RESUMO
Este artigo analisou a percepção e os sentimentos de casais sobre o atendimento recebido nos serviços de saúde acessados em função de perda gestacional (óbito fetal ante e intraparto). O convite para a pesquisa foi divulgado em mídias sociais (Instagram e Facebook). Dos 66 casais que contataram a equipe, 12 participaram do estudo, cuja coleta de dados ocorreu em 2018. Os casais responderam conjuntamente a uma ficha de dados sociodemográficos e uma entrevista semiestruturada, realizada presencialmente (n=4) ou por videochamada (n=8). Os dados foram gravados em áudio e posteriormente transcritos. A Análise Temática indutiva das entrevistas identificou cinco temas: sentimento de impotência, iatrogenia vivida nos serviços, falta de cuidado em saúde mental, não reconhecimento da perda como evento com consequências emocionais negativas, e características do bom atendimento. Os achados demonstraram situações de violência, comunicação deficitária, desvalorização das perdas precoces, falta de suporte para contato com o bebê falecido e rotinas pouco humanizadas, especialmente durante a internação após a perda. Para aprimorar a assistência às famílias enlutadas, sugere-se qualificação profissional, ampliação da visibilidade do tema entre diferentes atores e reorganização dos serviços, considerando uma diretriz clínica para atenção ao luto perinatal, com destaque para o fortalecimento da inserção de equipes de saúde mental no contexto hospitalar.(AU)
This study analyzed couples' perceptions and feelings about pregnancy loss care (ante and intrapartum fetal death). A research invitation was published on social media (Instagram and Facebook) and data collection took place in 2018. Of the 66 couples who contacted the research team, 12 participated in the study by filling a sociodemographic questionnaire and answering a semi-structured interview in person (n=04) or by video call (n=08). All interviews were audio recorded, transcribed, and examined by Inductive Thematic Analysis, which identified five themes: feelings of impotence, iatrogenic experiences in health services, lack of mental health care, not recognizing pregnancy loss as an emotionally overwhelming event, and aspects of good healthcare. Analysis showed experiences of violence, poor communication, devaluation of early losses, lack of support for contact with the deceased baby, and dehumanizing routines, especially during hospitalization after loss. Professional qualification, extended pregnancy loss visibility among different stakeholders, and reorganization of health services are needed to improve the care offered to grieving families, considering a clinical guideline for perinatal grief care with emphasis on strengthening the insertion of mental health teams in the hospital context.(AU)
Este estudio analizó las percepciones y sentimientos de parejas sobre la atención recibida en los servicios de salud a los que accedieron debido a la pérdida del embarazo (muerte fetal ante e intraparto). La invitación al estudio se publicó en las redes sociales (Instagram y Facebook). De las 66 parejas que se contactaron con el equipo, 12 participaron en el estudio, cuya recolección de datos se realizó en 2018. Las parejas respondieron un formulario de datos sociodemográficos y realizaron una entrevista semiestructurada presencialmente (n=4) o por videollamada (n=08). Los datos se grabaron en audio para su posterior transcripción. El análisis temático inductivo identificó cinco temas: Sentimiento de impotencia, experiencias iatrogénicas en los servicios, falta de atención a la salud mental, falta de reconocimiento de la pérdida como un evento con consecuencias emocionales negativas y características de buena atención. Los hallazgos evidenciaron situaciones de violencia, comunicación deficiente, desvalorización de las pérdidas tempranas, falta de apoyo para el contacto con el bebé fallecido y rutinas poco humanizadas, especialmente durante la hospitalización tras la pérdida. Para mejorar la atención a las familias en duelo, se sugiere capacitación profesional, ampliación de la visibilidad del tema entre los diferentes actores y reorganización de los servicios, teniendo en cuenta una guía clínica para la atención del duelo perinatal, enfocada en fortalecer la inserción de los equipos de salud mental en el contexto hospitalario.(AU)
