Cause Of Intrauterine Fetal Death Research Articles

Kliniğimizde Gerçekleşen İntra-Uterin Fetal Ölüm Vakalarının Retrospektif Olarak Değerlendirilmesi

The present study aims to retrospectively analyze the frequency, demographic characteristics, affecting risk factors and outcomes of intra-uterine fetal death (IUFD) cases delivered between 2015 and 2022 in our clinic, a tertiary center. Between January 2015 and December 2021, 92 pregnant women between 22-41 weeks of gestational age who gave birth due to IUFD in Muğla University Education and Research Hospital clinic were included in the study. Age at presentation, gravida, parity and body mass index (BMI) data, gestational weeks, and if after birth, birth weight, mode of delivery, infant sex and pathologic examination results were recorded. There were 92 cases of IUFD between the specified dates. The ratio of cases to the number of births was 1.03%. Of the cases, 88 (95.65%) were singleton pregnancies and 4 (4.34%) were multiple pregnancies. The mean age was 29.47±5.71 years. Among the cases, 1 (1.08%) pregnant woman was under 18 years of age and 1 pregnant woman was over 40 years of age. The mean BMI was 25.54±3.90 kg/m2 and 2 (2.16%) pregnant women were morbidly obese (≥40 kg/m2). The mean gestational age was 31.07±4.87 weeks. When the causes of IUFD were evaluated, placental abruptio1n was observed in 12 (13.18%) pregnant women. Hypertensive disorders of pregnancy were present in 6 (50%) of the pregnant women with placental abruption. While 5 (5.49%) pregnant women had diabetes mellitus, 2 (2.19%) had placenta previa. A total of 7 (7.60%) pregnant women had anhydroamniosis, a sign of uteroplacental insufficiency, during hospitalization, while 20 (21.97%) pregnant women had fetal anomaly. One (1.09%) pregnant woman developed disseminated intravascular coagulation. In addition, 3 (3.26%) pregnant women had COVID-19 and were hospitalized. The predictability of IUFD cases is low. But despite this, each center can partially reduce the incidence of IUFD with a pro-active approach by evaluating its own outcomes and identifying risk factors.

Intrauterine death in vasa previa without hemorrhage: case reports

Antepartum and intrapartum hemorrhage from vasa previa (VP) is one of the main causes of intrauterine fetal death (IUFD). Here, we present two cases with type I VP in which velamentous cord insertion below the fetal head and overlying the cervix were reported by prenatal ultrasound scanning, and IUFD occoured after 35 weeks with no signs of prenatal bleeding but with engaged fetal head at presentation. We hypothesized that the IUFD may attributed to the compression of the unprotected umbilical vessels by the engaged fetal head. Thus we suggest that VP with a velamentous cord insertion should be considered for earlier termination of the pregnancy to avoid the risk of non-hemorrhagic adverse fetal outcomes.

Morphological changes in fetal organs and tissues in intrauterine death

This article presents a literature review of post-mortem changes in the organs and tissues of the fetus in intrauterine death. The visual and morphological changes that can serve to determine the time of post-mortem changes in organs and tissues at various stages of pregnancy are covered. A detailed study of post-mortem changes in the fetus will help avoid medical errors and unjustified criminal prosecutions, provide an opportunity for an objective assessment of the consequences and causes of intrauterine fetal death, eliminate discrepancies in clinical and pathoanatomic diagnoses, and increase the accuracy of diagnosis and the quality of knowledge. Сomprehension of the key principles for assessing morphological changes in fetal organs and tissues in intrauterine death will allow for developing screening programs to identify relevant risk factors, which, in the future, will reduce perinatal mortality rates.

Fatal amniotic fluid embolism: incidence, risk factors and influence on perinatal outcome.

