The prevalence of 3.64% found in this study is identical to that found (3.9%) by TajiLeki S. et al. in 2018 in Bunia in the DRC [7] , but lower than those of several African authors: Kyembwa Mulyumba Michel in Goma (4.5%) and Ignace Bwana Kangulu (13.9%) in Kamina in DRC, Andriamandimbison Z. (5.22%) in Madagascar, Diallo MH (6.95%) in Guinea [3] [4] [8] [9] .

The lower rates are those of Moutongo [10] in Mali, 2.62% at National Hospital “G” and Z.N. Andriamandimbison 0.44% in Creil in France [11] .

The prevalence found in this hospital can be explained by the fact that the study was made in the national reference center but also by the inadequacies in the health policy itself of our country. Indeed, the rates varying between developed and developing countries show all the effort that remains to be done in the prevention of fetal deaths in uterus in our countries.

The most represented age group was 20-35 years old with 77.67% in our study (Table 1); Like Kyembwa Mulyumba Michel [3] who found that the age group of (20 - 34 years) was 72.7% and TajiLeki S [7] , 62.07% in Bunia in the DRC. In Mali Traore M. [5] , who found 59% of fetal death in uterus cases in patients aged 20 to 34 years. Diallo in Guinea, found that pregnant women over 30 years of age were more represented [9] .

This could be explained by the fact that this age group is in the period of obstetrical activity by excellence and not because it constitutes the maternity age group at risk. The age of over 35 years is more represented because the risk of chromosome abnormality and associated morbid pathology is more frequent.

The referred and evacuated patients constituted respectively 51% and 28% of the pregnant and 21% had come by themselves. In Traore’s study [5] , in Mali, 12.7% were referred and 27.8% evacuated, with 59.5% of patients coming on their own.

In fact the maternity office of Sylvanus Olympio Hospital is the national health reference center. All patients came from all peripheric centers.

Studies on the management of fetal death in utero have placed special emphasis on the risk of women with an obstetrical history of fetal death [12] . Our study shows that 74.33% of pregnant women had no history of fetal death in utero compared to 5.67% of pregnant women with at least one history of fetal death in utero. In Traore’s study [5] , 93.7% had no history and 6.3% had an antecedent fetal death in uterus.

After analyzing these different results, it can be said that an antecedent of fetal death in uterus can constitute in itself a favorable factor. These results account for the conjunction of several variables including maternity age, the absence of prenatal consultation and the precarious socio-economic situation experienced by Togolese pregnant women like Kubuya [12] , found in his study in Walikale (DRC).

In our study, multigravida women have a higher risk of fetal death in uterus, which is 49% of pregnant women. This rate is higher than that of Traore M.M [5] , who found in Mali in 2014, 33% of multigravida women. Kubuya [12] , in the DRC found that 57.4% was multigravida and multiparous.

This high rate of multigravida women could be explained by risk factors related to pregnancies too close together; the precarious socio-economic situations of these pregnant women with no or derisory income.

The nulliparous and women with less than two children were more concerned in the study of Amrouche Souhila [2] in Algeria and TajiLeki S in Bunia (DRC) [7] .

The 41% fetal death in uterus rate among nulliparous in this study could be explained by maternity age and inexperience at pregnancy on the part of these pregnant women.

Fetal death in uterus occurred in pregnant women in 39% of cases between [28 - 37 Weeks]. In Guinea, Diallo [9] found 60% of fetal death in uterus occurred between 27 - 31 weeks.

Indeed, the gestational age factor does not explain the fetal death in utero. It is in fact at this period of pregnancy that the pathologies contributing to the fetal death In Uterooccur (hypertensive disorders of pregnancy pathologies and Prelabor Rupture of Membranes).

In our study, the rate of fetal death In Utero in pregnant women with no prenatal consultation was 17%. Traore M. [5] had almost found the same rate of 16.4% in Mali in 2014. In Algeria this rate was only 6% [2] .

In contrast, in Congo Kyembwa found that the fetal death in uterus was higher among those who had less prenatal consultation [3]

Despite the high number of prenatal consultation, the fetal death rate in uterus still remains high. This paradoxical observation raises questions and we believe that the quality of services, the lack of qualified providers have an important role to play in these fetal deaths. In addition, the pathology related to pregnancy is a contributory factor to the deaths.

