Diverse placental pathologies as the main causes of fetal death.
OBJECTIVE
To estimate the occurrence of placental causes of fetal death in relation to different gestational ages and their clinical manifestations during pregnancy.


METHODS
In a prospective cohort study conducted from 2002 to 2006, we studied 750 couples with singleton intrauterine fetal death after 20 weeks of gestation. Cause of death was classified according to the Dutch Tulip cause of death classification for perinatal mortality. Differences between groups for categorical data were evaluated by the Fisher exact test or chi test.


RESULTS
The main causes were placental pathology (64.9%), congenital anomaly (5.3%), infection (1.9%), other (4.8%), and unknown (23.1%). The contribution of causes differed over gestational age periods. At lower gestational age, placental and unknown were the most dominant causes of death (34.8% and 41.7%, respectively); at higher gestational age, the relative importance of an unknown cause decreased and a placental cause increased (16.5% and 77.6%) (P<.001). Placental bed pathology was observed in 33.6% of all fetal deaths, with the highest occurrence between 24 0/7 and 31 6/7 weeks and a strong decline after 32 weeks. In contrast, contribution of developmental placental pathology (17.6%) increased after 32 weeks of gestation (P<.001), as did umbilical cord complications (5.2%) and combined placental pathology (5.4%). Solitary placental parenchyma pathology was less frequent (3.1%). Hypertension-related disease was observed in 16.1% (95% confidence interval [CI] 13.6-19.0) of the cohort, small for gestational age fetuses in 37.9% (95% CI 34.1-41.7), and diabetes-related disease in 4.1% (95% CI 2.8-5.8).


CONCLUSIONS
Most fetal deaths were caused by a variety of placental pathologies. These were related to gestational age, and their clinical manifestations varied during pregnancy.


METHODS
II.
Korteweg
Fleurisca J
FJ
From the Departments of Obstetrics; Hematology, Division of Homeostasis, Thrombosis and Rheology; Trial Coordination Centre, Department of Epidemiology; and Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Erwich
Jan Jaap H M
JJHM
Holm
Jozien P
JP
Ravisé
Joke M
JM
van der Meer
Jan
J
Veeger
Nic J G M
NJGM
Timmer
Albertus
A
D000293:Adolescent; D000328:Adult; D000013:Congenital Abnormalities / Q000503:physiopathology; D005260:Female; D005313:Fetal Death / Q000503:physiopathology*; D005865:Gestational Age; D006801:Humans; D008875:Middle Aged; D010922:Placenta Diseases / Q000473:pathology* / Q000503:physiopathology*; D011247:Pregnancy; D011446:Prospective Studies; D055815:Young Adult