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ORIGINAL RESEARCH |
From the Department of Obstetrics and Gynecology, Royal Victoria Hospital and the Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada; and the Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
Address reprint requests to: Robert H. Usher, MD Royal Victoria Hospital 687 Pine Avenue West Montreal, Quebec H3A 1A1 Canada E-mail: rusher{at}is.rvh.mcgill.ca
Objective: To assess fetal, maternal, and pregnancy-related determinants of unexplained antepartum fetal death.
Methods: We conducted a hospital-based cohort study of 84,294 births weighing 500 g or more from 1961–1974 and 1978–1996. Unexplained fetal deaths were defined as fetal deaths occurring before labor without evidence of significant fetal, maternal, or placental pathology.
Results: One hundred ninety-six unexplained antepartum fetal deaths accounted for 27.2% of 721 total fetal deaths. Two thirds of the unexplained fetal deaths occurred after 35 weeks’ gestation. The following factors were independently associated with unexplained fetal death: maternal prepregnancy weight greater than 68 kg (adjusted odds ratio [OR] 2.9; 95% confidence interval [CI] 1.85, 4.68), birth weight ratio (defined as ratio of birth weight to mean weight for gestational age) between 0.75 and 0.85 (OR 2.77; 95% CI 1.48, 5.18) or over 1.15 (OR 2.36; 95% CI 1.26, 4.44), fewer than four antenatal visits in women whose fetuses died at 37 weeks or later (OR 2.21; 95% CI 1.08, 4.52), primiparity (OR 1.74; 95% CI 1.26, 2.40), parity of three or more (OR 2.01; 95% CI 1.26, 3.20), low socioeconomic status (OR 1.59; 95% CI 1.14, 2.22), cord loops (OR 1.75; 95% CI 1.04, 2.97) and, for the 1978–1996 period only, maternal age 40 years or more (OR 3.69; 95% CI 1.28, 10.58). Trimester of first antenatal visit, low maternal weight, postdate pregnancy, fetal-to-placental weight ratio, fetal sex, previous fetal death, previous abortion, cigarette smoking, and alcohol use were not significantly associated with unexplained fetal death.
Conclusion: In this study, we identified several factors associated with an increased risk of unexplained fetal death.
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