Assuntos
Humanos , Masculino , Feminino , Gravidez , Adulto , Pessoa de Meia-Idade , Serviços de Saúde da Criança , Saúde Mental , Humanização da Assistência , Morte Fetal , Dor , Pais , Pediatria , Perinatologia , Doenças Placentárias , Preconceito , Cuidado Pré-Natal , Psicologia , Psicologia Médica , Política Pública , Qualidade da Assistência à Saúde , Reprodução , Síndrome , Anormalidades Congênitas , Tortura , Contração Uterina , Traumatismos do Nascimento , Auxílio-Maternidade , Trabalho de Parto , Prova de Trabalho de Parto , Adaptação Psicológica , Aborto Espontâneo , Cuidado da Criança , Enfermagem Materno-Infantil , Recusa em Tratar , Saúde da Mulher , Satisfação do Paciente , Poder Familiar , Licença Parental , Qualidade, Acesso e Avaliação da Assistência à Saúde , Privacidade , Depressão Pós-Parto , Credenciamento , Afeto , Choro , Curetagem , Técnicas de Reprodução Assistida , Acesso à Informação , Ética Clínica , Parto Humanizado , Ameaça de Aborto , Negação em Psicologia , Fenômenos Fisiológicos da Nutrição Pré-Natal , Parto , Dor do Parto , Nascimento Prematuro , Lesões Pré-Natais , Mortalidade Fetal , Descolamento Prematuro da Placenta , Violência contra a Mulher , Aborto , Acolhimento , Ética Profissional , Natimorto , Estudos de Avaliação como Assunto , Cordão Nucal , Resiliência Psicológica , Fenômenos Reprodutivos Fisiológicos , Medo , Doenças Urogenitais Femininas e Complicações na Gravidez , Fertilidade , Doenças Fetais , Uso Indevido de Medicamentos sob Prescrição , Esperança , Educação Pré-Natal , Coragem , Trauma Psicológico , Profissionalismo , Sistemas de Apoio Psicossocial , Frustração , Tristeza , Respeito , Angústia Psicológica , Violência Obstétrica , Apoio Familiar , Obstetra , Culpa , Acessibilidade aos Serviços de Saúde , Maternidades , Complicações do Trabalho de Parto , Trabalho de Parto Induzido , Ira , Solidão , Amor , Tocologia , Mães , Cuidados de EnfermagemRESUMO
BACKGROUNDS@#At present, there is no consensus on the induction methods in term pregnancy with borderline oligohydramnios. This study aimed to compare the effectiveness and pregnancy outcomes of labor induction with dinoprostone or single-balloon catheter (SBC) in term nulliparous women with borderline oligohydramnios.@*METHODS@#We conducted a retrospective cohort study from January 2016 to November 2018. During the study period, a total of 244 cases were enrolled. Of these, 103 cases were selected for induction using dinoprostone and 141 cases were selected for induction with SBC. The pregnancy outcomes between the two groups were compared. Primary outcomes were successful vaginal delivery rates. Secondary outcomes were maternal and neonatal adverse events. Multivariate logistic regression was used to assess the risk factors for vaginal delivery failure in the two groups.@*RESULTS@#The successful vaginal delivery rates were similar between the dinoprostone group and the SBC group (64.1% [66/103] vs. 59.6%, [84/141] P = 0.475), even after adjustment for potential confounding factors (adjusted odds ratio [aOR]: 1.07, 95% confidence interval [CI]: 0.57-2.00, P = 0.835). The incidence of intra-amniotic infection was lower in the dinoprostone group than in the SBC group (1.9% [2/103] vs. 7.8%, [11/141] P < 0.001), but the presence of non-reassuring fetal heart rate was higher in the dinoprostone group than in the SBC group (12.6% [13/103] vs. 0.7%, [1/141] P < 0.001). Multivariate logistic regression showed that nuchal cord was a risk factor for vaginal delivery failure after induction with dinoprostone (aOR: 6.71, 95% CI: 1.96-22.95). There were three factors related to vaginal delivery failure after induction with SBC, namely gestational age (aOR: 1.51, 95% CI: 1.07-2.14), body mass index (BMI) >30 kg/m2 (aOR: 2.98, 95% CI: 1.10-8.02), and fetal weight >3500 g (aOR: 2.49, 95% CI: 1.12-5.50).@*CONCLUSIONS@#Term nulliparous women with borderline oligohydramnios have similar successful vaginal delivery rates after induction with dinoprostone or SBC, with their advantages and disadvantages. In women with nuchal cord, the risk of vaginal delivery failure is increased if dinoprostone is used in the induction of labor. BMI >30 kg/m2, large gestational age, and estimated fetal weight >3500 g are risk factors for vaginal delivery failure after induction with SBC.
