Intrauterine fetal death during pregnancy: limitations of fetal surveillance

Perinatal statistics in Germany have shown that fetal death during pregnancy remained unchanged during the past 12 years. The question arises whether the quality of prenatal care can be improved and contributing factors to ante partum mortality (APM) reduced.

The perinatal data base from Hesse was evaluated for 1990-1995. It comprises 347,463 deliveries in a population based survey from the state of Hesse/Germany. Antepartum death occurred in 1,133 cases (0.33%). Pregnancy care was evaluated in a longitudinal investigation analysed from 1982 to 1995.

Fetal surveillance showed during the past years a steady improvement demonstrated by the number antenatal visits of more than 10: it rose from 54 to 75%, by the CTG recordings ante partum: it increased from 55 to 90% and ultrasound examinations more than 5: it rose from 12 to 26%. Despite the increase of ante partum care fetal death during pregnancy remained constant since 1985 at 0.5 to 0.6%. Malformations contribute to APM in 8.3%. In 44.4% various risk factors could be identified, whereas in 47.4% no causes could be shown. Special risk factors are hydramnios, diabetes, placenta praevia, multiple pregnancy, IUGR and others. Fetal death occurs preferentially during the last weeks of pregnancy with a maximum at 40 weeks of gestation. Social burden and insufficient prenatal care are contributing factors to APM.

APM can still be improved by using simple clinical estimates and by defined application of surveillance tools at present available.