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Causal analysis of fetal death in high-risk pregnancies

  • Mónica Aguinaga EMAIL logo , Yolotzin Valdespino , Daniela Medina , Salvador Espino y Sosa , Rosalba Sevilla , Osvaldo Miranda , Sandra Acevedo , Irma E. Monroy , Addy C. Helguera , Javier Pérez , Luisa F. Mariscal , Mauricio R. Murillo , Rosa M. Lara , Jessica C. Armijos , Gabriela Rogel und Jorge A. Cardona
Veröffentlicht/Copyright: 19. März 2021
Journal of Perinatal Medicine
Aus der Zeitschrift Journal of Perinatal Medicine Band 49 Heft 6

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
Corresponding author: Mónica Aguinaga, MD, MSc, Human Genetics and Genomics Department, Instituto Nacional de Perinatología, Montes Urales 800, Col. Lomas de Chapultepec IV Secc, C.P 11000, Mexico City, Mexico, Phone: +52 55209900 x316, E-mail:

Acknowledgments

We would like to express our gratitude to Regina Castro for the editorial assistance.

  1. Research funding: None declared.

  2. 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.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. 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.

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/jpm-2020-0352).

Received: 2020-07-24
Accepted: 2021-02-11
Published Online: 2021-03-19
Published in Print: 2021-07-27

© 2021 Walter de Gruyter GmbH, Berlin/Boston

Artikel in diesem Heft

  1. Frontmatter
  2. Special Section: Coronavirus Disease 2019 (COVID-19) in Obstetrics
  3. Editorial
  4. COVID-19 in pregnancy: where are we now?
  5. Review
  6. Newborns at risk of Covid-19 ― lessons from the last year
  7. Opinion Paper
  8. Ethical challenges in management of critically ill pregnant patients with coronavirus disease 2019 (COVID-19)
  9. Corner of Academy
  10. Antenatal depression and anxiety during the COVID-19 pandemic: a cross-sectional study in pregnant women from routine health care contact in Greece
  11. Original Articles – Obstetrics
  12. Pregnant women’s psychological state and influence factors: anxiety, and depression during COVID-19 outbreak
  13. Anxiety and depression during pregnancy in the era of COVID-19
  14. COVID-19 vaccine hesitancy in perinatal women: a cross sectional survey
  15. Covid-19 and pregnancy: the experience of a tertiary maternity hospital
  16. Infant outcomes and maternal COVID-19 status at delivery
  17. Assessment of fetal Doppler parameters in pregnant women with COVID-19 infection: a prospective case-control study
  18. SARS-CoV-2 in pregnancy and possible transfer of immunity: assessment of peripartal maternal and neonatal antibody levels and a longitudinal follow-up
  19. Peripartal anti-SARS-CoV-2-IgA/IgG in asymptomatic pregnant women during regional SARS-CoV-2-outbreak
  20. SARS-CoV-2 in asymptomatic pregnant women in South Brazil: RT-PCR and serological detection
  21. Letter to the Editor
  22. COVID-19 vaccine: the gender disparity
  23. Regular Papers
  24. Original Articles – Obstetrics
  25. Mode of delivery of women with Swyer syndrome in a German case series
  26. Risk factors and outcomes of abnormal bleeding after external cephalic version
  27. Causal analysis of fetal death in high-risk pregnancies
  28. Original Article – Neonates
  29. Prediction of encephalopathy in perinatal asphyxia score: reaching the unreached
  30. Short Communication
  31. Deoxyribonuclease activity negative correlates with extracellular DNA in uncomplicated singleton pregnancies in the third trimester
  32. Online Only: Congress Abstracts
  33. World Congress of Perinatal Medicine
https://doi.org/10.1515/jpm-2020-0352
Schlagwörter für diesen Artikel
antepartum; causal analysis; fetal death; intrapartum

Artikel in diesem Heft

  1. Frontmatter
  2. Special Section: Coronavirus Disease 2019 (COVID-19) in Obstetrics
  3. Editorial
  4. COVID-19 in pregnancy: where are we now?
  5. Review
  6. Newborns at risk of Covid-19 ― lessons from the last year
  7. Opinion Paper
  8. Ethical challenges in management of critically ill pregnant patients with coronavirus disease 2019 (COVID-19)
  9. Corner of Academy
  10. Antenatal depression and anxiety during the COVID-19 pandemic: a cross-sectional study in pregnant women from routine health care contact in Greece
  11. Original Articles – Obstetrics
  12. Pregnant women’s psychological state and influence factors: anxiety, and depression during COVID-19 outbreak
  13. Anxiety and depression during pregnancy in the era of COVID-19
  14. COVID-19 vaccine hesitancy in perinatal women: a cross sectional survey
  15. Covid-19 and pregnancy: the experience of a tertiary maternity hospital
  16. Infant outcomes and maternal COVID-19 status at delivery
  17. Assessment of fetal Doppler parameters in pregnant women with COVID-19 infection: a prospective case-control study
  18. SARS-CoV-2 in pregnancy and possible transfer of immunity: assessment of peripartal maternal and neonatal antibody levels and a longitudinal follow-up
  19. Peripartal anti-SARS-CoV-2-IgA/IgG in asymptomatic pregnant women during regional SARS-CoV-2-outbreak
  20. SARS-CoV-2 in asymptomatic pregnant women in South Brazil: RT-PCR and serological detection
  21. Letter to the Editor
  22. COVID-19 vaccine: the gender disparity
  23. Regular Papers
  24. Original Articles – Obstetrics
  25. Mode of delivery of women with Swyer syndrome in a German case series
  26. Risk factors and outcomes of abnormal bleeding after external cephalic version
  27. Causal analysis of fetal death in high-risk pregnancies
  28. Original Article – Neonates
  29. Prediction of encephalopathy in perinatal asphyxia score: reaching the unreached
  30. Short Communication
  31. Deoxyribonuclease activity negative correlates with extracellular DNA in uncomplicated singleton pregnancies in the third trimester
  32. Online Only: Congress Abstracts
  33. World Congress of Perinatal Medicine
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