Analysis of risk factors and maternal morbidity associated with intrauterine fetal death

Abstract

OBJECTIVE: To evaluate the maternal risk factors of the pregnancies complicated by intrauterine fetal death. STUDY DESIGN: Data of 443 pregnacies complicated by intrauterine fetal death between January.1.2000 and December.31.2001 and the analysis of the causes of maternal morbidity are presented in this retrospective study. Maternal hypofibrinogenemia (<400 mg/dl) and severe hypofibrinogenemia (<150 mg/dl) and their risk factors were assessed with multiple logistic regression analysis. RESULTS: The mean age of the analysed population was 28±5.9 and the mean gestational age was 237±36. The 63.9% of the mothers have not received antenatal care. Non-vertex fetal presentation was seen in 25.1% of the cases. The labor was induced by oxytocin in 7% and by misoprostol in 35.9% of the cases. Hypertensive disorders were detected in 19.6% of the mothers; diabetic disorders in 4.1%. Placenta previa was diagnosed in 0.9% (n=4) and abruption of placenta in 6.8% (n=30). In two cases (0.05%) uterine rupture was occured. Of the 443 cases of IUFD, 66 (14.9%) were delivered by cesarean section. Hypofibrinogenemia was diagnosed in 148 (33.4%) cases and severe hypofibrinogenemia in 18 (4.1%) cases. The most important risk factors leading to severe hypofibrinogenemia was diagnosed to be retained fetus for more than 4 weeks after death (OR=2.8; CI=1.2-6.6; p=0.01) and placental abruption (OR=40.6; CI=12.1-136.1; p<0.001). Premature rupture of membranes was found to decrease the risk of hypofibrinogenemia (OR=0.04; CI=0.1-0.9). One case of maternal death was observed because of postpartum acute fatty liver. CONCLUSION: The diagnosis of the fetal intrauterine death time by ultrasound and the early detection of placental abruption are effective to prevent a fatal complication as severe hypofibrinogenemia