ABSTRACT
Objetivos: Análisis de los factores etiopatogénicos, maternos, fetales y placentarios, asociados a la muerte fetal intrauterina (MFIU). Análisis de los avances en el diagnóstico causal de la MFIU tras instauración de un protocolo específico. Métodos: Estudio descriptivo retrospectivo. Análisis de todos los casos de muerte fetal tardía en gestaciones únicas acontecidas en el Complejo Hospitalario Universitario de Vigo (2005- 2010). Resultados: Hubo 56 casos de muerte fetal tardía. De las gestantes estudiadas, 4 eran menores de 17 años y 19 mayores de 35 años, un 21,4 por ciento fumaban, el 60 por ciento tenía un IMC > 25 kg/m2 y el 18 por ciento no controlaron el embarazo. La patología materna predominante fue la tiroidea, mientras que las patologías gestacionales principales fueron diabetes gestacional, preeclampsia y amenaza de parto prematuro. El principal motivo de consulta fue la disminución de movimientos fetales. Se realizó estudio anatomopatológico placentario en el 82 por ciento y necropsia en el 73 por ciento. El porcentaje de causa desconocida en el grupo de no protocolo fue 20 por ciento y con protocolo 15 por ciento. Conclusión: El establecimiento de la causa de MFIU es difícil y en algunos casos no posible, aunque sí el reconocimiento de factores de riesgo. La implantación de un protocolo permitió un mayor acercamiento a la causa de la muerte fetal y mejor manejo posterior. La autopsia, el estudio de la placenta, los análisis citogenéticos y el estudio de trombosis materna son la base para el diagnóstico de MFIU.
Objective: Analysis of the pathogenetic maternal fetal and placental factors associated with stillbirth. Analysis of progress in the diagnoses of the cause of stillbirth after the establishment of a specific protocol. Methods: Retrospective descriptive study. Analysis of the cases of late fetal death in singleton pregnancies occurred at the University Hospital of Vigo during the period 2005-2010. Results: We found 56 late fetal deaths. Four were under 17 and 19 above 35 years old, 21percent were smokers, 60 percent had a BMI > 25 kg/m2 and 18 percent had not prenatal care. Thyroid disease was the most prevalent whereas gestational diabetes, preeclampsia and threatened preterm labour were the main obstetric pathologies. The main reason of consultation was decrease of fetal movements. Pathological exam of the placenta was made in 82 percent of cases and necropsy in 73 percent. Rate of unknown cause in the cases of no protocol was 20 percent while in the protocol group was 15 percent. Conclusion: The cause of intrauterine fetal death is difficult to establish. The recognition of certain risk factors is possible. The implementation of a study protocol allowed a better approach to the cause of fetal death and its management. Autopsy, placental examination, cytogenetic analysis, maternal thrombosis study was basic tests for the diagnosis of intrauterine fetal death.
Subject(s)
Humans , Adolescent , Adult , Female , Pregnancy , Young Adult , Fetal Death , Cause of Death , Clinical Protocols , Epidemiology, Descriptive , Spain/epidemiology , Retrospective Studies , Risk FactorsABSTRACT
OBJECTIVES: The purpose of this study was to investigate the clinical characteristics and the risk factors of Intrauterine fetal death (IUFD). METHODS: We did retrospective review and investigated the risk factors from medical records of the 62 pregnancies with IUFD between January 2000 and December 2007. Also we statistically analyzed that maternal and perinatal risk factors compared with 3,887 live-birth pregnancies. RESULTS: The overall incidence of IUFD was 1.57%. The age distribution of mother with IUFD was between 21 to 41, and was highest in the 30 to 34 year old age group (41.94%). There were 29 cases (46.78%) with nulliparous and 5 cases (8.06%) with previous IUFD. IUFD was the most prevalent (48.39%) at 20-29 weeks of gestation and the sex ratio of male versus female fetus was 1.03:1. Most of cases (80.64%) were delivered vaginally (spontaneous labor: 62.90%, labor induction: 17.74%), and laparotomy was 19.35%. Risk factors were maternal obesity, infection, placental abnormality, advanced maternal age (> or =35), and unexplained cause in that order. 50 cases included more than two risk factors. The risk analysis showed statistically significant risk in preeclampsia (OR 2.733; 95% CI 1.408-5.306) and placental abruption (OR 5.190; 95% CI 2.165-12.441). CONCLUSION: Identification of risk factors for IUFD assists the clinician in performing a risk assessment for each patient. Clinicians need to be able to assess each patient's risk for IUFD and to have a low threshold to evaluate fetal growth in at-risk pregnancies.