Analysis of the causes of antenatal death of premature fetuses in the Chelyabinsk region

Abstract

Introduction. The stillbirth rate is steadily increasing accounting for about 80 per cent of perinatal mortality in Russia. There is currently no uniform international classification for coding the causes of perinatal death.The aim of the study was a comparative analysis of the causes of antenatal death of full-term fetuses in the Chelyabinsk region on the basis of various classifications of perinatal mortality to determine possible reserves for reducing the stillbirth rate.Materials and methods A retrospective case-control study based on the analysis of medical documentation of all cases of antenatal death of full-term fetuses during the period of pregnancy 37 weeks 0 days - 41 weeks 6 days held in the Chelyabinsk region from 2019 to 2021. We use the MedCalc software package (Version 20.110, Belgium, 2022) for statistical analysis.Results Based on the ICD-10 classification applied to perinatal deaths (ICD-PM), the leading cause of antenatal death of full-term fetuses is acute antenatal complication. In this case, disorders related to duration of pregnancy and growth of the fetus are the main concomitant pathology. There has also been an increase in the proportion of maternal conditions that have a direct impact on antenatal fetal death (placental and umbilical cord pathology) and other diseases or pathological conditions of the mother (hypertensive disorders and infectious and parasitic diseases). According to the Scandinavian-Baltic Classification, most cases fall into category III and are considered preventable. The distribution of full-term fetal death by CODAC showed that antenatal hypoxia of the fetus is rarely the primary and only cause. First comes the pathology of the placenta and umbilical cord.Discussion The ICD-PM classification allows to lead the most detailed analysis of the causes of antenatal death, considering the pathological conditions of the fetus and the mother, which have a direct influence on the occurrence of the adverse outcome. However, a comparison of the distribution of the cases studied by other classifications showed that the pathology of the placenta and umbilical cord could be considered as the main cause of antenatal death of full-term fetuses, rather than a concomitant cause.Conclusion The main cause of antenatal death of full-term fetuses in Chelyabinsk region is antenatal hypoxia of the fetus. At the same time, all cases of antenatal fetal death relate to preventable losses, which determines the urgent need to identify predictors of this unfavorable outcome in order to reduce the stillbirth rate.