Abstract
Intrauterine fetal death is the clinical term for the death of a baby in the uterus that happened after 18 week of gestation during pregnancy and before birth.
The incidence of intrauterine fetal death ( 18gestational weeks)in order to arrive at a potential cause of death , one of the issues in this thesis was to review the causes of (IUFD)to evaluate a certain arsenal of diagnostic procedures in cases of IUFD .This study examined 100 case of IUFD occurring among pregnant woman in Gwarinpa General Hospital Abuja 2021, the most common factors associated with intra uterine fetal death could be identified in un explained 37% bleeding 15% congenital anomalies 13% , preeclampsia 10% , placenta 8%, infection 5%, and 14% for different causes. The studies have been conducted in recent years on risk factors for fetal death. Women ≥35years higher risk of fetal death compared to women at age 20-29 years. This age associated risk is more pronounced among primiparas than among multiparas. A possible reason that could partly explain this age related risk may be higher incidence of multiple pregnancies, gestational diabetes, hypertension, pre eclampsia, and fetal malformation among older women. Social factors, such as socio economic status also has been conducted, the proportion of (IUFD) in which no identifiable cause can be determined it has been suggested that the risk factors among women delivered fetus with special cause of death. A better understanding of the causes of intra uterine fetal death (IUFD) is essential for adequate health planning and for the setting of research priorities in perinatal medicine. On individual basis, the parents over entail to an explanation as to why their baby died and a diagnosis can probably be helpful in their grieving process. Last, but not least, the cause of fetal death may be relevant to later pregnancies and make it possible to improve the outcome of such pregnancies.
Table of Content
Abstract
Chapter One: Introduction
1.1 Background
1.2 Research Problem
1.3 Research Questions
1.4 Research Objectives
1.4.1 The Main Objective
1.4.2 The Sub Objective
1.6 Organization of the Study
Chapter Two: literature Review
2.1 Introduction
2.2 Definition of Fetal Death
2.3 Fetal Death, Missed Abortion, and Intrauterine Death
2.4 Classification of Fetal Death
2. 4.1 Risk Factors and Causes
2.4.1.1 Maternal Conditions
2.2.1.2 Fetal Conditions
2.2.1.3 Obstetric Fetal Conditions
2.5 Symptoms
Chapter three; Research Methodology
3.1 Conceptual Framework
3.2 Endogenous Variables
3.2 Exogenous Variables
3.3 Intermediate Variables
3.4 Data Source
3.5 Sample Size and Sample Design
Chapter four: Analysis of Data
4.1 Introduction
4.2 Socio economic characteristics of the respondents
4:3 cross tabulation:
4.3.1 Cross Tabs between Causes of Fetal Death and Other Variables
Chapter five: Summary, Conclusion, and Recommendations
5.1 Summary
5.2 Conclusion
5.3 Recommendations
CHAPTER ONE
Introduction
1.1 Background of Study
Intrauterine fetal death and still birth is a tragic event for the parents and a great cause of stress for the caregiver, Defend as the death of fetus move than 24 weeks of gestation and weighting more than 500 grams. Intrauterine Fetal Death (IUFD) is major cause of pregnancy wastage. Who definition of still birth is fetal death in pregnancy. The gestational age at which intrauterine fetal demise is considered a still birth varies from country to country.
Stillbirth is a professional and lay term that refers to a dead-born foetus. Intrauterine death occurs either before onset of labour (antepartum death) or during labour (intrapartum death). Because of pregnancy complications or maternal diseases, foetuses may die intra utero, before onset of labour. No special reason, however, has been found for many antepartum intrauterine deaths. The main cause of death among almost all infants who were alive when labour started, but were born dead is complications arising during birth. It is therefore crucial to know at what point before birth the baby died, so that appropriate interventions can be planned accordingly. It is relatively easy to determine, in the context of childbirth care, approximately when the death occurred. The proportion of babies that die intrapartum is, therefore, a very important indicator enabling health personnel to take the most appropriate measures to prevent such deaths. Where women receive good care during childbirth, intrapartum deaths represent less than 10% of stillbirths due to unexpected severe complications.
Globally, approximately three million third-trimester stillbirths are said to occur. Past studies have revealed that stillbirth rates can vary within countries, with economically poorer communities having higher rates than their economically well-off counterparts. About 98% of these stillbirths occur in low-income and middle-income countries, with 55% occurring in rural families in sub-Saharan Africa and South Asia, where skilled attendance and caesarean sections are lower than for urban families. As at 2009, the stillbirth rate in Nigeria stood at 36 per 1000 live births.
Some countries count demise at 16 weeks as IUFD while others consider fetal demise as late as 28 weeks as IUFD, the perinatal mortality surveillance report Central for Maternal and Child Enquiries (CEMACE,2011) defines still birth as a baby delivered without sings of life after 24 completed weeks of pregnancy, IUFD demise occurring at or later than 20 weeks still birth is taken as a baby delivered without sings of life from 24 weeks gestation and IUFD is taken to defer to death in utero after 24 weeks gestation. IUFD in intra-partum fetal death together constitute a large proption of perinatal mortality. Ante-Partum fetal death contributes to about two thirds of prenatal mortality. Prevalence of IUDF has been reduced to minimum unavoidable rate in developed countries. Prevalence of perinatal deaths in a society is the direct indicator of the quality of antenatal care in the country, however it still remains very high in developed and developing countries. IUFD and still birth is expressed as number of fetal deaths per 1000 live births. Range of incidence varies in different countries, ranging from five 1000 births in high income countries, and 36 in 1000 births in development countries.
