Trends in the cause of late fetal death, 1982–2000

Authors


Dr R. Bell, School of Population and Health Sciences, Epidemiology and Public Health, Medical School, University of Newcastle, Framlington Place, Newcastle, NE2 4HH, UK.

Abstract

Background  Progress in reducing late fetal deaths has slowed in recent years, despite changes in intrapartum and antepartum care.

Objectives  To describe recent trends in cause-specific fetal death rates.

Design  Retrospective cohort study.

Setting  North of England.

Population/Sample  3,386 late fetal deaths (≥28 weeks of gestation and at least 500 g), occuring between 1982 and 2000.

Methods  Data on deaths were obtained from the Northern Perinatal Mortality Survey. Data on live births were obtained from national birth registration statistics. Rate ratios (RR) and 95% confidence intervals (CI) for fetal deaths in 1991–2000 compared with 1982–1990 were calculated.

Main outcome measures  Cause-specific late fetal death rates per 10,000 total births.

Results  Mortality in singletons declined from 51.5 per 10,000 births in 1982–1990 to 42.0 in 1991–2000 (RR 0.82, 95% CI 0.76–0.87). There was a greater decline in multiples, from 197.9 to 128.0 per 10,000 (RR 0.65, 95% CI 0.51–0.83). In singletons, the largest reductions occurred in intrapartum-related deaths, and deaths due to congenital anomalies, antepartum haemorrhage and pre-eclampsia. There was little change in the rate of unexplained antepartum death occurring at term (RR 0.97, 95% CI 0.84–1.11) or preterm (RR 0.94, 95% CI 0.82–1.07), these accounting for about half of all late fetal deaths. Unexplained antepartum deaths declined in multiple births and in singletons of birthweight <1500 g.

Conclusions  While late fetal mortality due to many specific causes has declined, unexplained antepartum death rates have remained largely unchanged. Improved identification of deaths due to growth restriction and infection, which may otherwise be classified as unexplained, is important. Further investigation of the underlying aetiologies of genuinely unexplained deaths is needed.

Ancillary