The causes of antepartum fetal death: a clinico-pathological study

Forty cases of antepartum fetal death occurring among 6668 deliveries at the Ist Department of Obstetrics and Gynecology of the University of Vienna between 1976 and 1979 were evaluated. The fetal death rate was 6 per 1000 births. In 32 cases (80%) a diagnosis identifying the disorder, that initiated the cause of fetal death, could be established. The remaining 20% did not have a demonstrable diagnosis. The most frequent cause of death in this series was in 40% severe toxemia of pregnancy causing a chronic nutritive placental insufficiency. Histologically in such cases regressive changes of the placenta, such as microinfarcts, necrosis and deposition of intervillous fibrin were found. Rarer causes, also associated with intrauterine asphyxia were 2 cases each of placenta praevia (5%), and abruption placentae (5%), one cord accident (2.5%) and one case of postmaturity (2.5%). The second most important etiological factor was in 12.5% the ascending intrauterine infection prior or after the premature rupture of the fetal membranes. Bacteriologically the most common organisms isolated were E. coli, enterococci and anaerobic bacteria. One fetal death was due to rhesus incompatibility, and in one case both twins died in utero (2.5%). Our results suggest, than an early diagnosis and a successful treatment of placental insufficiency would permit a further reduction of the perinatal mortality rate. In conclusion the absolute necessity of the performance of all available diagnostic means in order to prevent recurrence of a stillbirth is emphasized.