Assuntos
Feminino , Humanos , Recém-Nascido , Gravidez , Administração Intravaginal , Catéteres , Dinoprostona/uso terapêutico , Peso Fetal , Trabalho de Parto Induzido/métodos , Cordão Nucal , Oligo-Hidrâmnio , Ocitócicos , Resultado da Gravidez , Estudos RetrospectivosRESUMO
Introducción: La cesárea tiene por objetivo la extracción del feto a través de la incisión de las paredes del abdomen y del útero. La tasa ideal de cesárea debe oscilar entre el 10% y el 15% según la Organización Mundial de la Salud. Las complicaciones en las pacientes que habían tenido más cesáreas demostraron una morbilidad mucho mayor que las que habían tenido menos cirugías. Gran parte de esta morbilidad se concentró con placenta previa o acreta y las múltiples adherencias. Objetivos: Determinar las características clínicas en gestantes cesareadas y hallazgos transoperatorios más frecuentes en el servicio de ginecología y obstetricia, del Hospital Regional de Coronel Oviedo, 2017. Materiales y método: Estudio observacional descriptivo, con muestreo no probabilístico de casos consecutivos. La población de estudio estuvo constituida por gestantes cesareadas de distintas edades del servicio de ginecología y obstetricia del Hospital Regional de Coronel Oviedo. Resultados: La población base estuvo conformado por 224 cesareadas, de los cuales, la mediana de edad fue de 26 años, el rango etario más frecuente fue entre 20 a 24 años; de unión libre, de procedencia urbana, con estudios primarios, edad gestacional de termino, nulíparas , que presentaron controles prenatales la mayoría, con diagnóstico preoperatorio ecográfico más frecuentes de desproporción cefalopélvica, con antecedente quirúrgico obstétrico de cesárea por primera vez, y con hallazgos transoperatorios más frecuentes de circular ceñido de cordón, líquido meconial y múltiples adherencias en orden de frecuencia. Conclusión: Como antecedentes quirúrgicos obstétricos se encontró la cesárea por primera vez con mayor frecuencia en el rango de edad de 20-24 años, con hallazgos transoperatorios más frecuentes, de circular ceñido de cordón, liquido meconial y múltiples adherencias en orden de frecuencia
Assuntos
Humanos , Feminino , Gravidez , Adolescente , Adulto , Adulto Jovem , Cesárea , Complicações Intraoperatórias/epidemiologia , Paraguai/epidemiologia , Paridade , Complicações na Gravidez/epidemiologia , Cuidado Pré-Natal , Diagnóstico Pré-Natal , Fatores Socioeconômicos , Testes Sorológicos , Aderências Teciduais , Estudos Transversais , Fatores de Risco , Idade Gestacional , Estado Civil , Distribuição por Idade , Escolaridade , Cordão Nucal , MecônioRESUMO
PURPOSE: Accidental out-of-hospital deliveries are generally associated with high rates of perinatal morbidity and mortality. To determine the status of accidental out-of-hospital deliveries transferred by emergency medical services (EMS), we analyzed the records of EMS runsheets in two South Korean provinces, Gyeonggi and Gangwon. METHODS: The EMS runsheets of patients who were more than 20 weeks pregnant and had delivery-related symptoms between January 2012 and December 2013 in Gyeonggi and Gangwon province were reviewed retrospectively. We analyzed the characteristics of accidental out-of-hospital deliveries by comparing these with those non out-of-hospital deliveries. RESULTS: There were 1,426 urgent dispatches during the study period. In 137 (9.6%) out-of-hospital deliveries, which took place prior to arriving at the hospital, and 48 of these were attended by EMS providers. The accidental out-of-hospital deliveries were more frequent during night time and