Incidence and Risk Factors for Intrauterine Foetal Demise: a Retrospective Study in a Tertiary Care Centre in India

Relative prevalence and outcome of fetal posterior fossa abnormality

AIM

To find out the relative incidence and outcome of posterior fossa abnormality (PFA) in terms of survival at birth until 2 years of age.

METHODS

We conducted a prospective study; all fetuses diagnosed with posterior fossa abnormality were followed-up. The outcome was observed with respect to survival, the presence of associated anomalies, the existence of developmental delay after a telephonic interview.

RESULTS

Out of 2703 children with congenital anomalies, 921 (34.1%) had a central nervous system defect; 76 cases of PFA were fully followed. Dandy-Walker malformation (DWM) was present in 50% (38/76), mega cisterna magna 18.4% (14/76), Blake pouch cyst 13.2% (10/76), vermian hypoplasia (VH) 13.2% (10/76) and arachnoid cyst 5.2% (4/76). The diagnosis was possible before 20 weeks in only 12 (15.8%) cases. The mean gestational age at delivery was 34.7 ± 6.7 weeks. Associated anomalies were seen in 35/76 (46.1%) cases. A total of 35/76 (46.1%) survived after 2 years; there was developmental delay in 9.2% of cases.

CONCLUSION

There is a large variation in the outcome of PFA depending upon the type of anomaly. Associated anomalies are common in VH and DWM, making their prognosis worse.

Stillbirths among Pregnant Women Admitted to Department of Obstetrics in a Tertiary Care Centre: A Descriptive Cross-sectional Study

INTRODUCTION

Stillbirth is often defined as the death of a foetus in the uterus prior to its birth or during the process of birth. Most of the stillbirths are preventable global health problem. The aim of this study was to find out the prevalence of stillbirths among pregnant women admitted to the Department of Obstetrics and Gynaecology in a tertiary care centre.

METHODS

A descriptive cross-sectional study was conducted in the Department of Obstetrics and Gynaecology of a tertiary care centre among pregnant women admitted between 14 April 2021 to 13 April 2022. Ethical approval was taken from the Institutional Review Committee (Reference number: 43). Convenience sampling method was used. The data was collected from the medical record section using a proforma. Point estimate and 95% Confidence Interval were calculated.

RESULTS

Among 5118 pregnant women, stillbirths were found in 126 (2.46%) (2.04-2.88, 95% Confidence Interval).

CONCLUSIONS

The prevalence of stillbirth among pregnant women was higher than in the other studies done in similar settings.

Incidence and Causes of Stillbirth in Omdurman Maternity Hospital, Sudan: A Prospective Cross-Sectional Study

BACKGROUND

Stillbirth is an important indicator of the quality of antenatal health services. This study aimed to identify the incidence and causes of stillbirths among Sudanese women.

METHOD

This is a descriptive cross-sectional hospital-based study that was conducted at Omdurman Maternity Hospital during the period from December 1, 2019 to May 30, 2020. The study sample comprised 285 women who presented with stillbirths. Data were collected using a structured questionnaire administered to women after taking informed consent. Data were analyzed using descriptive statistics [Statistical Package for Social Sciences (SPSS) version 24 (IBM Corp., Armonk, NY)].

RESULTS

The incidence of stillbirths was 16/1000. Idiopathic causes were the most frequent causes which accounted for 20% (n=57), followed by pre-eclampsia 18.6% (n=53), congenital abnormalities 15.1% (n=43), and abruption placentae 14.4% (n=41). In addition, the less common causes were eclampsia 4.6% (n=13), ruptured uterus 4.2% (n=12), twin-twin transfusion 4.2% (n=12), cord prolapse 3.5% (n=10), uncontrolled diabetes mellitus (DM) 3.5% (n=10), malpresentation 2.6% (n=8), gestational DM 2.5%(n=7), anemia 2.5%(n=7), sepsis 2.1 (n=6), placenta previa 1.4% (n=4), renal disease 0.4% (n=1), and toxoplasmosis 0.4% (n=1).

CONCLUSION

The incidence of stillbirths was 16/1000. Unexplained causes of stillbirths were the most common causes which accounted for 20% of all deaths. In contrast, explainable causes were responsible for 80% of fetal deaths. Among explainable causes, pre-eclampsia and its consequences (abruption, eclampsia) remain the most common cause.

Placenta in intrauterine fetal demise (IUFD): a comprehensive study from a tertiary care hospital

Background: Intrauterine fetal demise (IUFD) is an unpredictable and challenging obstetric complication. Its etiology is multifactorial with more than 60% attributed to the placental cause. The present study was done with a primary objective of understanding the placental lesions underlying IUFD. Methods: In this retrospective observational study, IUFD cases (>22 weeks) between January 2012 and September 2015 were collected from pathology database. The clinical details with ultrasound findings were collected from mother's charts. The lesions were classified into (A) maternal vascular malperfusion (MVM) including retroplacental hematomas, (B) fetal vascular malperfusion (FVM), (C) inflammatory lesions, and (D) idiopathic. The contributor to fetal death was classified as direct, major, minor, unlikely, or unknown. Placental findings of fetal hypoxia were recorded. Results: The study included 100 cases of IUFD. The mean maternal age was 26 years (18-36 years). Primipara were 46. There were 65 early preterm (PT) (<34 weeks), 20 late PT (34 weeks to <37 weeks) and 15 term (>37 weeks) IUFD. The mean gestation age was 30 weeks. The ratio of male:female fetuses was 1:1.7. Relevant obstetric complications included preeclampsia (n = 39), intrauterine growth restriction (IUGR) (n = 7), pre-gestational diabetes (n = 7), bad obstetric history (n = 6), oligohydramnios (n = 5). The mean placental weight was 256 g. Maternal vascular malperfusion had the highest incidence (30%), followed by combined maternal and FVM (10%). Exclusive inflammatory lesions and FVM were seen in 12 and 6%, respectively. No cause was identified in 18%. Direct contributor to IUFD was identified in 51 cases and major, minor, unlikely contribution in 21, 11 and nine cases, respectively. In nine cases, it was unknown. Lesions indicating fetal hypoxia were noted in 35 cases. In both early and late PT, MVM featured more commonly (23 and 5%). In term placentas, the most common cause was idiopathic. Conclusions: Lesions of MVM were the most common cause of IUFD and served as a direct contributor to fetal demise.