TITLE:
Late Intrauterine Foetal Death in a Tertiary Centre of Bangladesh
AUTHORS:
Most. Sabina Yeasmin, M. Jalal Uddin, Rajat Sanker Roy Biswas, Farah Naz Mabud, Nishat Anjum Nourin
KEYWORDS:
Intrauterine Foetal Death, Antenatal Care, Risk Factors, Prevention, Maternal Complications
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.11 No.9,
September
3,
2021
ABSTRACT: Background: Late intrauterine foetal death (IUFD > 28 weeks)
is a tragedy to mothers and family members. The first step to reduce IUFD is to
obtain an accurate and detailed data for IUFD. The present study was done to
identify the probable causes of foetal death and determine the risk of
recurrence, prevention or corrective action. Methods: This prospective
observational study was conducted in a tertiary hospital during a period of one
year in Chattogram Maa-O-Shishu Hospital Medical college, from January to
December 2018, on all admitted pregnant women with intrauterine foetal death (>28
weeks). Detailed history, clinical examination, associated conditions, mode of
delivery, foetal conditions, placenta, condition of cord and investigation
reports were analyzed. Results: A total of 188 IUFD were reported amongst
8013 deliveries with its incidence 23.46/1000 live birth and recurrence rate
8.5%. Maximum (89.89%) occurred in antepartum
period. Mean maternal age 26.03 years.
59% unbooked cases, 48.93% belonging to lower class family and maximum (59%) from
slum and rural area. Most of the cases were Multigravidas (59.6%) and preterm
(52.7%) gestation. Regarding causes of IUFD hypertensive disorders in pregnancy
(45.2%) were commonest, followed by unexplained 24.5%,
diabetes Mellitus and gestational diabetes mellitus (23.9%), anaemia
20.7%, hypothyroidism 11.2%, oligohydramnios
11.2%, maternal infection 9.6%, antepartum
haemorrhage 8.5%, malpresentation 7.44%, intrauterine growth retardation 4.8%, fetal congenital anomalies 4.8%
& cord accident 4.3%. Maternal complications occurred 14.9% cases. Those
were postpartum haemorrhage 11.2%, sepsis 2.6%, acute renal failure 0.53% and disseminated
intravascular coagulation (DIC) 0.53%. Most of the patients (86.2%) delivered
vaginally. Maximum number of IUFD was seen in birth weight between 1 - 1.5 kg
(31.4%), followed by 2 - 2.5 kg (21.8%). Conclusions: HDP, GDM and anaemia were major
causes of IUFD. Most of the causes of IUFD may have been preventable by
pre-conceptional councelling, regular antenatal checkup, proper screening,
early diagnosis and treatment. Large number IUFD remained unexplained. So, to
unravel the complex pathophysiology of IUFD further study is needed.