Fetal deaths: challenges for knowledge and intervention

Fetal deaths: challenges for knowledge and intervention

Márcia F. de Almeida1, Rossana P. V. Francisco2, Luciana D. M.Pastro2, Expedito J.de A. Luna3, Gerusa M.Figueiredo3, Gizelton P. Alencar1, Mara S.Hoshida2, Zilda P. da Silva1, Hillegonda M. D.Novaes4, Nelson Gouveia4

(1) University of Sao Paulo School of Public Health, (2) Department of Gynecology and Obstetrics, University of Sao Paulo Medical School (3) Department of Preventive Medicine, University of Sao Paulo Medical School, (4) University of Sao Paulo Institute of Tropical Medicine

Background
Fetal mortality is still insufficiently known, valued and studied, especially through approaches that integrate the biological, epidemiological and social dimensions. Sao Paulo is a city with 12 million inhabitants. The fetal mortality is increasing since 2012. The aim of this multidisciplinary study is to understand the multiple risk factors of fetal death.

Methods
We are carrying out a prospective case control study with 415 cases (stillbirths, ≥22 weeks of gestation) and 415 controls (randomly selected live births) in hospitals of São Paulo. Mothers will be interviewed to obtain information on socioeconomic, clinical and obstetrical history, psychosocial characteristics, health care access and pregnancy conditions. Information on prenatal care card mother’s hospital records will be abstracted. Administrators of hospitals and managers of antenatal care program will be interviewed. To mothers of fetal deaths it will be applied the Perinatal Grief Scale. Placenta, umbilical cordon mother’s blood will be collected for investigation of serum and tissue markers of angiogenesis. This material will also be analyzed to identify infectious diseases and exposure to air pollutants. Non invasive autopsy will be conducted, by imaging and histopathology guided by image as well as traditional autopsy.

Results:
Analysis will identify environmental, clinical and epidemiological risk factors for stillbirth, and investigate their interrelationships and estimate the individual contributions to fetal mortality in this setting. Innovative statistical approaches for mapping the multicausal etiology of fetal deaths will be employed such as causal models and generalized spatial structural equation models with Bayesian inference.

Conclusions:
This proposal aims to articulate the epidemiological and clinical frontiers and search for new knowledge to fill important gaps in our understanding of fetal mortality which will allow the design of effective prevention strategies.

Ethics statement
This project was approved by The São Paulo Research Foundation, FAPESP title: Fetal deaths: challenges for knowledge and intervention, responsible researcher: Nelson da Cruz Gouveia CAAE: 97966918.6.0000.0065 Institution: University of Sao Paulo Medical School

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