Impact of intensive antenatal monitoring on perinatal outcomes among women with previous perinatal deaths in Nigeria: a prospective cohort study

Abstract

Background: Stillbirth and perinatal mortality remain major public health challenges in low- and middle-income countries, particularly in Nigeria, where rates remain among the highest globally. Women with previous perinatal deaths are at significantly increased risk of recurrence. This study evaluated the impact of an intensive antenatal monitoring protocol on pregnancy outcomes among such high-risk women in Ile-Ife, Nigeria. Methods: This prospective cohort study was conducted at the Fetal Medicine Unit of Obafemi Awolowo University Teaching Hospitals Complex between January 2021 and December 2024. Eighty-one pregnant women with a history of one or more perinatal deaths were recruited. In addition to routine antenatal care, participants received structured monitoring including early risk stratification, low-dose aspirin where indicated, fetal anomaly scanning, uterine artery Doppler, and serial fetal growth and umbilical artery Doppler assessments. Primary outcomes were stillbirth, early neonatal death, and perinatal mortality rates. Secondary outcomes included preterm birth, mode of delivery, and detection of fetal growth restriction (FGR). Results: A total of 84 neonates were delivered. The perinatal mortality rate was 59.5 per 1,000 total births, lower than national estimates. Five perinatal deaths (5.9%) were recorded, comprising four stillbirths and one early neonatal death. Preterm birth occurred in 59.5% of cases, with most being provider-initiated due to hypertensive disorders and FGR. FGR was detected in 4.9% of pregnancies. Caesarean section rate was 69.1%. Conclusions: Intensive antenatal monitoring among women with previous perinatal deaths was associated with improved perinatal outcomes compared to national averages. Scaling up structured surveillance strategies may contribute significantly to reducing perinatal mortality in high-risk populations in resource-limited settings.