more common among multiparous and younger age women; however, these observation was without any significance with respect to premature birth. The rate of the accidental out-of-hospital deliveries was not significantly different between rural and urban areas. Twenty cases of complication, including 10 arrests of neonates and EMS providers managed them by the following intervention: reduction of nuchal cord, umbilical cord clamping and cut, warming-up of and stimulating the neonates warms, using oropharyngeal suction, O₂ supplication, and neonatal cardiopulmonary resuscitation. CONCLUSION: As the rate of accidental out-of-hospital deliveries in patients who were transferred by EMS is higher than the rate of out-of-hospital deliveries in general, EMS providers should be fully trained. Moreover, there is the need for more completive records and continuous education.
Assuntos
Feminino , Humanos , Recém-Nascido , Gravidez , Reanimação Cardiopulmonar , Constrição , Educação , Emergências , Serviços Médicos de Emergência , Mortalidade , Cordão Nucal , Complicações do Trabalho de Parto , Nascimento Prematuro , Estudos Retrospectivos , Sucção , Cordão UmbilicalRESUMO
El objetivo del estudio fue comparar los resultados perinatales en las gestaciones con doble circular de cordón al cuello fetal según la vía del parto en el Instituto Nacional Materno Perinatal de Lima - Perú durante los años 2011-2012. Se realizó un estudio retrospectivo transversal, observacional analítico de tipo casos y controles. Se compararon los resultados perinatales de 101 mujeres con gestaciones con circular de cordón doble al cuello que tuvieron parto vaginal (casos) con los de 101 gestantes con circular de cordón doble al cuello a quienes se les realizó cesárea (controles). El análisis estadístico se realizó con el programa IBM Statistics SPSS 19. La edad de las gestantes varió entre los 12 y 46 años, con una media de 27,2 +/- 7,0 años. El análisis de regresión logística no demostró asociación entre las variables muerte fetal intraútero y muerte neonatal con la vía del parto (vaginal o cesárea) en las gestaciones con circular de cordón doble al cuello. Se concluyó que la vía del parto vaginal en las gestaciones con circular de cordón doble al cuello incrementó el riesgo asfixia perinatal, líquido amniótico meconial, sufrimiento fetal agudo, monitoreo electrónico fetal patológico, necesidad de reanimación neonatal e ingreso a la Unidad de Cuidados Intensivos Neonatal.
The objective of the study was to compare perinatal outcomes in pregnancies with double nuchal cord by the route of delivery in the National Maternal and Perinatal Institute in Lima - Peru during 2011-2012. An observational cross-sectional, retrospective case-control study was performed. Perinatal outcomes of 101 pregnant women with double nuchal cord delivered vaginally (cases) were compared with those of 101 pregnant women with double nuchal cord who underwent cesarean section (controls). Statistical analysis was performed with the IBM SPSS Statistics 19 program. The age of the pregnant women ranged between 12 and 46 years with a mean of 27.2 +/- 7.0. The logistic regression analysis showed no association between the variables intrauterine fetal death and neonatal death with the route of delivery (vaginal or cesarean) in pregnancies with circular double neck cord. It was concluded that the path of vaginal delivery in pregnancies with circular double neck cord increased the risk perinatal asphyxia, meconium, fetal distress, pathological EFM, need for neonatal resuscitation and admission lo Neonatal Intensive Care Unit.
