Intrauterine fetal demise: a retrospective study in tertiary care center in India
Keywords:Contributing factors, IUFD, Incidence, Preeclampsia
Background: An Intrauterine Fetal Demise (IUFD) is a major obstetrical catastrophe at any gestational age but the emotional pain and distress caused by this event increases in direct relation to the duration of pregnancy. The objective of the present study was to determine the incidence and possible causes of Intrauterine Fetal Demise (IUFD), and to determine preventive measures.
Methods: Retrospective observational study was done from Jan 2015 to Dec 2017 at Smt. Kashibai Navale Medical College and General Hospital, Narhe, Pune. Inclusion criteria were all the pregnant women with IUFD delivered at the centre, at or above 24 weeks of gestation. The methodology followed were parameters of assessment for analysis were maternal age, parity, probable causes for IUFD, booked or unbooked cases, mode of delivery, maternal complications, and placental histopathology. Statistical data were analyzed using SPSS version 25.
Results: The incidence of IUFD at authors’ hospital was 27/1000 live births. The IUFD rate was similar in maternal age <20years and >30years (p value 0.26). The incidence of IUFD increased with decreasing gestational age which was statistically significant (p value 0.001). IUFD incidence was higher in multiparous women compared to primiparous women (p value 0.036 with OR of 1.6 and 95% CI 1.02 to 2.54). The rate of IUFD was similar when sex of the baby was analyzed. 49.4% of fetuses had signs of maceration. The major cause of IUFD was severe preeclampsia (48.1%) which included HELLP syndrome, IUGR, Abruption. Maternal anemia (20.4%), GDM (3.8%), SLE (2.5%), APLA positive (2.5%), anhydramnios (6.3%) were some of the other important causes of IUFD.
Conclusions: This study was conducted to determine the incidence of IUFD and associated maternal risk factors. By understanding the contributing factors, we can seek ways of avoiding recurrence of IUFD by proper antenatal care and early diagnosis of obstetric complications and its appropriate management.
Lawn JE, Blencowe H, Pattinson R, Cousens S, Kumar R, Ibiebele I, et al. Lancet's Stillbirths Series Steering Committee. Stillbirths: Where? When? Why? How to make the data count?. Lancet. 2011;377(9775):1448-63.
Robinson GE. Pregnancy loss. Best Pract Res Clin Obstet Gynaecol. 2014;28(1):169-78.
Collins JH. Umbilical cord accidents: human studies. In Semin Perinatol. 2002;26(1):79-82.
Cacciatore J, Radestad J, Frederik Frøen J. Effects of contact with still born babies on maternal anxiety and depression. Birth. 2008;35(4):313-20.
Safarzadeh A, Ghaedniajahromi M, Ghaedniajahromi M, Rigi F, Massori N. Intra uterine fetal death and some related factors: A silent tragedy in Southeastern Iran. J Pain Relief. 2014;3(129):2167-0846.
Archibong EI, ASobande A, Asindi AA. Antenatal intrauterine fetal death, a prospective study in a tertiary hospital in South Western Saudi Arabia. J Obstet Gynaecol. 2003;23(2):170-3.
Fretts RC, Boyd ME, Usher RH, Usher HA. The changing pattern of fetal death, 1961-1988. Obstetr Gynecol. 1992;79(1):35-9.
Malati AJ, Lalana GC. Perinatal mortality in vellore Part I: A study of 21,585 infants. Indian J Pediatr. 1986;53(3):347-52.
Kumari R, Mengi V, Kumar O. Maternal risk factors and pregnancy wastage in a rural population of Jammu District. JK Science. 2013;15:82-5.
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.
Neetu S, Kiran P, Neena G, Arya AK. A retrospective study of 296 cases of intrauterine fetal death at a tertiary care center. Int J Reprod Contracept Obstet Gynaecol. 2013;2(2):141-6.