Associated risk factors with ante-partum intra-uterine fetal death

To determine ante-partum maternal risk factors for intrauterine fetal death.

We carried out a case control retrospective study, at the Maternity and Children's Hospital, Jeddah, Kingdom of Saudi Arabia. We included all pregnant women diagnosed as singleton intra-uterine fetal death in the third trimester with fetal weight of 1500 gm and more, admitted to the hospital over a 2-year (2001-2002) period (study group). We examined the following risk factors: diabetes, hypertension, abruptio-placenta, age, gestational age, parity, trauma, sepsis, booking, chromosomal abnormality, previous history of intra-uterine fetal death (IUFD) and intra-uterine growth restriction (IUGR). We compared the results to those pregnant women with live pregnancy admitted before and after each case (control group).

There were 157 cases of singleton IUFD during that period. The intra-uterine fetal death rate was 10.1 per 1000 deliveries. In 28% of the cases, we could not determine the associated risk factors. Among cases there were 57.3% (odds ratio [OR] 2.4 95% confidence interval [CI] 1.4-4) lacking antenatal care, cord accident in 56.6% (OR 5.1% 95 CI 2.7-9.5), 29.3% (OR 5.5 95% CI 2.4-12.6) hypertension, 26.1% (OR 12.9 95% CI 5.5-30.6) diabetes, IUGR in 24.8% (OR 1.73% 95% CI 1.1-2.7), 14% (OR 23.4% 95% CI 4.6-119.3) abruption-placenta, and previous history of IUFD in 8.3% (OR 7.01 95% CI 2.1-23.6). Other risk factors found were age between 20-30 years in 51.6%, gestational age between 37-41 weeks in 58.6%, parity between 0-5 in 77.1%, and chromosomal abnormality in 5.7% (OR 0.91% 95% CI 0.91-0.99).

The identified risk factors for IUFD in our community appear preventable. We should pay attention to health education with emphasis on antenatal care and the benefits of regular clinic attendance. Patients compliance is important in reducing most of these preventable fetal deaths.