Antepartum Intrauterine Foetal Deaths In Third Trimester At A Tertiary Care Center
Antepartum Intrauterine Foetal Deaths In Third Trimester
Keywords:
intrauterine fetal death (IUFD), DIC (disseminated intravascular coagulation)Abstract
Objective: Study was conducted to determine the rates, documented causal factors and obstetric outcome for intrauterine fetal deaths at a tertiary care centre in Gujarat. The study also aimed to prove the value of antenatal care in prevention of intrauterine fetal death. Methods: A prospective descriptive study was conducted at a tertiary hospital in Gujarat, India. The study was performed over 14 month’s period (Jun 2004 to July 2005). Patients having intrauterine fetal death on admission in the third trimester were included in this study. Total number of deliveries during this period was 9802. Among this, total numbers of antenatal IUFD in third trimester were 161. The causes of IUFD were determined purely on close clinical observations and preliminary investigations. Results: Total number of deliveries were 9802.Incidence of still birth at our centre was 31 per 1000. Antenatal IUFD rate was 16.5 per 1000 after excluding early trimester fetal deaths and intra partum fetal deaths. IUFD amounts to one third of perinatal mortality in this study. Among the identifiable causes,Hypertensive disorders (31%), placental abruption (15.5%), severe anemia (13%), were most common causes. Congenital malformations were responsible for 4.3% cases .Induction was done in 36, augmentation was done in 53 patients,67 patients had spontaneous onset of labor and caesarean section was done in 5 patients. The most devastating complication of IUFD was DIC found in 3 patients (1.9%). Conclusions: The present study is an effort to compile a profile of maternal, fetal and placental causes culminating to IUFD at our centre. This emphasizes the Importance of proper antenatal care and identification of risk factors and its treatment. Considerable number of IUFD are still labeled as unexplained, hence cannot be prevented. Decrease in the incidence of IUFD would significantly reduce the perinatal mortality. [ Dawari S NJIRM 2014; 5(2) :5-9]
References
2. Kahn B et al, Lumey LH, Zybert PA, Lorenz JM, et al “Prospective risk of fetal death in singleton twin and triplet gestationâ€, Obstet Gynecol , 2003 Oct; 102 (4)685-92.
3. Bushra Naseem,Arif Tajammul, Hameed Tajammul Khan, Ayesha Arif, et al “Intra uterine fetal death†Pak Pead J, March 1997;21 (1):17-22.
4. Andrew B Kairalla et al, “Previous preterm and small for gestational age and subsequent risk for IUFDâ€, New Eng J Med., 2004
5. N. Singh, Kiran Pandey, Neena Gupta, A K Arya, Charu Pratap, Reshika Nayak, et al “A retrospective study of 296 cases of intrauterine fetal deaths at a tertiary care centre†Intl J of Reprod Contracept Obstet and Gynecol. 2013 Jun;2 (2):141-146
6. Sawas EfKarpidis, Evangelos Alexopoulos, et al“Case contoll study of factors associated with IUFD†MedGenMed, 2004;6 (2): 53
7. Smith GC et al “Sex, birth weight, and the risk of still birth in Scotland, 1980-1996â€American J of Epidemiology (impact factor : 5,22) 04/2000; 151 (6):614-9.
8.Liberman E, Lang JM, Cohen AP, Frigoletto FD, Acker D, Rao R, et al The association of fetal sex with the rate of cesarean section. Am J Obstet Gynecol 1997; 176:667-671
9.Parazzini F, Pirotta N, La Vecchia C, Bocciolone L, Fedele L, Determinants of perinatal and infant mortality in Italy.Rev Epidemiol Sante Publique. 1992; 40:15-24.
10.Raymond EG, Cnattingius S, Kiely JL, Effects of materal age, parity, and smoking on the risk of still birth. Brit J Obstet Gynaecol. 1994;101:301-306.
11. Petridou E, Kotsifakis G, Revinthi K, Polychronopoulou A, Trichopoulos D, determinants of still birth in Greece. Soz Preventivmed.1996;41:70-78
12. Stanton, C., Lawn, J. E., Rahman, H., Wilczynska-Ketende, K., & Hill, K. (2006). Stillbirth rates: delivering estimates in 190 countries. Lancet, 367, 1487-1494.
13. Bhattacharya, S., Mukhopadhyay, G., Mistry, P. K., Pati, S., & Saha, S. P. (2010). Stillbirth in a Tertiary Care Referral Hospital in North Bengal - A Review of Causes, Risk Factors and Prevention Strategies. Online J
Health Allied Sciences, 9(4), 4.
14. Engmann, C., Matendo, R., Kinoshata, R., Ditekemena, J., Moore, J., Goldenberg, R., … Wright, L. (2009). Stillbirth and early neonatal mortality in rural Central Africa. Int J Gynaecol Obstet, 105(2),
15. Korde-Nayak, V. N., & Gaikward, P. R. (2008). Causes of Stillbirth. J Obstet Gynecol India, 58(4), 314-318.