Assuntos
Feminino , Humanos , Gravidez , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Cordão Nucal , Monitorização Fetal , Terapia Intensiva Neonatal , Estudos Observacionais como Assunto , Estudos Retrospectivos , Estudos Transversais , Estudos de Casos e ControlesRESUMO
Asphyxia is a medical condition in which placental or pulmonary gas exchange is impaired or they cease all together, typically producing a combination of progressive hypoxemia and hypercapnea. In addition to regional differences in its etiology; it is important to know its risk factors. This is a case-control study, all neonates born from May 2002 to September 2005 in Vali-e-Asr Hospital were studied. 9488 newborns were born of which 6091 of the live patients were hospitalized in NICU. 546 newborns were studied as case and control group. 260 neonates [48%] were female and 286 neonates [52%] were male. Among the neonates who were admitted, 182 of them were diagnosed with asphyxia and twice of them [364 newborns] were selected as a control group. The variables consist of; gestational age, type of delivery, birth weight, prenatal care, pregnancy and peripartum complications and neonatal disorders. Our studies showed that 35 [19.2%] patients had mild asphyxia, 107 [58.8%] had moderate asphyxia and 40 [22%] were diagnosed as severe asphyxia. Mean maternal age was 34.23 +/- 4.29yr; [range: 23-38 yr]; and mean of parity was 2 +/- 1.2; [range: 1-8]. Risk factors in our study included emergent Caesarian Section, preterm labor [<37w], low birth weight [<2500g], 5 minute Apgar [less than 6], need for resuscitation, nuchal cord, impaired Biophysical Profile, neonatal anemia, and maternal infertility. All risk factors listed above play a role in asphyxia. The majority of these factors are avoidable by means of good perinatal care
Assuntos
Humanos , Masculino , Feminino , Fatores de Risco , Recém-Nascido , Estudos de Casos e Controles , Cesárea , Trabalho de Parto Prematuro , Recém-Nascido de Baixo Peso , Ressuscitação , Cordão Nucal , Anemia Neonatal , Infertilidade FemininaRESUMO
O prolapso de cordão umbilical é uma intercorrência obstétrica que, embora pouco frequente,uma vez diagnosticada, necessita de rápida intervenção, devido ao grande riscode morbimortalidade fetal. A conduta mais recomendada ,nesse caso, é a interrupçãoda gestação por meio de cesariana. Algumas medidas pré e per-operatórias podemser utilizadas a fim de reduzir a compressão do cordão e manter adequado fluxo sanguíneopara o feto até a intervenção obstétrica definitiva. O intervalo de tempo entre oprolapso do cordão e a interrupção da gravidez, assim como o grau de compressão docordão são fatores determinantes para o prognóstico neonatal. Apresenta-se, neste relato,o caso de uma paciente primigesta de 21 anos, com 40 semanas de gestação, quefoi internada para indução do trabalho de parto e investigação de suspeita de síndromeHELLP. O quadro evoluiu com rotura da bolsa e prolapso de cordão umbilical. Foi realizadacesariana de urgência para resolução do caso.
Umbilical cord prolapse is an obstetric complication that, although uncommon, once diagnosed needs prompt intervention, due to high risk of fetal morbimortality. The widely recommended management in this set is the interruption of the pregnancy by means of cesarean. Some pre and peroperative techniques may be used in order to reduce funic compression and maintain appropriate blood flow to the fetus to definitive obstetric intervention. Time interval between cord prolapse and pregnancy interruption, as well as cord compression degree are crucial for neonatal prognosis. This report presents the case of a 21 year primigravida patient, with a 40 weeks pregnancy, who was admitted to the Hospital das Clínicas da UFMG for induction of labor and investigation of suspected HELLP syndrome. The patient developed rupture of mem-branes and umbilical cord prolapse. An urgency cesarean was performed to solve the case.