This study aimed to estimate the incidence of fatal amniotic fluid embolism, describe its risk factors, and analyze perinatal outcomes. Maternity cases and newborn records of amniotic fluid embolism were collected from the Zhejiang Maternal Surveillance System from October 2006 to October 2019. This study strictly limited the diagnostic criteria for AFE and excluded suspicious cases in order to minimize false-positive AFE cases. The risk factors of fatal amniotic fluid embolism and the relationship between perinatal prognosis and AFE were investigated using logistic regression analysis, estimating the adjusted odds ratios (aORs) and 95% confidence intervals (CIs). 149 cases of amniotic fluid embolism were registered, of which 80 cases were fatal. The estimated fatal AFE incidence was 0.99 per 100,000. The occurrence of fatal AFE was significantly correlated with spontaneous vaginal delivery (aOR 12.3, 95% CI 3.3-39.2) and cardiac arrest (aOR 64.8, 95% CI 14.6-287.8). The average diagnosis time of fatal AFE is 85.51min, and the peak period of female death is 1-12h after the onset of the disease, accounting for 60% (48/80) of cases. Fatal amniotic embolism is a cause of intrauterine fetal death and fetal death during delivery (aOR 11.957, 95% CI 1.457-96.919; aOR 13.152, 95% CI 1.636-105.723). Of the 149 confirmed AFE cases, 11 cases of stillbirth occurred, 12 cases were stillborn, and 7 cases of neonatal death were reported. The perinatal mortality rate was 202 per 1000. Early detection, diagnosis, and treatment of amniotic fluid embolism are essential to avoiding fatal AFE. Clinicians should fully evaluate the pros and cons of choosing the delivery method for pregnant women. When cardiac arrest occurs in women with amniotic fluid embolism, obstetricians should be particularly careful and provide timely and effective treatment to minimize the fatality rate. The outcome of AFE is not only related to maternal survival but also plays a decisive role in the prognosis of the infant over the perinatal period.

Intrauterine Foetal Death: A Hospital Based Study

Introduction: Foetal death at any stage of pregnancy is not just a tragic event but also a more traumatic for the mental well-being of a mother. It is one of the most wrenching events in the field of obstetrics.
 Aims: The study was done to determine the probable risk factors of intrauterine foetal death and role of antenatal care in its prevention.
 Methods: The study was conducted in Obstetrics and Gynecology department at Nepalgunj Medical college from July 2018 to July 2020 .Inclusion criteria were intrauterine fetal death of >28 weeks of gestation and baby weighing 1000 grams or more . An exclusion criterion was molar pregnancy.
 Results: There were 115(3.52%) intrauterine fetal death during the study period, making it 35 per 1000 cases. In 17(14.78%) the cause of intrauterine fetal death was not known. The other common associated risk factors were prematurity in 14(12.17%) and hypertension in 13(11.30%). Similarly anemia and antepartum hemorrhage were seen in 13(11.30%) each. 11(9.56%) patients had oligohydramnios. Mal presentation was found in 8(6.95%) patients while polyhydromnios in 6(5.21%).The commonest age range in whom intrauterine fetal death was seen was 20-30 (73.90%). 28 (24.34%) patients were at preterm pregnancy ranging between 28-30 weeks whereas 17(14.78) intrauterine fetal death occured at 32-34 weeks. 77 foetuses were preterm and their birth weight was between 1 - 1.5 kg with the mean wt of 1175.73 gms.
 Conclusion: Intrauterine fetal death is still common inspite of the improving awareness in importance of regular antenatal care. In majority, the cause of intrauterine fetal death is still unknown. However, where the cause was known prematurity was the commonest.

Covid-19 as a possible risk factor of intrauterine fetal death.

To summarize information about possible effects of covid-19 on intrauterine fetal death and present three cases of intrauterine fetal death in women with recent covid-19 infection. Review of available information about pregnancy with covid-19 and comparison with own observation of cases during spring 2021. Covid-19 influences risk of intrauterine fetal death, preeclampsia/eclampsia or HELLP syndrome. Coagulation changes and drop of platelets is considered as one of the causes of intrauterine fetal death due to fetal vascular malperfusion.

