Factors associated with intrauterine fetal death as seen at Kenyatta National Hospital, Nairobi

Abstract

Background: Fetal death in utero (stillbirth) is demise at 20 or more weeks of gestation and/or weight 500gms and more. Worldwide, fetal death rates vary considerably depending on quality of medical care available in the country in question. The local cut-off gestation is 28 weeks since the chances of survival below this gestational age are very minimal. There are gender and racial differences in perinatal mortality rates. Fetal death at any point during gestation is a traumatic event not only to the family but also to the caregiver. Although overall perinatal mortality rates have fallen considerably in the past several decades in the developed world, it remains significantly high in the third world. Despite improvement in antenatal and intrapartum care, stillbirth remains an important problem in obstetrics. Although several conditions have been linked to stillbirth, it is difficult to define theprecise aetiology in many cases. The proportion of stillbirths that have a diagnostic explanation is higher in centres that conduct a defined systematic evaluation. Objective: To determine factors associated with intrauterine fetal death at Kenyatta National Hospital labor ward. Study design: This is a cross-sectional descriptive study. Mothers with intrauterine fetal demise wereidentified before, during labor and delivery. Their outcome was noted and the mothers followed up prospectively until discharge. Study site: Labor ward, maternity theatre, antenatal/postnatal wards of Kenyatta National Hospital. This hospital is the national referral hospital and largest hospital in East and Central Africawith a capacity of about 2,000 beds. In the year 2010, a total of 10744 deliveries occurred atKNH, 557 (5.2%) of which were stillbirths. Study population: A total of 90 women with intrauterine fetal death were enrolled and followed upduring labor/delivery and postpartum period until the time of discharge. 9 Methods: A descriptive review of 90 cases of mothers with intrauterine fetal death between 1st February and is" April was done. Structured questionnaires were used for collecting data of maternal demographic characteristics, past medical and obstetric history, index pregnancy antepartum, intrapartum and postpartum events, fetal, placental and cord assessment. Once recruited the women were followed up until discharge. The placentae were submitted for histopathological evaluation with the patients consent. Results: 112 women had IUFD during the study period giving a prevalence of 5.1% and a stillbirth rate of 51 per 1000 total births. 90 cases (the calculated sample size) were recruited, theirdata collected and analysed.Hypertensive disorders were the commonest obstetric complications in these mothers (26.7%), followed by antepartum hemorrhage (25.6%), anemia(11.1%), PROM(11.1 %) and urinary tract infections(11.1 %). 10% of the mothers were sero-reactive, 6.7% had congenital fetal anomalies, 2.2% had a febrile illness while 2.2% had posttermgestation. Antepartum hemorrhage was the commonest cause of intrapartum deaths (34.3%). Majority(64.4%) of the placenta had detectable histopathological findings while 35.6% showed normalplacenta, cord and membranes. The commonest pathological findings encountered were infections (chorioamnionitis with or without funisitis)(21.1 %), acute ischaemic necrosis(20.0%), placentalhemorrhage and hematoma(13.3%) and placental calcification (7.8%). 90% of the mothers had no postpartum complications during the time of follow-up. The postpartum complications encountered were not directly related to the IUFD but to the obstetrics andmedical co-morbidities that contributed to the fetal demise. Conclusions: Hypertensive disorders and antepartum hemorrhage (APH) are the leading causes ofintrauterine fetal demise at KNH. 65% of the placenta evaluated had detectable histopathological findings. Women who delivered by caesarean section had more postpartum complications and prolonged hospital stays.