Intrauterine Foetal Death: Prognosis and Prevention

Abstract

Aim. The aim of the study was improving the possibilities of predicting intrapartum fetal death by conducting a comprehensive assessment of clinical, anamnestic, biochemical and morphological risk factors.

Design. A retrospective cohort study.

Materials and methods. The data of 208 birth histories of patients for 2021-2023 whose pregnancies ended in intrapartum fetal death (155 women — the main group) and 53 histories of patients with uncomplicated pregnancy and childbirth (comparison group) were analyzed. We searched information of family, obstetric-gynecological and somatic anamnesis, the results of the first prenatal screening with an assessment of the functional activity of the trophoblast (в human chorionic gonadotropin and pregnancy-associated plasma protein A). Retrospectively, a point assessment of the degree of perinatal risk was carried out (the scale of perinatal risk factors by V.E. Radzinsky et al., 2018), according to which patients who scored up to 15 points were regarded as belonging to alow degree, from 15 to 24 points — to an average, and above 25 points — to a high degree of perinatal risk). In the postpartum period, a morphological examination of the placenta was performed with macroand microscopic analysis.

Results. In the group of women whose pregnancy was complicated by antenatal fetal death, a combination of preplacental, placental and post-placental risk factors was noted. According to the ROC-curve analysis, with a combination of socio-demographic, somatic, gynecological and gravidary factors, the value of perinatal risk exceeding 9 points increases thelikelihood of antenatal fetal death.

Conclusion. The analysis of clinical and anamnestic data followed by a comprehensive dynamic assessment of risk factors will allow not only the identification of risk groups, but also significantly objectify the prognosis of pregnancy outcomes, timing and methods of delivery.