Profile of intrauterine fetal demise in Central India: is it preventable?
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20250192Keywords:
Etiology of IUFD, Intrauterine fetal demise, Perinatal death, PreeclampsiaAbstract
Background: Intrauterine fetal demise (IUFD) refers to the death of a fetus after 20 weeks of gestation but before or during labor, and it remains a significant obstetric concern worldwide. This study investigates the profile of IUFD in Central India, focusing on its causes, associated maternal factors, and the potential for prevention. Globally, unexplained stillbirth is reported in 76% of cases. The study aims to find the causes of IUFD in this area to help in achieving the goal of less than 12 neonatal deaths.
Methods: A retrospective observational study was conducted over two years from April 2022 to April 2024 at the Department of Obstetrics and Gynecology, R. D. Gardi Medical College, Ujjain, Madhya Pradesh. We included diagnosed cases of pregnancies with IUFD that presented at our hospital. Women before delivery and those who came in emergency with IUFD were included.
Results: 151 cases of IUFD were diagnosed out of 4492 deliveries in the study period of two years; rate of 3.36%. The most common cause of IUFD was preeclampsia (24%) followed by unexplained causes (12%), obstructed and prolonged labor (9.9%). Inspite of tertiary care level of health facility most of these intrauterine deaths were not prevented due to poor antenatal care, late reporting and callous attitude of relatives.
Conclusions: Certain causes of IUFD, such as congenital anomalies, are unavoidable, a significant proportion of cases could be prevented through enhanced maternal health management, improved prenatal screening, and better healthcare access across Central India.
Metrics
References
Martin JA, Hoyert DL. The national fetal death file. Seminars in Perinatology. 2002;26(1):3-11. DOI: https://doi.org/10.1053/sper:2002.29834
UNICEF. Stillbirths and stillbirth rates. UNICEF DATA, 2020. Available at: https://data.unicef.org/topic/child-survival/stillbirths/. Accessed 01 May 2024.
Lawn JE, Blencowe H, Waiswa P, Amouzou A, Mathers C, Hogan D, et al. Lancet Stillbirth Epidemiology investigator group. Stillbirths: rates, risk factors, and acceleration towards 2030. Lancet. 2016;387(10018):587-603. DOI: https://doi.org/10.1016/S0140-6736(16)00039-8
International Institute for Population Sciences (IIPS) and ICF. National Family Health Survey (NFHS-5), 2019-21, 2021. Available at: https://dhsprogram.com/pubs/pdf/FR375/FR375.pdf. Accessed 01 May 2024.
World Health Organization. Every Newborn: an action plan to end preventable deaths. Available at: https://www.who.int/maternal_child_adolescent/documents/every-newborn-action-plan/en/. Accessed 01 May 2024.
Man J, Hutchinson JC, Heazell AE, Ashworth M, Levine S, Sebire NJ. Stillbirth and intrauterine fetal death: factors affecting determination of cause of death at autopsy. Ultrasound Obstet Gynecol. 2016;48(5):566-73. DOI: https://doi.org/10.1002/uog.16016
Katti K, Anupama Rani V, Umashankar Km, Dharmavijaya Mn, Clinical study of intra uterine fetal death. Indian J Obstet Gynecol Res. 2017;4(4):404-6.
Jovanovic I, Ivanovic K, Kostic S, Tadic J, Dugalic S, Petronijevic M, Gojnic M, et al. Intrauterine Fetal Death in Term Pregnancy-A Single Tertiary Clinic Study. Life (Basel). 2023;13(12):2320. DOI: https://doi.org/10.3390/life13122320
Sharma S, Sidhu H, Kaur S. Analytical study of intrauterine fetal death cases and associated maternal conditions. Int J Appl Basic Med Res. 2016;6(1):11-3. DOI: https://doi.org/10.4103/2229-516X.173986
Choudhary A, Gupta V. Epidemiology of intrauterine fetal deaths: a study in tertiary referral centre in Uttarakhand. IOSR J Dent Med Sci. 2014;13(3):03-6. DOI: https://doi.org/10.9790/0853-13320306
Shravya Monica K, Rathnamma P. A retrospective study of intrauterine fetal demise in a tertiary care center. Int J Reproduct Contracept Obstetr Gynecol. 2023;12(3):590-4. DOI: https://doi.org/10.18203/2320-1770.ijrcog20230298
Gupta DrS, Rani DrK, Najam DR. Intrauterine fetal demise: A retrospective study in tertiary care center. Int J Clin Obstetr Gynaecol. 2022;6(2):18-21. DOI: https://doi.org/10.33545/gynae.2022.v6.i2a.1158
Saha D, Kurude VN, Sharvari Mundhe. A study of intrauterine fetal death in a tertiary care hospital. Int J Clin Obstetr Gynaecol. 2019;8(7):2647-7. DOI: https://doi.org/10.18203/2320-1770.ijrcog20193019
Bhatia T, Jayshree Narshetty, Priya Bagade, Kulkarni A, Rai M. Clinical study of cases of intrauterine foetal death in a tertiary centre. Int J Res Medi Sci. 2016;800-5. DOI: https://doi.org/10.18203/2320-6012.ijrms20160521
Singhal SR, Deepika A, Nanda S. Maternal and perinatal outcome in severe pre-eclampsia and eclampsia. South Asian Fede Obstetr Gynecol. 2009;1(3):25-8. DOI: https://doi.org/10.5005/jp-journals-10006-1005
Page JM, Bardsley T, Thorsten V, Allshouse AA, Varner MW, Debbink MP, et al. Stillbirth associated with infection in a diverse U.S. Cohort. Obstet Gynecol. 2019;134(6):1187-96. DOI: https://doi.org/10.1097/AOG.0000000000003515
Clark SL, Garite TJ, Hamilton EF, Belfort MA, Hankins GD. "Doing something" about the cesarean delivery rate. Am J Obstet Gynecol. 2018;219(3):267-71. DOI: https://doi.org/10.1016/j.ajog.2018.04.044
Flenady V, Koopmans L, Middleton P, Frøen JF, Smith GC, Gibbons K, et al. Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis. Lancet. 2011;377(9774):1331-40. DOI: https://doi.org/10.1016/S0140-6736(10)62233-7
Malacova E, Regan A, Nassar N, Raynes-Greenow C, Leonard H, Srinivasjois R, et al. Risk of stillbirth, preterm delivery, and fetal growth restriction following exposure in a previous birth: systematic review and meta-analysis. BJOG. 2018;125(2):183-92. DOI: https://doi.org/10.1111/1471-0528.14906
Mathiesen ER, Ringholm L, Damm P. Stillbirth in diabetic pregnancies. Best Pract Res Clin Obstet Gynaecol. 2011;25(1):105-111. DOI: https://doi.org/10.1016/j.bpobgyn.2010.11.001
Tennant PW, Glinianaia SV, Bilous RW, Rankin J, Bell R. Pre-existing diabetes, maternal glycated haemoglobin, and the risks of fetal and infant death: a population-based study. Diabetologia. 2014;57(2):285-94. DOI: https://doi.org/10.1007/s00125-013-3108-5
Swain PK, Jena A, Behera R. Associated risk factors of adverse pregnancy outcomes among women of reproductive age in India: a study based on NFHS-5. Demography India. 2024;53(1):1.