[Study of 178 ante partum deaths in 2001-2004 in the southern part of Reunion Island].
BACKGROUND
The perinatal mortality rate is 18.5 in the southern part of the Reunion Island (Indian Ocean), of which 2/3 are due to antepartum fetal deaths (APFD).


METHODS
During a 4-year period (2001-2004) all APFD from 22 weeks gestation were recorded and analyzed with placental histology, bacteriological samples and autopsies in 27% of cases. The Australasian and New-Zealand classification PSANZ-PDC (2000) was used. Risk factors of fetal death with monofetal pregnancies are determined in comparison with live births.


RESULTS
Out of 21.495 total births, 178 APFD were recorded. The main obstetrical risk factors were primiparity (OR 1.6, p = 0.002), maternal age over 34 years (OR 1.6, p = 0.01), hypertensive disorders of pregnancy (OR 3.0, p < .001) and multiple births (OR 2.5, p < 0.001). The great majority of APFD (76%) involved preterm fetuses, of which 61% of very preterm (<33 weeks), and 25% of fetuses were growth retarded (OR 3.9, p < 0.001). Only 8% of cases were considered unexplained. The main etiologies were infectious causes in 26% of cases, vascular fetal growth restriction (18%), specific perinatal conditions (14%) of which one-third were due to cord anomalies, preeclampsia (10%), maternal conditions (8%), congenital anomalies (8%) and ante-partum hemorrhage (7%). We discuss the interests and the limitations of using the Australian and New-Zealand classification PSANZ 2000. Intra-uterine growth retardation is one of the principal risk factors of fetal death.


CONCLUSIONS
Besides well-known obstetrical risk factors such as diabetes, hypertension, multiple pregnancies, all screening of intra-uterine growth retardation in the second trimester of pregnancy should include a special survey in order to minimize the incidence of APFDs.
Randrianaivo
H
H
Service de Gynécologie et Obstétrique, Groupe Hospitalier Sud Réunion, BP 350, 97448 Saint-Pierre Cedex, La Réunion. h.randrianaivo@ch-sudreunion.fr
Robillard
P-Y
PY
Barau
G
G
Gérardin
P
P
Heisert
M
M
Kauffmann
E
E
Laffite
A
A
Fourmaintraux
A
A
D000328:Adult; D002423:Cause of Death; D005260:Female; D005313:Fetal Death / Q000453:epidemiology*; D006801:Humans; D011247:Pregnancy; D017508:Reunion / Q000453:epidemiology; D012307:Risk Factors