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. 2021 Mar 19;49(6):740-747.
doi: 10.1515/jpm-2020-0352. Print 2021 Jul 27.

Causal analysis of fetal death in high-risk pregnancies

Mónica Aguinaga  1 , Yolotzin Valdespino  2 , Daniela Medina  1 , Salvador Espino Y Sosa  3 , Rosalba Sevilla  1 , Osvaldo Miranda  4 , Sandra Acevedo  5 , Irma E Monroy  1 , Addy C Helguera  6 , Javier Pérez  1 , Luisa F Mariscal  1 , Mauricio R Murillo  1 , Rosa M Lara  1 , Jessica C Armijos  1 , Gabriela Rogel  1 , Jorge A Cardona  7
Affiliations

Causal analysis of fetal death in high-risk pregnancies

Mónica Aguinaga et al. J Perinat Med. .

Abstract

Objectives: To determine the causes of fetal death among the stillbirths using two classification systems from 22 weeks of gestation in a period of three years in high-risk pregnancies. This is a retrospective observational study.

Methods: The National Institute of Perinatal Health in Mexico City is a Level 3 care referral center attending high-risk pregnancies from throughout the country. The population consisted of patients with fetal death during a three-year period. Between January 2016 and December 2018, all stillbirths were examined in the Pathology Department by a pathologist and a medical geneticist. Stillbirth was defined as a fetal death occurring after 22 weeks of gestation.

Results: Main outcome measures: Causal analysis of fetal death using the International Statistical Classification of Disease and Related Health Problems-Perinatal Mortality (ICD-PM) and initial causes of fetal death (INCODE) classification systems. A total of 297 stillborn neonates were studied. The distribution of gestational age in antepartum stillbirths (55.2%) showed a bimodal curve, 36% occurred between 24 and 27 weeks and 32% between 32 and 36 weeks. In comparison, the majority (86%) of intrapartum deaths (44.8%) were less than 28 weeks of gestation. Of the 273 women enrolled, 93 (34%) consented to a complete fetal autopsy. The INCODE system showed a present cause in 42%, a possible cause in 54% and a probable cause in 93% of patients.

Conclusions: The principal causes of antepartum death were fetal abnormalities and pathologic placental conditions and the principal causes of intrapartum death were complications of pregnancy which caused a premature labor and infections.

Keywords: antepartum; causal analysis; fetal death; intrapartum.

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