Umbilical Cord Teratoma: A Rare Case Report

The state of the stroma, blood vessels and the anatomical features of the umbilical cord are of direct diagnostic value, and various pathological changes can become the primary cause of fetal death. The frequency of umbilical cord tumors is not reliably known due to a very rare incidence: in the available literature there were reported about 19 cases.The aim of the study was to clinically and pathohistologically analyze a case of umbilical cord teratoma and to give an analytical review of recently reported cases.The material was obtained from a healthy 35-year-old woman with a third pregnancy. Combined ultrasound screening at the 20th week of pregnancy revealed a solid structure with cystic inclusions along the periphery on the umbilical cord. In the solid component, hyperechoic inclusions giving acoustic shadows were visualized; in the color Doppler imaging mode the neoplasm was avascular. A dead premature baby girl was born at 35th week. The cause of intrauterine fetal death was mechanical compression of the vessels of the umbilical cord by teratoma. Microscopic examination of the umbilical cord neoplasm in the area of the solid component demonstrated a pronounced development of the sebaceous glands, adipose tissue, myelinic nerve fibers, hair follicles; in the cystic component – epidermoid cysts. This evidenced about organismoid mature teratomas. Due to their rare incidence umbilical teratomas should be reported to better understand their pathomorphosis and impact on infant morbidity and mortality. Given the increased risk of concomitant malformations, the detection of an umbilical teratoma should be accompanied by a detailed and comprehensive examination of the newborn for additional pathologies.

Umbilical cord constriction as a cause of intrauterine fetal death

ABSTRACT The umbilical cord constriction (UCC) is an uncommon condition and an important etiology for stillborn fetuses. The main goal of this study was to verify the UCC occurrence as the cause of intrauterine fetal death, the associated etiology and its pathological characteristics. Therefore, a descriptive retrospective cross-sectional study was developed using the database from a Pathology Institute, in Brazil, from 1995 to 2017. The results presented a total of 1,359 embryo/fetus deaths – 69 (5.07%) due to UCC, 60.9% males and 39.1% females. The average age of pregnant women was 27.5 years ± 7.2 years of standard deviation (SD). The majority of deaths occurred during the second trimester (76.5%), followed by the first (14.7%) and third (8.8%) trimesters, respectively. One constriction alone was found in 87% of cases, 11% had two constrictions and only 1% had three or more. The presence of congenital malformations was detected in 20.2% of necropsies, the identification of chronic fetal distress was described in 71% of the technical reports and 17% of the cases had obstructive vasculopathy characteristics in microscopy analysis. Regarding the anatomopathological characteristics between the male and female sexes, no significant difference was found (p > 0.05) correlating gestational age, weight or congenital malformations. UCC was a cause of fetal death found in 5% of the cases, and it was linked to congenital malformations, fetal distress and obliterative vasculopathy.

Study on Etiology and Maternal Complications of Intrauterine Fetal Death

Background : Management of pregnancy with good fetal and maternal outcome is a challenge to the obstetrician which can be achieved by screening the risk factors of Intra Uterine Fetal Death (IUFD) and thereby prevent, control and treat them by quality preconceptional and antenatal care.
 Materials and methods: This cross-sectional study, done in a tertiary care hospital during a period of two years where 100 pregnant women with history of intrauterine fetal death were included after informed written consent. Intrauterine fetal death was confirmed by Ultrasonogram. Different risk factors and maternal complications were observed. Then data was analyzed with the help of SPSS-20.
 Results: Among 100 women, maximum patients were aggregated between age group 26-35 years (45%) and next to which was 16-25 years (35%) primipara was 32% and multipara was 31%. Regarding Antenatal care (ANC) 32% patients attended two antenatal visits and 28 % patients had no antenatal visits and 18% patients completed > 5 visits. Regarding causes of IUFD, 34% due to hypertension in pregnancy, 14% mother was severely anemic, 13% mother had Diabetes Mellitus (DM) abruptio placenta was found in 15% mother, maternal gastroenteritis 05%, maternal fever 09%, cord accident 3% and in 19% cases no causes were identified. Regarding maternal complications, blood transfusion needed in 28% patients, PPH occurred in 12% patients, Sepsis 08%, caesarean section needed in 07 % cases, ARF 4%, DIC in 03% cases and maternal mortality 01%. Mean ± SD of total hospital stay was 4 ± 1.5 days.
 Conclusion: There are different risk factors of IUFD which if identified earlier,then by treating the correctable etiologies, recurrence of IUFD and its related maternal complications can be prevented or reduced.
 Chatt Maa Shi Hosp Med Coll J; Vol.18 (1); Jan 2019; Page 23-26

