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Unexplained intrauterine death near term.

N A Beischer, C N De Garis

    The Australian & New Zealand Journal of Obstetrics & Gynaecology
    |May 1, 1986
    PubMed
    Summary

    Unexplained intrauterine hypoxia causes stillbirths in mature infants. Screening for gestational diabetes and timely labor induction in high-risk pregnancies may reduce these tragic perinatal deaths.

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    Area of Science:

    • Perinatal Medicine
    • Obstetrics
    • Neonatalogy

    Background:

    • Intrauterine hypoxia of unknown cause is a significant factor in perinatal deaths of mature infants.
    • These unexplained deaths occur in approximately 1 in 1,000 pregnancies near term, often in infants of normal size for gestational age.

    Purpose of the Study:

    • To analyze the causes and circumstances surrounding unexplained perinatal deaths.
    • To evaluate the role of screening for gestational diabetes and the timing of labor induction in preventing such deaths.

    Main Methods:

    • Retrospective analysis of perinatal death data in Victoria, Australia.
    • Review of cases involving intrauterine hypoxia in infants with birth weight ≥2,500 g.
    • Examination of the utility of fetoplacental function tests and glucose tolerance tests.

    Main Results:

    • In 1984, 59 of 252 perinatal deaths (birth weight ≥2,500 g) were attributed to unexplained intrauterine hypoxia.
    • Fetoplacental function tests were performed in 27 cases, and glucose tolerance tests in 6 cases prior to fetal death.
    • The majority of affected infants were of appropriate size for their gestational age.

    Conclusions:

    • Screening all pregnant women for gestational diabetes between 24-28 weeks' gestation is recommended to potentially reduce intrauterine deaths.
    • Labor induction should not be deferred past 37-38 weeks in high-risk pregnancies, even with normal fetoplacental function tests, emphasizing clinical judgment over laboratory results.
    • Identifying infants at risk for unexplained death, if feasible, is likely cost-effective given their mature and apparently normal status.

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