Assuntos
Humanos , Feminino , Recém-Nascido , Adulto , Cordão Nucal , Cordão Umbilical , ProlapsoRESUMO
PURPOSE:To investigate the significance of umbilical artery acidosis and compare perinatal outcomes according to the types of acidosis for a tertiary hospital population delivered at term. METHODS:We reviewed maternal and neonatal medical records of all term liveborn infants with an umbilical artery pH or =20 mEq/L) and high pCO2 (> or =20 mmHg) were significantly associated with low pH value, the perinatal outcomes were not significantly different according to the level of base deficit or pCO2. CONCLUSION:The mixed acidemia was more associated with pathologic fetal acidemia than pure respiratory or metabolic acidosis. The ability to predict not only metabolic but also respiratory component of fetal acidemia may help in safe management of delivery leading to reduce the fetal acidemia.
Assuntos
Humanos , Lactente , Recém-Nascido , Acidose , Acidose Respiratória , Concentração de Íons de Hidrogênio , Prontuários Médicos , Cordão Nucal , Complicações na Gravidez , Centros de Atenção Terciária , Artérias UmbilicaisRESUMO
OBJECTIVE: to find out the incidence of nuchal cord at delivery, intrapartum complication and perinatal outcomes in the cases with nuchal cord. MATERIALS AND METHODS: A prospective, cross-sectional, comparative study done at Kathmandu Medical College Teaching Hospital (KMCTH) between March 2006 to September 2006. Total 512 deliveries occurred during this period that were enrolled in the study and were analyzed for presence of nuchal cord at the time of delivery, number of coils whether loose or tight, intrapartum complications and perinatal outcome. The cases with nuchal cord at the time of delivery were taken as study group and the cases without nuchal cord served as control group. Outcome variables between the two groups were compared. Outcome variables used were meconium staining of liquor, rate of instrumental and caesarean delivery, intrapartum fetal heart rate (FHR) irregularities. As a measure of perinatal outcome Apgar score<7 at 1 minute and 5 minutes and incidence of neonatal unit admission was taken. RESULTS: Incidence of nuchal cord at the time of delivery was 22.85%. Incidence of single nuchal cord was highest (18.95%). Intrapartum complications like FHR irregularities and meconium staining of liquor were increased in nuchal cord group but statistically not significant. Instrumental delivery rate was high in nuchal cord group but statistically not significant (0.108). However, caesarean section rate was high in the group without nuchal cord (p=0.029). Apgar score<7 at 1 minute was significantly low in nuchal cord group (p=0.010) but apgar score at 5 minutes and admission to neonatal unit was not more common. CONCLUSION: Nuchal cord is not associated with adverse perinatal outcome.
