Trends in intrapartum fetal death, 1979-2003.
OBJECTIVE
This study was undertaken to analyze trends in intrapartum fetal death and rates of perinatal autopsy over a 25-year period in Dublin, Ireland.


METHODS
A retrospective multicenter analysis of 508,342 nonanomalous infants 500 g or more, delivering in 3 tertiary-referral university institutions between 1979-2003.


RESULTS
There has been a significant downward trend in the rate of intrapartum fetal death over the past 25 years (P < .0001). Nulliparous labors were statistically more likely to be complicated by an intrapartum fetal demise than parous labors (odds ratio, 1.49; 95% confidence interval [CI], 1.16-1.92; P = .0018). Intrapartum deaths secondary to hypoxia fell significantly over the study period (P < .0001). Infants of multiple gestations were twice as likely to die in labor as singletons (odds ratio, 2.2; 95% CI, 1.22-3.74; P = .0058). Rates of perinatal autopsy fell significantly over the 25 years studied (P < .0001).


CONCLUSIONS
There has been a significant fall in rates of intrapartum fetal death. This has primarily resulted from a reduction in deaths attributable to intrapartum hypoxia. Infants of multiple gestations still retain a significantly higher chance of intrapartum death. The fall in uptake rates of perinatal autopsy in recent years is concerning.
Walsh
Colin A
CA
Department of Obstetrics and Gynaecology, the Rotunda Hospital, Dublin, Ireland.
McMenamin
Moya B
MB
Foley
Michael E
ME
Daly
Sean F
SF
Robson
Michael S
MS
Geary
Michael P
MP
D000328:Adult; D001344:Autopsy; D002423:Cause of Death; D016001:Confidence Intervals; D005260:Female; D005313:Fetal Death / Q000453:epidemiology; D046689:Fetal Mortality / Q000639:trends*; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007494:Ireland / Q000453:epidemiology; D016017:Odds Ratio; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011272:Pregnancy, Multiple; D011336:Probability; D012189:Retrospective Studies; D012307:Risk Factors