MATERNAL HEALTH-CARE PROGRAM AND MARKERS FOR LATE FETAL DEATH

Objective. To identify markers for late fetal death, a multicenter stu dy was performed, based on routinely obtained data from maternal healt h care units. Material and methods. Prospectively recorded, data were obtained from maternal health care units belonging to five delivery un its. In all, 233 consecutive cases of singleton pregnancy involving la te fetal death (greater than or equal to 28 weeks) were identified bet ween 1983 and 1989. As a control for each case, the next consecutive m other giving birth to a live infant at the same delivery unit was sele cted, the sole matching criterium being parity. Results. After exclusi on of pregnancies with lethal malformations or trauma, 205 cases remai ned for the statistical analysis. Two main subgroups were identified: mothers with placental abruption (n = 44), and pregnancies with no obv ious reason for fetal death (n = 101). An increased risk for late feta l death was evident in expectant mothers greater than or equal to 40 y ears (10 vs 1; chi(2) = 7.6, p < 0.01), and in smokers where an associ ation was seen to placental abruption. A significantly increased risk was also seen in women with medical treatment for essential hypertensi on (8 vs 1; chi(2) = 5.6, p < 0.05). On the other hand, we found no co rrelation between proteinuria, glucosuria, decreasing symphysis-fundal height, or changes in the Hb, on the one hand, and late fetal demise, on the other. There was no overrepresentation of post dated pregnancy (by ultrasound early in the second trimester) among the cases. Nor di d post dated pregnancies (greater than or equal to 42 weeks) estimated from first day of last menstrual period (but not post dated by ultras ound) imply a higher rate of fetal death, as has been suggested in pre vious studies. Conclusion. In the present material, there was no sign of systematic error in the evaluation of data routinely obtained from the antenatal clinics and maternity units. Apart from placental abrupt ion in smokers, a high maternal age, and medical treatment for essenti al hypertension, deviating data were recorded as often among controls as among cases. No correlation was evident between a post date pregnan cy and fetal demise. A short symphysis-fundal height was recorded as o ften among controls as among cases and the even distribution of fetal birthweight in case pregnancies around the standard curve for the norm al population is noteworthy.