factors of stillbirth, a substantial part of fetal deaths is still la-beled as unexplained intrauterine fetal death . The purposeof counting perinatal mortality is ultimately to understand con-tributing factors and trends, and to seek ways of avoiding recur-rence. However, the high proportion of unexplained stillbirths isnot helpful to this endeavor. The present study is an effort tocompile a profile of maternal and fetal characteristics, culminat-ing to intrauterine fetal death in Saudi population, a unique op-portunity to study the effect of steadily improving health careand awareness in a conservative society. The effects of earlymarriage, large family, reluctance to terminate pregnancy andunacceptability of necropsy may provide interesting compari-sons with studies carried out elsewhere.
Materials and Methods
A four-year retrospective study of intrauterine fetal deaths,managed at King Khalid University Hospital, Riyadh, was car-ried-out. Data was collected by reviewing the medical recordsof all intrauterine fetal deaths occurring after 24 weeks of gesta-tion, during the period from 1
January 2000 through 31
De-cember 2003. A still birth was defined as a product of concep-tion weighing
500gram or with a gestational age of >22 weekswithout any evidence of life at birth. Four cases were omittedfrom the study because the fetus weighed less than 500 gramsat delivery. Information was retrieved regarding the mother’sethnic origin, booking status, age and parity. Past obstetricalhistory was noted with reference to previous complications e.g.stillbirths, early neonatal deaths, congenitally abnormal babies,abortions, operative deliveries, gestational diabetes etc.Gestational age was calculated from the dates given by thepatient and confirmed by an ultra-sonogram. Complications inpresent pregnancy, duration and methods of induction, if anywere note. Postpartum complications were also recorded. Thebabies were examined thoroughly after delivery by a Pediatri-cian. They were weighed, measured and an X-ray was takenfor any skeletal anomaly. Blood sample was taken for TORCHand in some cases biopsies were obtained for chromosomalanalysis. Necropsy was not done in any case of this study.Placentae were sent for histologic examination.
One hundred and three cases of still births were recordedamong 16882 total deliveries managed at the King Khalid Uni-versity Hospital, Riyadh, in a four-year study period. The still-birth rate was 6.1 per 1000 total births. Singleton fetuses were92 and 11 fetuses from twin pregnancies. Antepartum fetaldeaths were 87 (84.5%) while intrapartum fetal deaths were 16(15.5%). There were 52 male, 49 female and two fetuses withambiguous genitalia. The Saudi population accounted for 80(77.6%), Asians 14 (13.6%) and Africans 9 (8.7%) cases of in-trauterine fetal death. Most of the patients (80%) were beingfollowed in the hospital for antenatal care, while 14% presentedas unbooked emergencies and 6% were referred from other hospitals.The maternal age ranged between 17 to 41 years, with a meanage of 27.6 years. The majority (85.2%) of the mothers werebetween the ages of 20 to 35 years. Very young mothers i.e.below 20 years of age were 2.94%, while those above 35 yearswere 11.76%. Nulliparous patients were 22 (21.56%) and para1-4 were 53 (51.96%), while grandmultiparae accounted 27(26.47%). The mean parity in our series was 2.96. Gestationalage in our series ranged from 24 to 43 weeks. The mean gesta-tional age was 33 week. There were 12 cases (11.6%) below28-week gestation and 8 cases were 41-week or above (7.7%).Among fifty-two fetuses weighing less than 1500gm, thirty-threefetuses (32%) were appropriate for gestational age, 18 (17.5%)were small for gestational age and one (0.97%) was large for gestational age. In the second group of forty nine fetuses weigh-ing between 1500 - 3999gm, 37 (35.9%) were considered ap-propriate to gestational age, nine (8.7%) were small for gesta-tional age and 3 (2.9%) were considered large for gestationalage. Two fetuses (1.9%) weighing
4000gm were large for ges-tational age. The two smallest fetuses weighed 550gm whereasthe heaviest one was 5020 gm.
Complications in present pregnancy
Sixteen patients in our study were on insulin at some stage of their pregnancy and eight were controlled on diet alone. Fivepatients were known hypertensive and received anti-hypertensi-ve drugs. Six patients developed pre-eclampsia and another sixmothers had antepartum haemorrhage in the second and/or third trimester prior to onset of labour. Intrauterine growth retar-dation was diagnosed antenatally in four cases. Ten cases of polyhydramnios were noted clinically and confirmed by ultra-sound. Iron deficiency anaemia was diagnosed in five motherswhile there was one case of sickle cell trait.
Past obstetrical complications
Previous stillbirth was recorded in seven (6.79%) cases whilesix (5.82%) had an early neonatal death. Seven (6.79%) moth-ers had at least one congenitally abnormal baby. Two mothershad a previous growth retarded baby. Three mothers had beentreated for infertility. Seventeen mothers (16.5%) had history of two or more abortions. Sixteen (15.5%) patients had a history of caesarean sections.
Onset of labour was spontaneous in sixty five (63.1%) caseswhile thirty eight (36.9%) patients needed induction. Only fivecases of spontaneous labour required augmentation. The meanduration of labour in spontaneous deliveries was 7 hours and 24minutes while in induced labour it was 6 hours and 29 minutes.Prostaglandin vaginal pessaries were used in twenty five(24.3%) cases, intramuscular prostaglandin in three (2.9%),extra-amniotic prostaglandin in two (1.9%) and syntocinon infus-ion in three (2.9%) patients. A combination of Prostaglandin va-ginal pessaries and Syntocinon infusion was used for induction