IUFD incidence, causes and complications: a retrospective study done at a tertiary care centre in greater Noida, India

Abstract

Background: Demise of a fetus is not only a cause of distress to the parents but also leaves the obstetrician with little choice. Managing such a pregnancy and counselling of the patient becomes a difficult task for us. Early assessment and timely intervention are the key approaches for reducing the incidence of still births globally. By such a strategy, peripartum complications can also be reduced. The current study was undertaken with an aim to assess the incidence of IUFD, causes and peripartum complications associated, in order to formulate a management protocol at our centre.Methods: This is a retrospective study done over a period extending from September 2014 to October 2015. IUFD was taken as absent fetal heart sounds beyond 20 weeks gestation which was confirmed by sonography. Maternal and fetal records were analysed for studying demographic profile, obstetric details including present and past complications, along with evaluation of fetal parameters.Results: Total number of deliveries over this period was 995 and cases of IUFD reported were 56. Hence calculated proportion was 5.62%. Majority of the cases were unbooked (66%) and presented to obstetric casualty. Maximum cases were found in primi gravida patients, i.e., 35.7% and most of the cases were identified at a gestational age of 20-24 weeks, 32.1%. Hypertensive disorders of pregnancy, 41% and Anaemia, 25% were found to be the leading maternal causes at our centre. Whereas congenital anomalies 23.2% and Antepartum haemorrhage 30.3% were the commonest causes in fetal and placental factors studied. Prolonged labor was observed in 33.9% and Atonic PPH was present in 21.4% patients. ARF was present in 3.5% and DIC was also found in 3.5% of the cases. However, no explainable cause could be found in 12.5% of the patients.Conclusions: Barring the unexplained fetal losses, most of the causes that were ascertained in present study were avoidable. This highlights the importance of our need to understand the avoidable causes of IUFD and to enforce the need of adequate antenatal care so as to timely identify the risk factors. In addition, the necessity of pre-conceptional counselling in order to avoid complications and recurrence must also be emphasized.