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Critical analysis of risk factors for intrapartum fetal death

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Intrapartum fetal death is devastating for both parents and medical caregivers. The purpose of this study was to evaluate the risk factors for intrapartum fetal death, which often influence management in subsequent pregnancies.

Methods

This population-based cohort study included all singleton deliveries between the years 1991–2016 at Soroka University Medical Center. Trends over the years, risk factors for intrapartum fetal death and the effect of day of the week were examined. A generalized estimation equation (GEE) model was used to control for confounders.

Results

During the study period 344,536 deliveries were recorded, of which 251 (0.1%) suffered intrapartum fetal death. Rates did not change significantly over the years (p = 0.130, using the chi-square test for trends). Preterm delivery, placental abruption, uterine rupture, shoulder dystocia, congenital malformations, severe preeclampsia and fetal malpresentation were significantly more common in pregnancies complicated by intrapartum death. Using a GEE model; shoulder dystocia (aOR 23.8, 95% CI 9.9–57.3, p < 0.005), uterine rupture (aOR 19.0, 95% CI 7.0–51.4, p < 0.05), preterm delivery (aOR 11.9, 95% CI 8.6–16.5, p < 0.001), placental abruption (aOR 6.2, 95% CI 4.1–9.4, p < 0.001), fetal malpresentation (aOR 3.6, 95% CI 2.6–4.9, p < 0.005) and congenital malformations (aOR 2.6, 95% CI 1.9–3.5, p < 0.05) were all independent risk factors for intrapartum fetal death. Weekend deliveries were not at increased risk of intrapartum fetal death.

Conclusion

Several risk factors were identified for intrapartum fetal death, with shoulder dystocia demonstrating the highest risk. Unfortunately most factors are neither preventable nor predictable and interventions to decrease the rate of intrapartum fetal death remain elusive.

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Funding

The authors declare that no funds, grants or other support were received during the preparation of this manuscript. The authors have no relevant financial or non-financial interests to disclose.

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Author notes

  1. Eitan Levitas is an equal contributor and should be considered a second first author.

Authors and Affiliations

  1. Department of Obstetric and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev, POB151, 8410100, Beer Sheva, Israel

    Sharon Davidesko, Eitan Levitas, Eyal Sheiner & Gali Pariente

  2. Department of Epidemiology and Health Sciences Evaluation, Ben Gurion University of the Negev, Beer Sheva, Israel

    Tamar Wainstock

Authors
  1. Sharon Davidesko
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  2. Eitan Levitas
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  3. Eyal Sheiner
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  4. Tamar Wainstock
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  5. Gali Pariente
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Contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by EL, ES and GP. Data analysis was performed by TW. The first draft of the manuscript and all subsequent editions were written by SD and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. LE: Data collection and management. DS: Manuscript writing/editing. SE: Protocol/project development. WT: Data analysis. PG: Protocol/project development.

Corresponding author

Correspondence to Sharon Davidesko.

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Conflict of interest

The authors conclude that they can report no conflicts of interest.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the ethics committee of Soroka University Medical Center (IRB 0358-19-SOR, 2019).

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Davidesko, S., Levitas, E., Sheiner, E. et al. Critical analysis of risk factors for intrapartum fetal death. Arch Gynecol Obstet 308, 1239–1245 (2023). https://doi.org/10.1007/s00404-022-06811-x

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  • DOI: https://doi.org/10.1007/s00404-022-06811-x

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