IUFD incidence, causes and complications: a retrospective study done at a tertiary care centre in greater Noida, India

Abstract

Background: Demise of a fetus is not only a cause of distress to the parents but also leaves the obstetrician with little choice. Managing such a pregnancy and counselling of the patient becomes a difficult task for us. Early assessment and timely intervention are the key approaches for reducing the incidence of still births globally. By such a strategy, peripartum complications can also be reduced. The current study was undertaken with an aim to assess the incidence of IUFD, causes and peripartum complications associated, in order to formulate a management protocol at our centre.Methods: This is a retrospective study done over a period extending from September 2014 to October 2015. IUFD was taken as absent fetal heart sounds beyond 20 weeks gestation which was confirmed by sonography. Maternal and fetal records were analysed for studying demographic profile, obstetric details including present and past complications, along with evaluation of fetal parameters.Results: Total number of deliveries over this period was 995 and cases of IUFD reported were 56. Hence calculated proportion was 5.62%. Majority of the cases were unbooked (66%) and presented to obstetric casualty. Maximum cases were found in primi gravida patients, i.e., 35.7% and most of the cases were identified at a gestational age of 20-24 weeks, 32.1%. Hypertensive disorders of pregnancy, 41% and Anaemia, 25% were found to be the leading maternal causes at our centre. Whereas congenital anomalies 23.2% and Antepartum haemorrhage 30.3% were the commonest causes in fetal and placental factors studied. Prolonged labor was observed in 33.9% and Atonic PPH was present in 21.4% patients. ARF was present in 3.5% and DIC was also found in 3.5% of the cases. However, no explainable cause could be found in 12.5% of the patients.Conclusions: Barring the unexplained fetal losses, most of the causes that were ascertained in present study were avoidable. This highlights the importance of our need to understand the avoidable causes of IUFD and to enforce the need of adequate antenatal care so as to timely identify the risk factors. In addition, the necessity of pre-conceptional counselling in order to avoid complications and recurrence must also be emphasized.

Study on Etiology and Maternal Complications of Intrauterine Fetal Death

“…IUFD due to Hypertension in pregnancy is due to placental insufficiency which can be prevented or reduced by qualitypreconceptional and antenatal care. In present study Abruptio placenta is the second common cause 15%, another study had showed it 19.87% which is comparable to present study but Jamal S found it as high as 30.03% this condition can be reduced by antenatal care by controll of Blood Pressure and supplementation of Folic acid 5,6 . Present study showed Diabetes Mellitus (DM) as a cause in 13% cases , but Pattanaik showed it 5.5% which is much lower than our observation 7 .…”

“…Although the overall perinatal mortality has decreased in past three decades, the number of IUFD is higher as compared to that of early neonatal deaths. Usually intrauterine fetal death is diagnosed in the antenatal period by history (i.e less fetal 81% which is much lower than our study 5,6 . IUFD due to Hypertension in pregnancy is due to placental insufficiency which can be prevented or reduced by qualitypreconceptional and antenatal care.…”

“…IUFD due to DM can be prevented by quality preconceptional and antenatal care by controll of Blood glucose by diet, Insulin and 12 weeks prepregnancy supplementation of Folic acid. Present study showed anemia as a cause in 14% cases, Jamal S.found anemia as a cause in 25% cases 6 . This condition is also preventable by identify the type of anemia and correction of anemia by diet, iron ,folic acid, because most common type is iron deficiency anemia.…”

The study of causes, mode of delivery in intrauterine fetal death and associated complications

“…The rate of IUFD and still birth directly point towards the quality of Antenatal Care received by the patient in the society. 2 In most of the cases, IUFD is unexpected and hence difficult to explain the exact cause of it in many cases.…”

“…3 Worldwide over 2.6 million stillbirths happen annually of which 23.2% were from India. 2 A vast majority (98%) of IUFD occur in developing countries. 1 It is important to diagnose the cause of IUFD in order to avoid further recurrence and to treat any maternal associated factors.…”