Analysis of the causes of fetal death in a high risk population in the National Institue of Perinatology, Mexico City.

Analysis of the causes of fetal death in a high risk population in the National Institue of Perinatology, Mexico City.

Aguinaga M, Valdespino Y, Medina D, Sevilla R, Monroy I, Pérez J, Helguera C, Miranda O, Espino S, Cardona JA.

1Genetics and Genomics; Pathology; Inmunobiochemical; Obstetrics; Clinical investigation, General Director. Instituto Nacional de Perinatología, Mexico City.

Background:
The National Institute of Perinatology (INPer) is a third-level hospital in Mexico City which attends high risk pregnancies. The number of fetal deaths during 2016, 2017 and 2018 was 3.2%, 2.7% and 1.9%, respectively. The purpose of this study was to determine the causes of fetal death using the ICD-PM classification system from 22 weeks of gestation in a period from January 2016 to October 2018.

Methods:
All stillbirths were examined by a pathologist and a medical geneticist. Stillbirth was defined as a fetal death occurring after 22 weeks of gestation. A complete maternal clinical history was performed. At birth, gestational age, birth weight and length, presence of congenital anomalies, macroscopic and microscopic findings in the placenta, autopsy, and cytogenetics studies were recorded.

Results:
During the study period, 297 babies presented with fetal death of which 55.2% were antepartum and 44.8% intrapartum. Antepartum deaths presented more frequently at two gestational ages: 24 to 27 weeks and from 32 to 36 weeks. The majority of antepartum deaths were A1M5: Congenital abnormalities with no maternal condition and A3M4: Antepartum hipoxia and maternal medical and surgical conditions. 78.7% of intrapartum deaths presented from 22 to 27 weeks of gestation. The most common causes were I3M1: Acute intrapartum event and complications of placenta, cord and membranes and I3M2: Acute intrapartum event and maternal complications of pregnancy.

Conclusion:
Fetal and maternal diseases are the most common cause of antepartum death. Intrapartum deaths are most commonly due to prematurity because of obstetrical complications of pregnancy.

Ethics statement:
All patients gave their consent to participate in the study.

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