Why fetuses die - A retrospective observational study in a tertiary care center

Background: Late intrauterine fetal death (IUFD) and stillbirth are a cause of concern and not widely reported though it contributes a large chunk in perinatal mortality. It is a traumatic experience for the family and obstetrician. If the cause of fetal deaths can be ascertained, preventive strategies can be formulated. Objectives: This study was done to estimate the incidence and suspected causes leading to IUFD and stillbirth. Materials and Methods: The present study was conducted in the Department of Obstetrics and Gynecology of Veer Chandra Singh Garhwali Government Institute of Medical Science and Research (VCSGGIMS&R) and RI and its attached hospital. Retrospective data of all the cases of IUFD were recorded in a predesigned performa from for April 2016–March 2017. Data was compiled and analyzed statistically using simple statistical measures such as percentage and proportions. Results: The incidence of stillbirth in our study was 24.8/1000 live birth. Among all factors responsible for IUFD, hypertensive disorder of pregnancy was present in 14 (18.42%) of the patients; placental abruption was present in 10 (13.2%) cases. In 28.95% of cases, no apparent cause of IUFD could be ascertained. Conclusion: Poor socioeconomic background, illiteracy, and late seeking of antenatal care are the predisposing factors for IUFD. Many of the causes of intrauterine deaths are preventable such as placental abruption, hypertensive disorders, and diabetes which can be avoided by proper antenatal care. Early detection of high-risk pregnancy and timely referral to equipped center will help in decreasing IUFD.

Clinical analysis of 105 intrauterine fetal deaths in 17 years

Objective: To study the cause of intrauterine fetal death (IUFD) in 17 years. Methods: From June 1(st), 2000 to May 31(st), 2017, 65 621 women delivered in Peking University First Hospital. Clinical data of 105 cases of IUFD (including 82 singleton pregnancies and 23 twin pregnancies) during the 17 years were analyzed retrospectively. Results: (1) In singleton pregnancies, the leading cause of IUFD was maternal complications, including severe pre-eclampsia (36/82, 43.9%) and diabetes mellitus (6/82, 7.3%). The second reason was umbilical cord factors (13/82, 15.9%), including over-screwed umbilical cord, cord entanglement, true knot of cord. 54 women of singleton pregnancy (65.9%, 54/82) felt abnormal fetal movements (decreased or disappeared). (2) In twin pregnancies, the leading cause was complications of monochorionic twins (12/23, 52.2%). Seven woman of twin pregnancy (65.9%, 54/82) felt abnormal fetal movements. Conclusions: To reduce the occurrence of IUFD, the pregnancy complications should be managed in time and properly. Monochorionic twins should be determined as early as possible. More attention should be paid toabnormal fetal movement and the application of ultrasound.

Causes of intrauterine fetal death are changing in recent years.

To investigate, how causes of intrauterine fetal death (IUFD) have changed in recent years with the advancement of prenatal diagnosis at a single perinatal center in Japan. Medical records were retrospectively reviewed for all cases of IUFDs that occurred between 2001 and 2014. The most commonly associated causes of fetal deaths were compared between 2001-2007 and 2008-2014. The number of IUFD after 20 weeks' gestation/all deliveries in our center was 38/6878 cases (0.53%) in 2001-2007 and 35/7326 (0.48%) in 2008-2014. The leading cause of IUFD in 2001-2007 was fetal abnormalities (43.2%), the prevalence of which was only 8.6% in 2008-2014 (P<0.01). Meanwhile, the prevalence of umbilical cord abnormalities was relatively increased from 30.0% in 2001-2007 to 54.5% in 2008-2014 (P=0.06). In 2001-2007, chromosomal abnormalities were frequently observed (56% of IUFDs due to fetal abnormalities). Hyper-coiled cord (HCC) and umbilical ring constrictions were the most frequent cause of IUFD in both periods. The relatively decreased prevalence of IUFD due to velamentous cord insertion and umbilical cord entanglement, HCC and umbilical cord constriction was increased. The prevalence of IUFD due to fetal abnormalities was reduced, but IUFD associated with umbilical cord abnormalities tended to increase relatively.

