental pathology, which remained significantly associated with stillbirth in the adjusted model.\u003c/p\u003e\u003cp\u003eIn this study, umbilical cord length demonstrated a strong association with stillbirth in the adjusted logistic regression model. This finding aligns with other studies that have reported a statistical association between cord complications and increased cord length, noting that the incidence of cord-related complications rises as cord length increases. However, some authors have suggested that stillbirth may not be directly attributable to cord length itself, but rather to complications secondary to excessive cord length. The observed association between parenchymal maturity and stillbirth is consistent with previous research, which has demonstrated that the most prevalent histopathological lesions in stillbirths compared to live births include disorders of villous maturation. Such patterns are suggestive of intrauterine hypoxia, foetal vascular malperfusion, and chronic placental inflammation (\u003cspan additionalcitationids=\"CR34\" citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Specifically, Jaiman and colleagues reported that delayed villous maturation was significantly more common in stillbirths than in live births. The role of chorioamnionitis in stillbirth is also supported by prior studies, which reported significantly higher rates of chorioamnionitis among stillbirths compared to controls (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). In our study, however, chorioamnionitis was also observed among live births. This suggests that while chorioamnionitis may be an important risk factor for stillbirth, its effect could be influenced by confounding factors such as the higher prevalence of preterm birth among stillbirth cases.\u003c/p\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eStudy strengths and limitations\u003c/h2\u003e\u003cp\u003eOne of the key strengths of this study lies in its use of a robust case-control design combined with appropriate statistical techniques to analyse associations across three outcome variables. This approach allowed for the investigation of a broad range of maternal, foetal, and placental pathological characteristics.\u003c/p\u003e\u003cp\u003eNotably, the inclusion of placental histopathology is a significant strength, particularly in low-resource settings such as Zambia, where such analyses are seldom performed due to high financial costs, logistical barriers, and a shortage of trained pathology personnel. The limited demand for placental histopathology in routine clinical or research practice may further contribute to its underutilization. By incorporating this component, the study adds valuable data to the limited body of knowledge on placental pathology in stillbirths, particularly within Zambia and other similar resource-constrained settings.\u003c/p\u003e\u003cp\u003eAt the same time, the study faced important limitations. Financial and logistical constraints restricted the scope of investigations. The robustness of the findings could have been further enhanced by incorporating genetic and molecular testing for congenital anomalies, which may have contributed to some of the stillbirths and would have provided greater context to the placental pathology results. Additionally, cord blood aspiration for screening infections\u0026mdash;including TORCH infections (Toxoplasmosis, Other agents, Rubella, Cytomegalovirus, and Herpes simplex virus)\u0026mdash;was not performed. Such analyses might have yielded insights into infectious causes of placental changes that are not always detectable through gross or histological examination alone.\u003c/p\u003e\u003cp\u003eDespite these constraints, the study provides novel insights and highlights the feasibility and utility of incorporating placental pathology into stillbirth investigations in low-resource contexts. It lays a foundation for future research and policy dialogue on strengthening diagnostic capacity and surveillance in maternal and perinatal health.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study identified several maternal, obstetric, and placental factors significantly associated with stillbirth, including late initiation of antenatal care (ANC), a history of abortion, and previous stillbirth. With respect to placental pathology, umbilical cord length remained significantly associated with stillbirth in the adjusted model. Although marginal cord insertion, parenchymal maturity, and chorioamnionitis demonstrated strong associations in univariable analyses, these did not persist after adjusting for confounders. Interestingly, placental pathologies showed significant association only when considered collectively, highlighting the complex and multifactorial nature of placental contributions to stillbirth.