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.
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.
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.
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.
We would like to express our gratitude to Regina Castro for the editorial assistance.
Research funding: None declared.
Author contributions: JAC, SE, MA initiated the concept. MA, YV, SE and JAC designed the study. DM, RS, OM, LM, MM, RML, CA, YV and MA evaluated the patients. MA, YV, SE, OM, SA and DM performed the analysis. IM, CH, JP and GR performed the genetic and infectious analysis. MA, YV and SE drafted the initial manuscript. MA, YV, DM, SE, RS, OM, SA, IM, CH, JP, LM, MM, RML, CA, GR and JAC reviewed and approved the submitted manuscript. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: The procedures of the study received ethics approval from the Institutional Review Board, Comité de Etica Hospitalaria del Instituto Nacional de Perinatología, Mexico City in January 2016.
1. Froen, JF, Cacciatore, J, McClure, EM, Kuti, O, Hakeem, A, Islam, M, et al.. Stillbirths: why they matter. Lancet 2011;377:1353–66. https://doi.org/10.1016/S0140-6736(10)62232-5.Search in Google Scholar
2. UNICEF, WHO. Every newborn: an action plan to end preventable deaths. Geneva: WHO; 2014.Search in Google Scholar
3. INEGI. Instituto Nacional de Estadística y Geografía. Mortalidad fetal. Available from: http://www.inegi.org.mx/lib/olap/consulta/general_ver4/MDXQueryDatos.asp?proy=mortfet_mf.Search in Google Scholar
4. Reinebrant, HE, Leisher, SH, Coory, M, Henry, S, Wojcieszek, AM, Gardener, G, et al.. Making stillbirths visible: a systematic review of globally reported causes of stillbirth. BJOG 2018;125:212–24. https://doi.org/10.1111/1471-0528.14971.Search in Google Scholar
5. Page, JM, Christiansen-Lindquist, L, Thorsten, V, Parker, CB, Reddy, UM, Dudley, DJ, et al.. Diagnostic tests for evaluation of stillbirth: results from the stillbirth collaborative research network. Obstet Gynecol 2017;129:699–706. https://doi.org/10.1097/aog.0000000000001937.Search in Google Scholar
6. Korteweg, F, Erwich, JJ, Timmer, A, van der Meer, J, Ravisé, J, Veeger, N, et al.. Evaluation of 1025 fetal deaths: proposed diagnostic workup. Am J Obstet Gynecol 2012;206:53.e1–12. https://doi.org/10.1016/j.ajog.2011.10.026.Search in Google Scholar
8. Korteweg, F, Erwich, JJ, Holm, J, Raivisé, J, van der Meer, J, Veeger, N, et al.. Diverse placental pathologies as the main cause of fetal death. Obstet Gynecol 2009;114:809–17. https://doi.org/10.1097/aog.0b013e3181b72ebe.Search in Google Scholar
10. Dudley, DJ, Goldenberg, R, Conway, D, Silver, R, Saade, G, Varner, M, et al.. A new system for determining the causes of stillbirth. Obstet Gynecol 2010;116:254–60. https://doi.org/10.1097/aog.0b013e3181e7d975.Search in Google Scholar
11. World Health Organization. The WHO application of ICD-10 to deaths during the perinatal period: ICD-PM. Geneva, Switzerland: World Health Organization; 2016.Search in Google Scholar
12. Heazell, AEP, Siassakos, D, Blencowe, H, Burden, C, Bhutta, ZA, Cacciatore, J, et al.. Stillbirths: economic and psychosocial consequences. Lancet 2016;387:604–16. https://doi.org/10.1016/s0140-6736(15)00836-3.Search in Google Scholar
13. Badillo-López, C, González-Mejía, A, Helguera-Repetto, AC, Salas-Rangel, LP, Rivera-Gutiérrez, S, Cerna-Cortés, JF, et al.. Differential expression of dnaA and dosR genes among members of the Mycobacterium tuberculosis complex under oxic and hypoxic conditions. Int Microbiol 2010;13:9–13.Search in Google Scholar
14. Aminu, M, Unkels, R, Mdegela, M, Utz, B, Adaji, S, ven den Broek, N. Causes of and factors associated with stillbirth in low- and middle-income countries: a systematic literature review. BJOG 2014;121:141–53. https://doi.org/10.1111/1471-0528.12995.Search in Google Scholar
15. Copper, RL, Goldenberg, RL, DuBard, MB, Davis, RO. Risk factors for fetal death in white, black, and Hispanic women. Collaborative group on preterm birth prevention. Obstet Gynecol 1994;84:490–5.Search in Google Scholar
16. McClure, EM, Garces, A, Saleem, S, Moore, JL, Bose, CL, Esamai, F, et al.. Global network for women’s and children’s health research: probable causes of stillbirth in low- and middle-income countries using a prospectively defined classification system. BJOG 2018;125:131–8. https://doi.org/10.1111/1471-0528.14493.Search in Google Scholar
18. Goldenberg, RL, Harrison, MS, McClure, EM. Stillbirths: the hidden birth asphyxia – US and global perspectives. Clin Perinatol 2016;43:439–53. https://doi.org/10.1016/j.clp.2016.04.004.Search in Google Scholar
The online version of this article offers supplementary material (https://doi.org/10.1515/jpm-2020-0352).
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