The goal of maternity care is to achieve a safe delivery of a healthy mother and baby. Delivery of a stillbirth foetus is a major source of depression to the mother, her relations and managing obstetrician. The stillbirth rate is a marker of the adequacy of obstetric care and utilization and an important source of medical litigation in some countries.
Advances in prenatal, intrapartum and neonatal care in Western countries have led to significant reduction in their perinatal mortality as well as determining causes for so many previously categorized ”unexplained stillbirth”. However, in developing countries, perinatal mortality is still very high with figures up to 2 to 4 times as high as those reported in developed countries. Stillbirths account for between 50 and 88 percent of overall perinatal mortality in the various regions of the world and it is a close reflection of the perinatal mortality rate of the community. “WHO estimates that worldwide 3.3 million stillbirths occur each year, accounting for over half of all perinatal deaths”. “The varieties of definitions make comparisons of stillbirth rates difficult. In the United Kingdom (UK), a stillbirth is defined as the delivery of a baby with no signs of life after 24 weeks of pregnancy”. The threshold for defining a stillborn in our environment is 28 weeks of gestation. However, for the purpose of statistics for international comparison, the World Health Organization (WHO) noted that inclusion of the extremely low-birth weight group will disrupts the validity of comparison and is not recommended. Stillbirth is thus defined as the “death of a foetus before the complete expulsion or extraction from its mother at term, weighing at least 1000 g and occurring after 28 completed weeks of gestation or having at least 35 cm body length, which is indicated by the fact that after such a separation, the foetus does not show any evidence of life”. Reported incidence of stillbirths from Western Countries ranged between 2.08.7/1000 deliveries, while the rates in South Africa and Nigeria were 38.4/1000 and 40.5/1000 respectively (WHO, 2010).
1.2 Research Problem:
Despite the fact that stillbirths are very real to families who experience a death, they are invisible in many societies and on the worldwide policy agenda. The global focus has remained on survival after live birth, in spite of 30 years of attention to interventions on child survival, more than 20 years of attention to safe motherhood and recent increases in attention to newborn baby survival. Stillbirths do not persist in only low-income countries. There has only been a one percent decrease per annum for the past 15 years in the United Kingdom and the United States and two-thirds of all perinatal deaths in the United Kingdom are due to stillbirths. Stillbirths exceed deaths from sudden infant death syndrome by a factor of 10 in high-income countries; however, they receive less attention in programmes and funding for research. In least developed African countries, such as Malawi and Zambia, stillbirth rates of between 40 per 1000 live births and 50 per 1000 live births are common. Among middle-income and lesser-developed countries in Latin America, stillbirth rates generally range between 15 and 25 per 1000 live births. Stillbirth rates among Middle Eastern countries range between 10 and 20 per 1000 live births. In many developing countries, stillbirth rates have remained steady or declined slightly over the last decades. Although three million still births occur annually worldwide, almost as high as postnatal deaths, they have not been addressed as much. The developing countries in Asian and Africa constitute 70% the worlds still birth burden. Lake of prenatal care, inaccessible or limited heath care facility is the major factor responsible for high perinatal deaths in the regions.
Many times these mortalities are due to preventable causes. Multitudes of factors are recognized as the causes of IUDF and still birth. Despite the method of categorizing the causative factors, majority of the intrauterine deaths remain unexplained. Parents need to have closure with tragedy and alley their fear regarding future pregnancies.
1.3 Research Questions:
1. What is the management of IUFD among patients in Gwarinpa General Hospital Abuja?
2. What are the types of stillbirth that occur among patients in Gwarinpa General Hospital Abuja?
3. What are the risk factors associated with IUFD among patients in Gwarinpa General Hospital Abuja?
1.4 Research Objectives:
1.4.1 Main Objectives:
The main objective is to determine the Management of intrauterine death and focus mind on existing data to the topic.
1.4.2 Sub Objectives:
1. To ascertain the prevalence of IUFD among patients in Gwarinpa General Hospital Abuja.
2. To identify the types of stillbirth that occur among patients in Gwarinpa General Hospital Abuja.
3. To ascertain the risk factors associated with IUFD among patients in Gwarinpa General Hospital Abuja.
1.5 Justification
Every intrauterine is a disaster and a potential life injury. It represents a devastating pregnancy outcome and there is a need for increased efforts to identify the causes and to implement preventive measures. Despite efforts to identify the factors contributing to fetal death, a substantial portion of fetal deaths are still classified as unexplained intrauterine fetal demise. This proportion of unexplained deaths has remained fairly constant over the decades. These deaths are therefore difficult to prevent because the determinants have not been adequately identified. Even in cases in which a cause of death can be determined, the lack of uniformity in data collection and classification of factors of fetal death have made comparisons and accurate reporting difficult. In addition, knowledge of the relative importance of the different factors of intrauterine and neonatal deaths in developing countries is still lacking.
intrauterine represent a devastating pregnancy outcome and there is a need for increased efforts to identify the factors and to implement preventive measures. Knowledge of the relative importance of the different factors of intrauterine in Nigeria is still lacking. A detailed study of the factors of stillbirths in Gwarinpa Hospital, with a view to identifying possible interventions within the available resources is essential. Therefore, the study conducted to determine socio- demographic, maternal, fetal factors influencing occurrence of stillbirths in a public teaching hospital.
1.6 Organization of the Study:
This study is divided into fiv chapters, Chapter one consist of introduction research problem, objectives and organization of the research, chapter two review the literature, Chapter three methodology chapter four; data analysis display the result and interpretation and chapter five summary, conclusion and recommendations.
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