Risk Factors Related to Intra Uterine Fetal Death in Iran, A Case-control Study

Abstract:

Intra uterine fetal death (IUFD) is a traumatic event for the family which occurs in for about 1% of all pregnancies. In comparison with other countries this rate is increasing in Iran. Statistical reports from health centers of Firoozabad estimated the rate of 2.2% per year. Although obstetrical management has improved significantly, more than 50% of these cases are still unexplained. This research was a case-control study to determine risk factors for intra uterine fetal death. A standard questionnaire was designed consisting of four major parts: Maternal, fetal, placenta and umbilical cord factors. The questionnaire was filed by using medical records, between 1998 - 2003. Samples included 450 records, including 150 cases (those who had IUFD) and 300 controls (those who had live newborn). Generally, mothers education (P = 0.000), and gestational age (P = 0.001) were found as major risk factors. Moreover, season of delivery had a statistically significant association with IUFD (P = 0.000). Maternal risk factors included), receiving prenatal care (P = 0.001), and consanguinity (P = 0.004), pregnancy complications (P = 0.06), the history of IUFD (P = 0.000), ruptured amniotic fluid (P = 0.007). Structural abnormality (P = 0.000) such as impaired neural tube (P = 0.000), fetal sex (P = 0.000) and fetal weight (P = 0.000) were major fetal risk factors. Intra uterine growth retardation (IUGR) (P = 0.000) and third trimester bleeding (P = 0.000) were the risk factor related to placenta and cord prolapse (P = 0.01) was the only umbilical risk factor for IUFD. Logistic regression analysis was further clarified the role of confounding variables. Risk factors related to mother, fetus, placenta and cord were investigated for IUFD. It is difficult to identify preventable factors of IUFD, however consultation, proper prenatal care, early diagnosis of complications and careful evaluation may reduce the incidence of IUFD. This study suggests that certain measures has to be taken by Irans health Ministry to make the women aware of the risk factors related to IUFD. Also during teaching sessions to medical students and staff, preventive medicine should be taken into consideration with emphasis on the local studies