\u003c/p\u003e\n\u003cp\u003eThese findings underscore the importance of strengthening post-delivery screening for placental pathology as part of routine perinatal audits. Furthermore, integrating point-of-care tools such as Doppler ultrasound for targeted assessment of placental function in high-risk pregnancies may provide earlier opportunities for intervention and prevention of adverse outcomes\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecommendations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on these study findings, we recommend the following actions to strengthen maternal and newborn health in Zambia:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u003cstrong\u003ePromotion of early and sustained ANC attendance\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eStrengthening community-level awareness is critical to encourage early ANC booking (before 12 weeks of gestation). Early initiation of ANC enhances opportunities for timely screening, risk stratification, and detection of high-risk pregnancies, ultimately improving pregnancy outcomes.\u0026nbsp;\u003c/p\u003e\n\u003col start=\"2\"\u003e\n \u003cli\u003e\u003cstrong\u003eEnhancement of clinical capacity for placenta and foetal surveillance\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eOur findings provide a foundation for larger-scale and more advanced research into the role of placental pathology in perinatal mortality, particularly in low-resource settings. Building clinical and research capacity in placental histopathology and integrating point-of-care tools such as Doppler ultrasound for foetal and placental assessment should be prioritized.\u0026nbsp;\u003c/p\u003e\n\u003col start=\"3\"\u003e\n \u003cli\u003e\u003cstrong\u003eFurther investigation into infection-related factors\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eThe prevalence of chorioamnionitis in both cases and controls suggests the role of pre-existing infections. We therefore recommend incorporating additional investigations, such as vaginal swabbing and microbial culture, particularly among high-risk or clinically suspicious cases, to better understand and address infection-related contributions to adverse pregnancy outcomes.\u0026nbsp;\u003c/p\u003e\n\u003col start=\"4\"\u003e\n \u003cli\u003e\u003cstrong\u003eLinking placental pathology to neonatal outcomes\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eFurther surveys are needed to establish the relationship between placental pathological findings (such as chorioamnionitis) and early neonatal outcomes, including sepsis. Such research would strengthen understanding of the continuum between stillbirth and neonatal morbidity and mortality, and guide more comprehensive interventions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe above recommendations are aligned with the objective of the Zambia National Health Strategic Plan 2022 – 2026 and the WHO ANC model (37, 38). These strategies call for integrated, evidence-based, and quality-driven maternal health services to avoid preventable stillbirths and foster positive pregnancy experience.\u0026nbsp;\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eANC\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Antenatal Care\u003c/p\u003e\n\u003cp\u003eAOR\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Adjusted Odds Ratio\u003c/p\u003e\n\u003cp\u003eBEmONC\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Basic Emergency Obstetric and Neonatal Care\u003c/p\u003e\n\u003cp\u003eCEmONC\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Comprehensive Emergency Obstetric and Neonatal Care\u003c/p\u003e\n\u003cp\u003eCI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Confidence Interval\u003c/p\u003e\n\u003cp\u003eDHS\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Demographic Health Surveys\u003c/p\u003e\n\u003cp\u003eENAP\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Every Newborn Action Plan\u003c/p\u003e\n\u003cp\u003eFeSo4\u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Ferrous Sulphate\u003c/p\u003e\n\u003cp\u003eHIV\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Human Immunodeficiency Syndrome\u003c/p\u003e\n\u003cp\u003eICD-10 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;International Classification of Diseases, 10th revision\u003c/p\u003e\n\u003cp\u003eNHRA\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;National Health Research Authority\u003c/p\u003e\n\u003cp\u003eROC\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Receiver Operating Characteristic\u003c/p\u003e\n\u003cp\u003eSDG\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Sustainable Development Goals\u003c/p\u003e\n\u003cp\u003eSSA\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Sub-Saharan Africa\u003c/p\u003e\n\u003cp\u003eSTROBE \u0026nbsp; \u0026nbsp; \u0026nbsp; Strengthening the Reporting of Observational Studies in