Stillbirth Rates and Avoidable Factors Across Public Hospitals in the South South Geopolitical Zone: A Prospective Cohort Analysis

Stillbirth rates in Nigeria remain among the highest globally, yet systematic prospective documentation of avoidable contributing factors at the facility level in the South South zone has not been reported. This prospective cohort study analyses stillbirth rates and avoidable contributing factors at public hospitals across Rivers, Delta, Bayelsa, Akwa Ibom, Cross River, and Edo States in the South South geopolitical zone. All stillbirths occurring over a 12-month period at one tertiary hospital per state were prospectively documented using the WHO ICD-PM (Perinatal Mortality) classification system. Avoidable factors were categorised using the three-delays framework, and a modified perinatal death audit conducted for each case. A total of 284 stillbirths were recorded across six facilities, yielding a pooled stillbirth rate of 22 per 1,000 total births. Antepartum stillbirths constituted 58 percent. Foetal growth restriction (34 percent), severe preeclampsia (28 percent), and cord complications (14 percent) were the most common antecedent conditions. Avoidable delays were identified in 74 percent of cases, predominantly third-delay failures at facility level including delayed recognition of foetal compromise and insufficient monitoring. Unbooked status was documented in 49 percent. The study identifies facility-level clinical failures as the dominant avoidable stillbirth factor in the South South zone. Recommendations include structured perinatal audit institutionalisation, cardiotocography availability, and third-trimester risk stratification protocols. Keywords: stillbirth, perinatal mortality, avoidable factors, South South Nigeria, perinatal audit