Epidemiological study on intrauterine fetal death: analysis of 113 cases

Stillbirth rates in high-income countries have shown little reduction over the past two decades, despite the global efforts to improve maternal health and perinatal care. In order to evaluate the trend of the incidence of the intrauterine fetal death (IUFD) in our University Hospital (A. Gemelli, Rome), a retrospective case-control study was carried out: all cases of IUFD who occurred at our Department in the period 01/01/2005- 31/12/2010, were included. The inclusion criteria were: - gestational age ≥ 22 weeks - no sign of life at birth (Apgar score= 0 at 1’ and 5’). The study population, on which the inferential and descriptive statistical analysis were conducted, consisted of 113 stillbirths and of 325 control newborns, alive and well. The association to IUFD was evaluated for some of the major risk factors: the maternal smoking (aOR= 4.56 [95% CI 1.53 – 13.56]), maternal age over 40 years (adjusted odds ratio: aOR= 4.33 [95% CI 1.45 – 12.97]) and the presence of maternal diseases (aOR 4.5 [95%CI 1.46 – 13.89]) are associated with a higher probability of intrauterine death, as well as the birth weight less than 2.000 grams (aOR=3.98 [95% CI 1.31 – 12.09]). In contrast, the Italian nationality (meaning a better socioeconomic status and not ethnicity) seems to be a protective factor against the IUFD outcome (0.23 [95% CI 0.06 – 0.91]). The causes of death were ranked following Re.Co.De. Classification. A cause of death is been indentified in all 113 stillbirths, but it was difficult to define the precise etiology without the fundamental support of the histopathological examinations of placenta and fetal adnexa.