Pre-eclampsia by itself accounts for 24% of the etiologies of fetal death in uterus in our study. TajiLeki S in Bunia (DRC) [7] found the same 24.1%. This rate is higher than the one in Moutongo’s studies [10] who found that in Mali among 8.89% of predictable causes, 13% derive from pre-eclampsia and 13.3% of fetal deaths from eclampsia. In France 15.4% is due to eclampsia, 19% due to retroplacental hematoma [11] .

Pre-eclampsia remains a common cause of fetal death in uterus in our countries where the quality of pregnancy monitoring is often problematic. Eclampsia and retroplacental hematoma are serious conditions, most often complicating pre-eclampsia with a very high risk of fetal death in uterus. RPH is the most common placental cause. This high level of RPH could be explained mainly by the pathophysiology of the condition; failure of pregnancy monitoring; the ineffective management of pre-eclampsia prior to RPH and the late reference of pregnant women to the standard care. We believe that careful antenatal surveillance could actually result in a significant decline in fetal mortality during this pathology.

It presents 0.33% of fetal deaths in uterus in our study. Diallo [9] found that placentaprevia is a factor of hemorrhagic. He is very serious because of acute anemia, prematurity and delay in the procedure. This rate is lower than those of Moutongo [10] who found in Mali in 2000, 5.56% among predictable causes.

During our study it was associated with fetal death in 4.33%. Our rate is lower than the one of Traore M. [5] who found 13.92% and Amrouche Souhila in Algeria where the PROM was 6% [2] and 5.7% for TajiLeki Sin DRC [7] .

When the egg opens before the labor begins, the fetus is threatened with death if the delivery is not done in a short period time because of the oligoamnios, funicular compression, and the infection it causes (chorioamniotitis).

Fetal death in uterus occurred in 9% of pregnant women with malaria. This rate is higher than the one of Moutongo [10] who found in Mali in 2000, 2.5%. We believe that these high rates are due, on one hand to the geographical situation (zone with high parasitic endemia), to the irregularity or the absence of Prenatal consultation in our pregnant women and on the other hand to a decrease of the immunity during pregnancy, where the pathologies are most often noisy, breakage of the antimalarial prophylaxis (sulfadoxine-pyrimethamine) in our health structures and the difficulties of using a long-lasting insecticidal nets action by some pregnant women.

From the 300 fetal death cases, we recorded 4.67% severe anemia. This rate is higher than Moutongo’s rate [10] who found in Mali in 2000, 3.89%. These cases of anemia almost always occur on precarious socio-economic grounds. The high rate of anemia in our series is thought to be due to a lack of systematic iron supplementation during prenatal consultation and to the disruption of the free distribution of Folic Acid Iron in health centers, but also to malaria, malnutrition and digestive parasitosis which pregnant women suffer from.

It represented 40.33%; this rate is higher than that of Amrouche in Algeria 31% [2] . This high rate in our hospital could be explained by the difficulties in carrying out etiological assessments to our pregnant and the refusal or not practical autopsy in our structure. These difficulties are of an economic nature; cultural and religious practices. All this makes the etiologies more unknown in our practices in Togo.

Acute psychosis was more recorded at 4.67% in our study. This could be explained by the lack of support for pregnant women and their families as soon as the diagnosis of the fetal death in uterus is confirmed. This is the result of a total absence of psychologist in the maternity ward or qualified staff for this purpose in the service. In addition, the lack of infrastructure is an important factor to mention. For instance, mothers who have been admitted with a fetal death In Uterostay in the room with those whose babies are alive.

It represented 3.33% in our study. Diallo had found 3 cases and Amrouche 6% in Algeria. This rate could be explained by the late reference, a late artificial activation of expulsion of the dead fetus, the difficulty to perform the hematological assessment in case of fetal death. In uterus, the poor supervision of our pregnant women is due to the small number of healthcare personnel and their working conditions.

We recorded 1.67% endometritis in our study. This can be explained on the one hand by the prelabour rupture of membranes and obstetric treatment and, on the other hand by the poor follow up with mothers and the shortage of the staffs.