Main Article Content
Objective: To establish the prevalence, etiology, demographic, socioeconomic, and obstetric risks factors of intrauterine fetal deaths among term pregnancies with no risk factors. Our study is the first to investigate term stillbirth risk factors in such a large population.
Material and Methods: A total of 96 cases of stillbirth between 37th and 42nd weeks with no risk factors out of 90,557 births conducted in 2011-2015 were investigated retrospectively. Eighty patients that had stillbirth in our clinic were chosen as the study cases and 80 others that had risk-free live birth at the weeks of 37-42 chosen randomly accepted as the control group. Variables such as age of mothers, gravidas, parities, level of education of mothers, time since the previous pregnancy, BMIs, weight gained during pregnancy, gestational week, birth weights of infants, systolic and diastolic blood pressures, hemoglobin values, blood glucose levels, white blood cell counts, smoking history, follow-ups at the hospital, gender of babies, and seasonal distribution of stillbirths were evaluated.
Results: The stillbirth rate was found as 14 per million and stillbirth in risk-free population at 37-42 weeks was 1.05 per mill. BMI, hemoglobin levels, and systolic blood pressures of mothers were significantly higher in stillbirths. Any statistically significant difference in mean maternal age, gravida/parity, education level, weight gained during pregnancy, smoking and fetal gender distribution was not established between the groups
Conclusion: Term stillbirths in the risk-free group may be correlated with advanced gestational week, increased BMI, systolic blood pressure, and hemoglobin levels of the mother also insufficient antenatal follow-up.
2. Stanton C, Lawn JE, Rahman H, Wilczynska-Ketende K, Hill K. Stillbirth rates: delivering estimates in 190 countries. The Lancet. 2006 May 6;367(9521):1487-94.
3. Lawn JE, Blencowe H, Waiswa P, Amouzou A, Mathers C, Hogan D, Flenady V, Frøen JF, Qureshi ZU, Calderwood C, Shiekh S. Stillbirths: rates, risk factors, and acceleration towards 2030. The Lancet. 2016 Feb 6;387(10018):587-603.
4. Sims MA, Collins KA. Fetal death: a 10-year retrospective study. The American journal of forensic medicine and pathology. 2001 Sep 1;22(3):261-5.
5. Cunningham FG, MacDonald PC, Gant NF, Leveno KJ, Gilstrap LC, Hankins GD. Williams obstetrics 20th edition. Stamford, CT: Appleton and Lange. 1997.
6. Morrison I, Olsen J. Weight-specific stillbirths and associated causes of death: an analysis of 765 stillbirths. American journal of obstetrics and gynecology. 1985 Aug 15;152(8):975-80.
7. Fretts RC, Boyd ME, Usher RH, Usher HA. The changing pattern of fetal death, 1961-1988. Obstetrics and gynecology. 1992 Jan;79(1):35-9.
8. Pitkin RM. Fetal death: diagnosis and management. American journal of obstetrics and gynecology. 1987 Sep 1;157(3):583-9.
9. Özcan a, Mehmet k, Kopuz ay, Turan v, Özeren m. Intrauterin ölü doğum olgularinda önlenebilir risk faktörlerinin belirlenmesi. Bozok Tıp Dergisi. 2015;5(1):32-6.
10. Jacobsson B, Ladfors L, Milsom I. Advanced maternal age and adverse perinatal outcome. Obstetrics & Gynecology. 2004;104(4):727-33.
11. Huang L, Sauve R, Birkett N, Fergusson D, van Walraven C. Maternal age and risk of stillbirth: a systematic review. Canadian Medical Association Journal. 2008;178(2):165-72.
12. Gordon A, Raynes-Greenow C, McGeechan K, Morris J, Jeffery H. Risk factors for antepartum stillbirth and the influence of maternal age in New South Wales Australia: A population based study. BMC pregnancy and childbirth. 2013;13(1):1.
13. Penn N, Oteng-Ntim E, Oakley LL, Doyle P. Ethnic variation in stillbirth risk and the role of maternal obesity: analysis of routine data from a London maternity unit. BMC pregnancy and childbirth. 2014;14(1):1.
14. Group SCRNW. Association between stillbirth and risk factors known at pregnancy confirmation. JAMA: the journal of the American Medical Association. 2011;306(22).
15. Addo V. Body mass index, weight gain during pregnancy and obstetric outcomes. Ghana medical journal. 2010;44(2).
16. Whiteman VE, Crisan L, McIntosh C, Alio A, Duan J, Marty PJ, et al. Interpregnancy body mass index changes and risk of stillbirth. Gynecologic and obstetric investigation. 2011;72(3):192-5.
17. Smith GC. Sex, birth weight, and the risk of stillbirth in Scotland, 1980–1996. American journal of epidemiology. 2000 Mar 15;151(6):614-9.
18. Mondal D, Galloway TS, Bailey TC, Mathews F. Elevated risk of stillbirth in males: systematic review and meta-analysis of more than 30 million births. BMC medicine. 2014;12(1):1.
19. Bukowski R, Hansen NI, Willinger M, Reddy UM, Parker CB, Pinar H, et al. Fetal growth and risk of stillbirth: a population-based case–control study. PLoS Med. 2014;11(4):e1001633.
20. Cnattingius S, Haglund B, Kramer MS. Differences in late fetal death rates in association with determinants of small for gestational age fetuses: population based cohort study. Bmj. 1998;316(7143):1483.
21. Nakamura MU, Alexandre SM, Santos JFKd, Souza Ed, Sass N, Beck APA, et al. Obstetric and perinatal effects of active and/or passive smoking during pregnancy. Sao Paulo Medical Journal. 2004;122(3):94-8.
22. Aliyu MH, Wilson RE, Alio AP, Kristensen S, Marty PJ, Whiteman VE, et al. Association between tobacco use in pregnancy and placenta-associated syndromes: a population-based study. Archives of gynecology and obstetrics. 2011;283(4):729-34.
23. Marufu TC, Ahankari A, Coleman T, Lewis S. Maternal smoking and the risk of still birth: systematic review and meta-analysis. BMC public health. 2015;15(1):1.
24. Health UDo, Services H. The health consequences of smoking: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. 2004;62.
25. Mihaila C, Schramm J, Strathmann FG, Lee DL, Gelein RM, Luebke AE, et al. Identifying a window of vulnerability during fetal development in a maternal iron restriction model. PLoS One. 2011;6(3):e17483.
26. Abeysena C, Jayawardana P, SENEVIRATNE DA. Maternal hemoglobin level at booking visit and its effect on adverse pregnancy outcome. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2010;50(5):423-7.
27. Stephansson O, Dickman PW, Johansson A, Cnattingius S. Maternal hemoglobin concentration during pregnancy and risk of stillbirth. Jama. 2000;284(20):2611-7.
28. Seyom E, Abera M, Tesfaye M, Fentahun N. Maternal and fetal outcome of pregnancy related hypertension in Mettu Karl Referral Hospital, Ethiopia. Journal of ovarian research. 2015;8(1):1.
29. Nicholson J, Kellar L, Ahmad S, Abid A, Woloski J, Hewamudalige N, et al. USA Term Stillbirth Rates and the 39-Week Rule: a cause for concern? American Journal of Obstetrics and Gynecology. 2016.