INTRAUTERINE FETAL DEATHS

Objectives: The objective of the study was to identify the frequency of causesof intrauterine fetal deaths in patients presenting to a tertiary care setting. Study Design: CrossSectional Survey. Settings: Study was conducted at department of obstetrics and gynaecology,unit- ii Lahore General Hospital, postgraduate medical institute, Lahore. Duration: From April2010 to October 2010. Results: Majority of the patients of the subjects under the study wererecorded between 21-30 years of age with mean age 26.24+3.58 years. Distribution of ofcauses of intrauterine fetal death shows 42% (n=63) with no cause, 23.33% (n=35) with morethan two causes, 20.67% (n=31) with two causes and 14%(n=21) with one cause. Hypertensivedisorders 41.43%(n=62), unexplained 42%(n=63), 35.33%(n=53) were found with physicalinjuries, 17%(n=24) with congenital anomaly, antiphospholipid syndrome in 14%(n=21) whilediabetes mellitus was found in 12.67%(n=19) cases. Most of the women were found primiparityi.e. 49.33% (n=74), Multi para 2-4 in 31.33% (n=47) and only 19.34% (n=29) were found with &gt;4 grand multi para. Conclusion: The frequency of causes of intrauterine fetal death in patientspresenting to a tertiary care setting shows most of the patients with hypertensive disorders,unexplained and physical injuries while antiphospholipid syndrome and diabetes mellitus werefound the less common causes.

English

.. Objectives: The objective of the study was to identify the frequency of causes of intrauterine fetal deaths in patients presenting to a tertiary care setting. Study Design: Cross Sectional Survey. Settings: Study was conducted at department of obstetrics and gynaecology, unitii Lahore General Hospital, postgraduate medical institute, Lahore. Duration: From April 2010 to October 2010. Results: Majority of the patients of the subjects under the study were recorded between 21-30 years of age with mean age 26.24+3.58 years. Distribution of of causes of intrauterine fetal death shows 42% (n=63) with no cause, 23.33% (n=35) with more than two causes, 20.67% (n=31) with two causes and 14%(n=21) with one cause. Hypertensive disorders 41.43%(n=62), unexplained 42%(n=63), 35.33%(n=53) were found with physical injuries, 17%(n=24) with congenital anomaly, antiphospholipid syndrome in 14%(n=21) while diabetes mellitus was found in 12.67%(n=19) cases. Most of the women were found primiparity i.e. 49.33% (n=74), Multi para 2-4 in 31.33% (n=47) and only 19.34% (n=29) were found with > 4 grand multi para. Conclusion: The frequency of causes of intrauterine fetal death in patients presenting to a tertiary care setting shows most of the patients with hypertensive disorders, unexplained and physical injuries while antiphospholipid syndrome and diabetes mellitus were found the less common causes.

Novel pathological findings of placenta with fetal heart failure associated with congenital heart disease

Novel pathological findings of placenta with fetal heart failure associated with congenital heart disease

TAPS sequence – unknown and underestimated problem of monochorionic pregnancies

Monochorionic twin pregnancy is associated with an increased perinatal morbidity and mortality Placental anastomoses are typical for monochorionic pregnancies and may play a role in the development of severe complications such as twin-twin transfusion syndrome (TTTS) and recently discovered twin anemia-polycythemia sequence (TAPS). Both TTTS and TAPS are the chronic form of feto-fetal transfusion. There is a typical oligohydramnios/polyhydramnios sequence in the TTTS syndrome, whereas TAPS is characterized by large inter-twin hemoglobin difference in the absence of amniotic fluid discordances. The paper presents a case of TAPS at 20 weeks of gestation in a 35-year-old primigravida with monochorionic, diamniotic pregnancy TAPS was the cause of Intrauterine fetal death of one of the twins. In the absence of signs of fetal distress an expectant management was considered. An elective cesarean section was performed at 35 weeks of gestation due to decelerations in CTG. This paper presents a clinical case, as well as diagnostic criteria, classification, perinatal management and outcome in TAPS. The review of the literature is also included, focusing on the diagnostic differences between TAPS and TTTS, two distinct variants of feto-fetal transfusion. This case presents a twin anemia-polycythemia sequence, a rare and heterogeneous disease with a wide range of outcome. TAPS may remain undetected during pregnancy and result in the delivery of two healthy neonates with large inter-twin hemoglobin discordance. Unfortunately TAPS may also lead to intrauterine fetal demise of one or both twins, particularly in cases when it is undetected and untreated.

