Prise en charge de la mort in utero: quel bilan proposer? [Management of in utero foetal death: Which assessment to undertake?]


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Prise en charge de la mort in utero: quel bilan proposer? [Management of in utero foetal death: Which assessment to undertake?]
Journal de Gynécologie, Obstétrique et Biologie de la Reproduction
Martinek  I. E., Vial  Y., Hohlfeld  P.
0368-2315 (Print)
Statut éditorial
Date de publication
English Abstract
Journal Article --- Old month value: Oct
OBJECTIVE: To assess the value of para-clinical exams prescribed in case of in utero foetal death, to result in the establishment of a new algorithm of diagnostic tests. MATERIALS AND METHODS: A retrospective analysis on a series of 106 stillbirths gathered between September 1989 and December 1998 in the obstetrical and gynaecological department of the Lausanne University Hospital which is a tertiary centre. Stillbirth was defined as foetal death occurring as from the date of foetal viability. Thus, only pregnancies from 24 weeks and onwards were included in this series. We excluded all stillbirths occurring during medical termination of pregnancy and cases with incomplete data files. The Fretts' classification was used. The different exams asked by the physician were screened and we analysed their pertinence to determine the aetiological diagnosis for each case. The search for significant risk factors was also taken into account. We compared our management of in utero foetal death with data from the literature to propose a new algorithm. RESULTS: The aetiology of in utero foetal death could be attributed in ninety percent of the cases. The principal causes were in utero growth retardation (19.8%), foetal congenital and chromosomal anomalies (18.9%), infections (15.1%), placental abruption (7.5%), preeclampsia (5.6%), maternal diabetes (3.8%). The remaining 18.9% are divided in to miscellaneous causes. In 10.4% of the cases we could not find any explanation to the death of the foetus. The exams that yielded the most information when done were: foetal autopsy which was abnormal in 92.7%, placental investigation which was abnormal in 93% and the babygramme (X-ray of the foetal skeleton) which was abnormal in 53%. Maternal serology for infections was informative in 6.6% of the cases. CONCLUSION: We present here a protocol for the diagnostic management of stillbirth which is differentiated according to the circumstances surrounding the event. This should prove useful to reduce superfluous tests.
Abruptio Placentae Algorithms Chromosome Aberrations Diabetes Complications Female Fetal Death/*etiology/*therapy Fetal Growth Retardation Gestational Age Humans Infection/complications Placenta Diseases Pre-Eclampsia Pregnancy Pregnancy Complications Retrospective Studies Risk Factors
Création de la notice
25/01/2008 11:12
Dernière modification de la notice
20/08/2019 13:33
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