Introduction: Stillbirth is a significant global public health issue, with approximately 98% occurring in low- and middle-income countries. The Solomon Islands is a Pacific nation with poor perinatal outcomes and very little previous research investigating stillbirth. Methods: We conducted a retrospective cohort study investigating all stillbirths at the National Referral Hospital in Honiara, Solomon Islands, between January 2017 and December 2018. Causes of stillbirth and risk factors were classified on review of available case files. Results: Over two years, there were 341 stillbirths and 11,056 total births at the National Referral Hospital (30.8 stillbirths per 1000 births). Cause of death was documented for 198 and 142 full case files were available. Most stillbirths occurred antenatally (n=170/198) and 62% were at preterm gestations (<37 weeks). Low birthweight (<2500g) was present in 59% (n=84/142) and preventable maternal conditions, including hypertensive disorders and syphilis, were present in 42% (n=59/142) of cases. Acute events caused 46% of intrapartum deaths and 92% of these had inadequate intrapartum monitoring. Conclusion: Our study is the first to investigate causes of stillbirth in the Solomon Islands. We found a large proportion of preventable stillbirths and significant gaps in documentation. This highlights the importance and feasibility of a national registry. There is an urgent need for targeted training in data collection, improved quality of antenatal and intrapartum care and community awareness to reduce preventable stillbirths in the Asia-Pacific.

Objective: Vaginal birth after caesarean (VBAC) has been suggested to be associated with an increased risk of obstetric anal sphincter injury (compared with primiparous women who birth vaginally). However, prior studies have been small, or used outdated methodology. We set out to validate whether the risk of obstetric anal sphincter injury among women having their first VBAC is greater than that among primiparous women having a vaginal birth. Design: State-wide retrospective cohort study. Setting: Victoria, Australia. Population: All births (455,000) between 2009-2014. Methods: The risk of severe perineal injury between first vaginal birth and first vaginal birth after previous caesarean section was compared, after adjustment for potential confounding variables. Covariates were examined using logistic regression for categorical data and Wilcoxon rank-sum test for continuous data. Missing data were handled using multiple imputation; the analysis was performed using regression adjustment and Stata v16 multiple imputation and teffects suites. Results: Women having a VBAC (n=5,429) were significantly more likely than primiparous women (n=123,353) to sustain a 3rd or 4th degree tear during vaginal birth (7.1 vs 5.7%, p<0.001). After adjustment for mode of birth, body mass index, maternal age, infant birthweight, episiotomy and epidural, there was a 21% increased risk of severe perineal injury (relative risk 1.21 (95%CI 1.07 – 1.38)). Conclusions: Women having their first vaginal birth after caesarean section have a significant increased risk of sustaining a 3rd or 4th degree tear, compared with primiparous women having a vaginal birth. Patient counselling and professional guidelines should reflect this increased risk.