The Incidence Of Probable Missed Intrauterine Growth Restriction As A Cause Of Unexplained Intrauterine Fetal Death In A Low Resource Setting. A One-Year Retrospective Study

Trichkov C and Huseyin TD

Published on: 2022-04-29

Abstract

Introduction: In South Africa, 25% of perinatal deaths are unexplained stillbirths, with causes rarely investigated, this can be prevented if risk factors for fetal growth restriction are identified during the antenatal period

Aim: To determine if most unexplained intrauterine deaths are probably missed intrauterine growth restriction (IUGR)

Methods: Antenatal records, together with the South African Perinatal Problems Identification Program (PPIP) database allowed for the analysis of gestational age at death. A structured data collection tool was used to capture socio-demographic, maternal, obstetric and neonatal data. Data was analysed using SPSS (version (25).

Results: The majority of stillbirths (78.8 percent) were discovered pre-delivery by ultrasonography, and  the gestational age of the mother was estimated based on ultrasound or clinical examination. The median gestational age was 34 weeks. Seventy-two infants (43.6%) were preterm, forty-seven (28.5%) were late-preterm and forty-six (27.9%) were term. The overall incidence of unexplained stillbirth was 3.9% (305/7780). Our data showed that forty percent of the stillbirths were probably growth restricted. All women had at least one antenatal appointment, and all were from low socioeconomic backgrounds. There were forty-six (27.9 %) HIV-infected pregnant women and twenty (30.3%) with growth-restricted fetuses, but this was not statically significant. Syphilis was found in four of the mothers (2%). Anemia, pregnancy-induced hypertension, and pregnancy-associated diabetes are all known maternal risk factors for stillbirth. Hypertension was a significant contributor to stillbirths among these maternal risk variables (p value 0.04). There was a low prevalence of smoking and drinking during pregnancy.

Conclusion: This study highlights the fact that a large proportion of unexplained intrauterine deaths can be attributed to missed intrauterine growth restriction during antenatal care, with the majority being delivered pre-term. There is a need for adequate investigations of unexplained fetal deaths. It is possible that a better understanding of the vulnerable foetus will be required in order to reduce the rate of unexplained stillbirth. Training primary health care providers in the identification of foetal growth restriction and the identification of those at risk during antenatal care may assist to reduce the number of stillbirths caused by fetal growth restriction in the future.