Epidemiology\u003c/p\u003e\n\u003cp\u003eTORCH \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Toxoplasmosis, Other agents, Rubella, Cytomegalovirus, and Herpes Simplex Virus\u003c/p\u003e\n\u003cp\u003eUNFPA \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; United Nations Population Fund\u003c/p\u003e\n\u003cp\u003eUNICEF \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;United Nations Children\u0026rsquo;s Emergency Fund\u003c/p\u003e\n\u003cp\u003eUN IGME \u0026nbsp; \u0026nbsp; United Nations Inter-Agency Group for Child Mortality Estimation\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUTH\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;University Teaching Hospital\u003c/p\u003e\n\u003cp\u003eWHO\u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;World Health Organization\u003c/p\u003e\n\u003cp\u003eWNH\u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Women and Newborn Hospital\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Oversight\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained through the University of Zambia Biomedical Research Ethics Committee (Unzabrec) (reference number 3718-2023). This was followed by the National Health Research Authority (NHRA) clearance with reference number 000012/16/03/2023. There was Confidentiality and privacy for study participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA comprehensive brief on the study aim, procedures, potential risks, and benefits were conducted using the participants’ information sheet and then obtaining informed consent before recruitment. Participants were also informed on their right to withdrawal from participating. Participants’ personal data was anonymized. Data was collected and kept on a password-protected device that was only accessible by the principle investigator. Encrypted backup was used with restricted access.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDue to ethical restrictions which prevent public sharing of minimal data for this study which contains potentially identifiable patient information. Data used are available from the corresponding author and the University of Zambia School of Public Health representative, Joseph Zulu, professor of Community Health Medicine (via email [email protected]) on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe hereby declare that there are no actual or potential conflicts of interest—financial, professional, or personal—that could have influenced the conduct, analysis, or reporting of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable as this was not a funded project.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHeazell AE, Siassakos D, Blencowe H, Bhutta ZA, Cacciatore J, Dang N, et al. Ending preventable stillbirths 3 Stillbirth: Why invest? 2015.\u003c/li\u003e\n\u003cli\u003eHeazell AE, Siassakos D, Blencowe H, Burden C, Bhutta ZA, Cacciatore J, et al. Stillbirths: economic and psychosocial consequences. The Lancet. 2016;387(10018):604-16.\u003c/li\u003e\n\u003cli\u003eBlencowe H, Hug L, Moller AB, You D, Moran AC. Definitions, terminology and standards for reporting of births and deaths in the perinatal period: International Classification of Diseases (ICD‐11). International Journal of Gynecology \u0026amp; Obstetrics. 2024.\u003c/li\u003e\n\u003cli\u003eComfort H, McHugh TA, Schumacher AE, Harris A, May EA, Paulson KR, et al. Global, regional, and national stillbirths at 20 weeks\u0026apos; gestation or longer in 204 countries and territories, 1990\u0026ndash;2021: findings from the Global Burden of Disease Study 2021. The Lancet. 2024;404(10466):1955-88.\u003c/li\u003e\n\u003cli\u003eHug 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;398(10302):772-85.\u003c/li\u003e\n\u003cli\u003eDe Bernis L, Kinney MV, Stones W, ten Hoope-Bender P, Vivio D, Leisher SH, et al. Stillbirths: ending preventable deaths by 2030. The lancet. 2016;387(10019):703-16.\u003c/li\u003e\n\u003cli\u003eNations U. Department of Economic and Social Affairs, Sustainable Development. Ensure Access to Affordable, Reliable, Sustainable and Modern Energy for All. 2022.\u003c/li\u003e\n\u003cli\u003eHug L, Mishra A, Lee S, You D, Moran A, Strong KL, et al. A neglected tragedy the global burden of stillbirths: report of the UN inter-agency group for child mortality estimation, 2020. 2020.\u003c/li\u003e\n\u003cli\u003eWHO U, UNFPA BT. Trends in maternal mortality: World Bank; 2014.\u003c/li\u003e\n\u003cli\u003eChild EWE. The global strategy for women\u0026apos;s, children\u0026apos;s and adolescents\u0026apos; health (2016-2030): Every Woman Every Child; 2015.\u003c/li\u003e\n\u003cli\u003eBlencowe H, Cousens S, Jassir FB, Say L, Chou D, Mathers C, et al. National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis. The Lancet Global Health. 2016;4(2):e98-e108.