Early detection of IUGR: can it prevent stillbirth?
Keywords:Stillbirth, IUGR, Small for gestational age (SGA)
Background: Maternal mortality in India is decreasing with the advances in health care facilities, increase in the number of hospital deliveries, improvement in the transport facilities etc. Present study aimed at to evaluate the causes for antepartum stillbirths.
Methods: It is a retrospective study from the case records of the stillbirths that occurred from June 2015 to March 2018. All stillbirths between 28-41 weeks were studies. Stillbirths occurring in twin pregnancies were excluded. The total number of stillbirths that were studied was 102.
Results: Most of the IUDs occurred between 28-37 weeks 82 (80.39%). The mean period of gestation at which the stillbirth occurred was 33.84±3.8 weeks. There was more number of male stillborns as compared to female stillborns. When the weight distribution of all stillbirths was compared with weight for gestational age 48 (47.5%) were <10% (SGA) and 46 (45.09%) of stillbirths weighed between 10th and 50th percentile Most of the IUDs were caused due to cord accidents, abruption and as a complication of hypertensive disorders of pregnancy.
Conclusions: Stillbirths were higher in IUGR fetusus as compared to AGA fetuses. Hence in order to prevent stillbirth it would be mandatory to detect IUGR at an earlier stage and delivery should be planned if the fetus shows any features of compromise. Doppler studies can help in deciding the timing of delivery.
Gardosi J, Kady SM, McGeown P. Classification of stillbirth by relevant condition at death (ReCoDe): Population based cohort study. Br Med J. 2005;3331:1113-7.
Jason G, Theo Mul, Max M, David F. Analysis of birthweight and gestational age in antepartum stillbirths. Br J Obstet gynecol 1998;105:524-530
Ruth CF. Etiology and prevention of Stillbirth. Am J Obstet Gynecol. 2005;193:1923-35.
Smith GC, Stenhouse EJ, Crossley JA, Aitken DA, Cameron AD, Connor JM. Early pregnancy levels of pregnancy associated plasma protein a and the risk of intrauterine growth restriction, premature birth, preeclampsia and stillbirth. J Clin Endocrinol Metab. 2002;87:1762-7.
Bernstein IM, Horbar JD, Badger GJ et al. Morbidity and mortality among very-low birth weight neonates with intrauterine growth restriction: the Vermont Oxford Network. Am J Obstet Gynecol. 2000; 182:198-206.
Zeitlin JA, Aneel PY, Saurel-Cubezolles MJ, Papiernik E. Are risk factors the same for small for gestational age versus other preterm births?. Am J Obstet Gynecol. 2001;185:208-15.
Bukowski R, Gahn D, Denning J, Saade G. Impairment of growth in fetuses destined to deliver preterm. Am J Obstet Gynecol. 2001;185:463-7.
Buowski R, Hansen NI, Willinger M, Reddy UM, Parker CB et al. Fetal growth and risk of stillbirth: a population-based-case-control study. PLOS Med. 2014;11(4):e1001633.
Williams RL, Creasy RK, Cunningham GC et al. Fetal growth and perinatal viability in California. Obstetrics and Gynecol. 1982;59(5):624-32.
Alexander GR et al.: A United States national reference for fetal growth Obstet Gynecol. 1996;87(2):163-8.
Peter JR, Ho JJ, Valliappan J, Sivasangari S. Symphysial fundal height measurement in pregnancy for detecting abnormal fetal growth. BJOG-Int J Obstet Gynecol. 2012;119-78.
Reuwer PJ, Bruinse HW, Stoutenbeek P, Haspels AA. Doppler assessment of the fetoplacental circulation in normal and growth-retarded fetuses. Eur J Obstet Gyneco Reprod Biol. 1984;18(4):199-205.
Neilson JP, Alfirevic Z. Doppler ultrasound for fetal assessment in high risk pregnancies. Cochrane Database Sys Rev. 2000;2:CD000073.
Lavin T, David B, Preen, Robert P. Timing and cause of perinatal mortality for small-for-gestational age babies in South Africa: critical periods and challenges with detection. Mat Health Neonatol Prinatol. 2016;2:11.
Ray JG, Urquia ML. Risk of stillbirth at extremes of birthweight between 20-41 weeks gestation. J Perinatol. 2012;32(11):829-36.
Korteweg FJ, Erwich JJ, Holm JP, Ravise JM, Van der Meer J, Veeger NJ et al. Diverse placental pathologies as the main cause of fetal death. Obstet Gynecol. 2009;114;809-17.
Jason G, Vichithranie M, Mandy W, Asad M, Andre F. Maternal and fetal risk factors for stillbirth: population based study. BMJ. 2013;346:f108.