Human Cytomegalovirus Infection Is Detected Frequently in Stillbirths and Is Associated With Fetal Thrombotic Vasculopathy

Human cytomegalovirus (CMV) is the most common congenital infection in developed countries and is a known cause of intrauterine fetal death. We examined CMV infection in stillbirths and the relationship with histopathological findings at autopsy. We collected liver, kidney, and placenta specimens from 130 stillbirths. CMV DNA and protein were detected using polymerase chain reaction and immunohistochemistry, along with routine autopsy of stillborn infants. Overall, CMV DNA was detected in 15% of singleton, >20-week stillborn infants. CMV DNA was detected in kidney (9%), liver (11%), and placenta (5%) specimens, with 75% of infections confirmed by immunohistochemistry. Fetal thrombotic vasculopathy was the only histopathological abnormality associated with CMV infection (in 60% CMV-infected vs 28% uninfected stillbirths P = .010). Stillbirth has multiple etiologies. However, the detection of CMV DNA in 15% of fetal tissues or placentae suggests a strong association between CMV infection in pregnancy and stillbirth. Molecular testing during postmortem investigation has an important role to determine the contribution of CMV infection.

Chromosomal mosaicism in spontaneous abortions: Analysis of 650 cases

It is known that up to 50% spontaneous abortions (SA) in the first trimester of pregnancy are associated with chromosomal abnormalities. We studied mosaic forms of chromosomal abnormalities in 650 SA specimens using interphase mFISH and DNAprobes for chromosomes 1,9, 13/21, 14/22, 15, 16, 18, X, and Y. Numerical chromosomal abnormalities were discovered in 58.2% (378 cases). They contained combined chromosomal abnormalities (aneuploidy of several chromosomes or aneuploidy in combination with polyploidy in the same specimen) in 7.7% (29 cases) or 4.5% of the entire SA sample; autosomal trisomy, in 45% (18.2% in chromosome 16, 8.9% in chromosomes 14/22, 7.9% in chromosomes 13/21, 3.1% in chromosome 18, and 1.4% in chromosome 9). Chromosome X aneuploidy was found in 27% cases, among which 9.6% represented chromosome X monosomy. Polyploidy was observed in 22.9% cases. In 5.1% cases, we observed mosaic form of autosomal monosomy Among the SA cases with chromosomal abnormalities mosaicism was observed in 50.3% (approximately 25% of the entire SA sample). The results of the present study indicate that significant amount of chromosomal abnormalities in SA cells are associated with disturbances in mitotic chromosome separation, which represents the most common cause of intrauterine fetal death. It was also shown that original collection of DNA probes and the technique of interphase MFISH could be useful for detection of chromosomal mosaicism in prenatal cell specimens.

Warfarin‐induced fetal intracranial subdural hematoma

Antenatal intracranial hemorrhage is a rare cause of intrauterine fetal death, with an incidence of 4.6-5.1% in autopsy studies of stillborn fetuses. Warfarin-associated fetal bleeding is also a rare problem, with an incidence of 4.3% in the literature. We present a case of warfarin-induced subdural hematoma occurring in the second trimester.

A Placental Cause of Intra-uterine Fetal Death Depends on the Perinatal Mortality Classification System Used

Different classification systems for the cause of intra-uterine fetal death (IUFD) are used internationally. About two thirds of these deaths are reported as unexplained and placental causes are often not addressed. Differences between systems could have consequences for the validity of vital statistics, for targeting preventive strategies and for counselling parents on recurrence risks. Our objective was to compare use of the Tulip classification with other currently used classification systems for causes of IUFD. We selected the extended Wigglesworth classification, modified Aberdeen and the classifications by Hey, Hovatta, de Galan-Roosen and Morrison. We also selected the ReCoDe system for relevant conditions, comparable to contributing factors in the Tulip classification. Panel classification for 485 IUFD cases in the different systems was performed by assessors after individual investigation of structured patient information. Distribution of cases into cause of death groups for the different systems varied, most of all for the placental and unknown groups. Systems with a high percentage of cases with an unknown cause of death and death groups consisting of clinical manifestations only are not discriminatory. Our largest cause of death group was placental pathology and classification systems without placental cause of death groups or minimal subdivision of this group are not useful in modern perinatal audit as loss of information occurs. The most frequent contributing factor was growth restriction. This illustrates the vital role of the placenta in determination of optimal fetal development. In the Tulip classification, mother, fetus and placenta are addressed together. The system has a clear defined subclassification of the placenta group, a low percentage of unknown causes and is easily applied by a multidisciplinary team. A useful classification aids future research into placental causes of IUFD.