[Fetal death in the 20th to the 36th week of pregnancy]

In the period from 1986 to 1988, intrauterine fetal deaths from 20-36 weeks of gestation and 500 gm and more birth weight were analysed in a prospective study from the clinical and pathomorphological point of view. There were 57 such fetal deaths or 7.96% of the total number of 716 births till the 36th week of gestation, while 42.4% of women with the intrauterine fetal loss were cigarette smokers during pregnancy vs. 29.1% of such women among all those who gave birth during the same period. Smokers faced a relative risk of 1.8 for the fetal loss between the 20th and the 36th week of gestation. From the clinical standpoint, the cause of death was presumed in 40 or 71.4% of cases, while only in 24 or 42.1% of autopsies could the pathomorphological disorder be considered the cause of the intrauterine death. In 47 or 82.5% of cases, the observed pathomorphological disorders of the placenta, fetal membranes or the umbilical cord could also have contributed to the fetal death. Most often, i.e. in 20 or 35.1% of cases, chorioamnionitis was diagnosed and in 13 (22.3%) cases disorders of the placental circulation. In 7 cases (12.3%) neither clinical nor pathomorphological potential cause of death could be found. From the health care point of view it is important to find out those risk factors of fetal mortality which are preventable. Smoking during pregnancy could be the most preventable risk factor of fetal death.