\u003c/li\u003e\n\u003cli\u003eBedwell C, Danna VA, Lyangenda K, Tuwele K, Kuzenza F, Kimaro D, et al. \u0026lsquo;Moving towards understanding\u0026rsquo;, acceptability of investigations following stillbirth in sub‐Saharan Africa: A grounded theory study. BJOG: An International Journal of Obstetrics \u0026amp; Gynaecology. 2023;130(1):59-67.\u003c/li\u003e\n\u003cli\u003eKulkarni AD, Palaniappan N, Evans MJ. Placental Pathology and Stillbirth: A review of the literature and guidelines for the less experienced. Journal of Fetal Medicine. 2017;4(04):177-85.\u003c/li\u003e\n\u003cli\u003ePatel O, Pradhan P, Das P, Mishra SK, Das Jr P. Placental Pathology and Maternal Risk Factors for Stillbirth: A Case-Control Study. Cureus. 2023;15(5).\u003c/li\u003e\n\u003cli\u003ePatel O, Pradhan P, Das P, Mishra SK. Placental Pathology and Maternal Risk Factors for Stillbirth: A Case-Control Study. Cureus. 2023;15(5):e39339.\u003c/li\u003e\n\u003cli\u003eKleinbaum DG, Klein M. Survival analysis a self-learning text: Springer; 1996.\u003c/li\u003e\n\u003cli\u003eVon Elm E, Altman DG, Egger M, Pocock SJ, G\u0026oslash;tzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. The lancet. 2007;370(9596):1453-7.\u003c/li\u003e\n\u003cli\u003eLean SC, Derricott H, Jones RL, Heazell AEP. Advanced maternal age and adverse pregnancy outcomes: A systematic review and meta-analysis. PLOS ONE. 2017;12(10):e0186287.\u003c/li\u003e\n\u003cli\u003eZhang T, Wang H, Wang X, Yang Y, Zhang Y, Tang Z, et al. The adverse maternal and perinatal outcomes of adolescent pregnancy: a cross sectional study in Hebei, China. BMC pregnancy and childbirth. 2020;20(1):339.\u003c/li\u003e\n\u003cli\u003eStringer EM, Vwalika B, Killam WP, Giganti MJ, Mbewe R, Chi BH, et al. Determinants of stillbirth in Zambia. Obstet Gynecol. 2011;117(5):1151-9.\u003c/li\u003e\n\u003cli\u003eMcClure EM, Saleem S, Goudar SS, Garces A, Whitworth R, Esamai F, et al. Stillbirth 2010\u0026ndash;2018: a prospective, population-based, multi-country study from the Global Network. Reproductive Health. 2020;17(2):146.\u003c/li\u003e\n\u003cli\u003eTerefe B, Jembere MM, Abrha NN, Asgedom DK, Assefa SK, Assimamaw NT. Pooled prevalence and multilevel determinants of stillbirths in sub-Saharan African countries: implications for achieving sustainable development goal. Global Health Research and Policy. 2025;10(1):11.\u003c/li\u003e\n\u003cli\u003eAduragbemi B-T, Cephas Ke-on A, Uchenna G-A, Lenka B. Influence of travel time and distance to the hospital of care on stillbirths: a retrospective facility-based cross-sectional study in Lagos, Nigeria. BMJ Global Health. 2021;6(10):e007052.\u003c/li\u003e\n\u003cli\u003eYusrawati Y, Respati T, Sekarwana N. Factors to improve the quality of comprehensive emergency obstetric and newborn care. International Journal of Public Health. 2023;12(3):1030-9.\u003c/li\u003e\n\u003cli\u003eWidyantari KY, Sulistyaningsih I, editors. The Effectiveness of Cemonc on Maternal Mortality: Systematic Literature Review. Proceeding International Conference; 2019.\u003c/li\u003e\n\u003cli\u003eElrasheed FE, Abdelwahid A, Omer S, Abdelmageed MM, Elwali T, Elzein AM, et al. Booked vs. Unbooked Pregnancy Outcomes: Implications for Maternal and Fetal Health in a Resource-Limited Setting. Cjebm. 2025.\u003c/li\u003e\n\u003cli\u003eMansoor J, Hafeez U, Khan NU, Ali A, Zubair R, Swathi N, et al. Fetal and Neonatal Outcomes in Booked vs. UnBooked Deliveries: A Systematic Review and Meta-analysis of the Global Literature. 2024.\u003c/li\u003e\n\u003cli\u003eFeleke BE, Feleke TE. A longitudinal study on the effects of previous stillbirth or abortion on subsequent pregnancies and infants. European journal of public health. 2021;31(6):1237-41.\u003c/li\u003e\n\u003cli\u003eSuleiman MB, Mokuolu OA. Perinatal mortality in a Northwestern Nigerian city: a wake up call. Frontiers in Pediatrics. 2014;2:105.\u003c/li\u003e\n\u003cli\u003eMakasa M, Mutale W, Lubeya MK, Mpetemoya T, Chinayi M, Mangala B, et al. Determinants of stillbirth in the Five General Hospitals of Lusaka, Zambia: A Case-Control study. Medical Journal of Zambia. 2023;50(1):35-46.\u003c/li\u003e\n\u003cli\u003eDube K, Lavender T, Blaikie K, Sutton CJ, Heazell AE, Smyth RM. Identification of factors associated with stillbirth in Zimbabwe\u0026ndash;a cross sectional study. BMC pregnancy and childbirth. 2021;21:1-14.\u003c/li\u003e\n\u003cli\u003eLawn JE, Blencowe H, Waiswa P, Amouzou A, Mathers C, Hogan D, et al. Stillbirths: rates, risk factors, and acceleration towards 2030. The Lancet. 2016;387(10018):587-603.\u003c/li\u003e\n\u003cli\u003eJaiman S, Romero R, Pacora P, Jung E, Bhatti G, Yeo L, et al. Disorders of placental villous maturation in fetal death. Journal of perinatal medicine. 2020;48(4):345-68.\u003c/li\u003e\n\u003cli\u003eKhong TY, Mooney EE, Ariel I, Balmus NC, Boyd TK, Brundler M-A, et al. Sampling and definitions of placental lesions: Amsterdam placental workshop group consensus statement. Archives of pathology \u0026amp; laboratory medicine. 