A Retrospective Study on Etiological Aspects of Intrauterine Foetal Demise after 28 weeks of Gestation in a Tertiary Care Hospital in Eastern India

Abstract

Back ground: An intrauterine foetal demise or death (IUFD) is a major obstetrical catastrophe at any gestational age. The objective of the present study is to determine the possible causes of stillbirths or intrauterine foetal demise after 28 weeks of gestation and to determine the preventive measures.Materials & Methods: A retrospective study was done in all pregnant women admitted with IUFD delivered at or above 28 weeks of gestation. Data analysis were done for maternal age, parity, antenatal visits, gestational age, probable causes of IUFD, pregnancy complications, placental abnormalities. Statistical data were analysed by using Microsoft Excel sheet.Results: Incidence of IUFD was 20.8 per 1000 total birth. It happened mostly (67.1%) in maternal age between >20 years and <30 years (p <0.001), illiterate (64.6%; p <0.001) and in middle class family (54.4%; p < 0.001). IUFD occurred with increasing gestational age (53.2% vs 46.8%; p = 0.045) and occurs mostly in rural areas than urban (68.4% vs 31.6%; p = 0.012). IUFD occurred with decrease in antenatal visit (46.2% with <=1 visit; p = 0.03), low birth weight of baby (52.5%; p = 0.004), pre-term births (71.5% vs28.5%; p = <0.001) and iron-folate intake is inadequate (63.3% vs 36.7%; p <0.001) but it does not increase with previous pregnancy loss (13.9% vs 86.1%; p value <0.001). Major maternal - foetal complications causing IUFD included maternal hypertension related disorders (27.2%), preterm (5.7%), prolonged labour and obstructed labour (7%), maternal anaemia (12.6%), jaundice (5.1%), maternal infection (3.8%), congenital anomalies (3.2%), GDM (2.5%) and unexplained aetiology (10%). Cord complications occur in 5.1% cases. Mode of delivery is mostly vaginal (88.6%) and sex is predominantly male (54.4%).Conclusions: Causes of IUFD are multifactorial and they can be prevented with proper community education, good quality obstetric care and urgent intervention from the healthcare provider to prevent stillbirth and improve the perinatal mortality of India.