Assuntos
Adulto , Cesárea/estatística & dados numéricos , Distribuição de Qui-Quadrado , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Nepal/epidemiologia , Cordão Nucal/epidemiologia , Gravidez , Resultado da Gravidez , Estudos Prospectivos , Fatores de RiscoRESUMO
To asses the ability of color Doppler ultrasonography to detect the presence of nuchal cord [NC] before induction of labor in uncomplicated postterm pregnancies, and to investigate whether fetal umbilical artery vascular resistance, mode of delivery, and neonatal outcome are affected by its presence in such cases. In a prospective study, a transabdominal grayscale and color Doppler ultrasound imaging was performed prior to induction of labor in 250 women with uncomplicated postterm pregnancies at 41 weeks to detect the presence of nuchal cord and to measure the umbilical artery [UA] systolic/diastolic ratio [S/D] and resistance index [RI]. The outcomes of labor, delivery and neonates were obtained. Outcome parameters evaluated included presence of nuchal cords at delivery, mode of delivery, non-reassuring fetal heart rate patterns [NRFHR], meconium-stained amniotic fluid, birth weight, 1 and 5 minutes Apgar scores, and admission to neonatal intensive care unit. A total of 250 women were included in this study, of which 71 had sonographic evidence of NC [group I] and 179 without sonographic evidence of NC [group II]. A nuchal cord was present at 26.8% of deliveries. The sensitivity of color Doppler sonography in diagnosing NC was 94%, with specificity, positive and negative predictive values of 95.6%, 88.7%, and 97.7%, respectively. No abnormal UA waveform patterns were detected in either group, and no statistically significant differences in UA S/D or RI values were found between the two study groups. There were also no significant differences between group I and group II with respect to mode of delivery, NRFHR, meconium-stained amniotic fluid, birth weight, 1 and 5 minutes Apgar scores, and neonatal intensive care unit admissions. Color Doppler ultrasonography is highly sensitive and specific method of diagnosing nuchal cord prior to induction of labor in uncomplicated postterm pregnancies. However, fetal umbilical artery vascular resistance, mode of delivery, and neonatal outcome are not affected by cord encirclement in such cases. Therefore, ultrasonographic nuchal cord assessment is neither a necessary nor a useful procedure before labor induction in uncomplicated postterm pregnancies, and intrapartum intervention based on the antenatal diagnosis may not be appropriate
Assuntos
Humanos , Feminino , Gravidez Prolongada/diagnóstico , Ultrassonografia Doppler em Cores , Cordão Umbilical , Pescoço , Resultado da Gravidez , Cordão NucalRESUMO
Hyperextended neck of the fetal head is among the various fetal attitudes detected by prenatal sonography. Various etiologies may lead to hyperextension of the fetal head, including fetal anomalies such as structural abnormalities, conjoined twins and fetal neck masses, nuchal cord and uterine factors such as leiomyoma and uterine malformations. The importance of the precise prenatal diagnosis of this condition relates not only to the delivery mode, but also to the detection of associated conditions, as noted above. We report a case of a fetus whose persistent hyperextended neck was detected by midtrimester sonography, and who later demonstrated ventriculomegaly and lung immaturity in the 3rd trimester.
Assuntos
Feminino , Humanos , Gravidez , Feto , Cabeça , Leiomioma , Pulmão , Pescoço , Cordão Nucal , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Diagnóstico Pré-Natal , Gêmeos UnidosRESUMO
OBJECTIVE: The purpose of this study was to evaluate the incidence, causes and maternal complications in cases of fetal death in utero (FDIU). METHODS: This is a clinical study of 224 cases of FDIU among 10,582 deliveries at 00 University Hospital during January 1990 to December 2004. All the clinical informations were obtained by reviewing medical records retrospectively. RESULTS: The average incidence of FDIU was 2.1%. The mean age of mothers with FDIU was 28.5 years old. The mean gestational age was 30.4 weeks and mean weight of dead fetus was 1442 gm. The causes of FDIU were placenta abuptio (14.3%), severe preeclampsia (13.4%), congenital anomalies (9.4%), severe intrauterine growth restriction (IUGR, 9.4%), nuchal cord (6.7%), chrioamnionitis (5.8%). However the causes of FDIU were largely unknown (18.8%). The modes of delivery were induced labor (65.2%), laparotomy (26.8%), spontaneous labor (8.0%). The most common indication of laparotomy was placenta abuptio (36.7%). There were 66 cases (29.5%) with maternal complications and common complications were hemorrhage (11.2%), fever (8.5%), DIC (5.8%). The incidence of hypofibrinogenemia (<150 mg/dL) was 14.3%. CONCLUSION: The most common suspected causes of FDIU were placenta abruptio, severe preeclampsia and the causes could not be determined in 42 cases (18.8%). The proper prenatal care should be taken of fetuses on the basis of risk factors of antepartum and intrapartum so that unnecessary intrauterine fetal death might be able to be prevented.