2016;140(7):698-713.\u003c/li\u003e\n\u003cli\u003eClark A, Jackson T, Nagahawatte N, Poologasundarampillai G, Brownbill P, Evangelinos A, et al. Development of integrated models of the fetal and placental circulations to improve prediction of stillbirth. Placenta. 2024;154:e46.\u003c/li\u003e\n\u003cli\u003eLahra MM, Gordon A, Jeffery HE. Chorioamnionitis and fetal response in stillbirth. Am J Obstet Gynecol. 2007;196(3):229.e1-4.\u003c/li\u003e\n\u003cli\u003eOrganization WH. WHO antenatal care recommendations for a positive pregnancy experience: nutritional interventions update: multiple micronutrient supplements during pregnancy. 2020.\u003c/li\u003e\n\u003cli\u003eMinistry of Health - MOH. National-Health-Stratergic-Plan-for-Zambia-2022-to-2026-revised-February-2023-lower-resolution.pdf. Lusaka, Zambia: MoH; 2022. p. 150.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Maternal, Placenta pathology, Stillbirth, Case-control study","lastPublishedDoi":"10.21203/rs.3.rs-7425494/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7425494/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eAn estimated 3.04 million stillbirths were recorded in 2021 with a global stillbirth rate decline from 21.4 to 13.9/1000 live births from 2000 to 2019. Despite this decline south Asia and sub-Saharan Africa recorded the least progress with an estimated decrease of 24.9%. The region accounts for 77.3% (2.35 million) of the global stillbirths’ total. To have a stillbirth is a devasting experience such that victims desire to understand the cause of death. This study aimed to evaluate the association between maternal and placental factors with stillbirth.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: This was a prospective unmatched case-control study conducted from September 2023 to February 2024 in selected hospitals in Lusaka, Zambia. Eligible participants were mothers with pregnancies beyond 28 weeks' gestation who experienced a stillbirth (cases) or a live birth (controls), enrolled at a 1:4 ratio. A purposive sampling technique was employed. Placental specimens were preserved in formaldehyde and sent for histopathological examination. Data were collected using a structured Google Sheets form. Statistical analysis included Chi-square and Fisher’s exact tests to assess associations with stillbirth. Univariate and stepwise multivariable logistic regression models were applied to identify risk factors associated with stillbirth.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The 180 participants analysed comprised of 36 stillbirths (cases) and 144 live births (controls). The maternal mean age was 27.6 (SD±6.5: range 18-43). Unmarried participants had lower odds of stillbirth (COR=0.18; 95% CI: 0.05-0.62; p = 0.01). Above ≥5km residence from the hospital had higher odds (2.33; 95% CI: 1.11-4.91; p = 0.03). Early antenatal booking was protective (COR=4.28; 95% CI: 1.96-9.38; p \u0026lt; 0.00), as was early start of iron and folate (COR=2.62; 95% CI: 1.15-5.99; p = 0.02). History of stillbirth (COR=3.17; 95% CI: 1.21-8.28; p = 0.02) or abortion (COR=4.60; 95% CI: 1.39-15.25; p = 0.01) higher risk. Abnormal placental pathology had a strong association with stillbirth (AOR=4.53; 95% CI: 1.13-18.12; p \u0026lt; 0.03). Cord length umbilical cord was protective had lower odds (AOR = 0.07, 95% CI: 0.02–0.35, p = 0.00).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Several maternal, obstetric, and placental factors were associated with stillbirth, including late initiation of antenatal care, a history of abortion, and previous stillbirth. Among placental findings, umbilical cord length remained significantly associated in adjusted models, while other abnormalities—such as marginal cord insertion, villous maturation disorders, and chorioamnionitis—showed strong associations only in univariable analyses. Collectively, placental pathologies demonstrated a significant contribution, underscoring the value of exploring the use of Doppler ultrasound for targeted surveillance in high-risk pregnancies.\u003c/p\u003e","manuscriptTitle":"Maternal and Placental Factors Associated with Stillbirth: Evidence from Selected Hospitals in Lusaka, Zambia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-01 08:06:08","doi":"10.21203/rs.3.rs-7425494/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2cb3ada3-c3b5-4424-8da4-4b9daaf17a1e","owner":[],"postedDate":"October 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-14T12:40:34+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-01 08:06:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7425494","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7425494","identity":"rs-7425494","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}