(899) Critical analysis of risk factors for intrapartum death

This population-based cohort study included all singleton deliveries between the years 1991-2016 at a single tertiary medical center. Trends over the years, as well as risk factors for intrapartum fetal death and the effect of day of the week were examined. A generalized estimation equation (GEE) model was used to control for confounders.

Results:

During the study period 344,536 deliveries were recorded, of which 251 (0.1%) suffered intrapartum fetal death. Rates of intrapartum fetal death did not change significantly over the years (p=0.13, using the chi-square test for trends). Preterm delivery, placental abruption, uterine rupture, shoulder dystocia, congenital malformations, severe preeclampsia and fetal malpresentation were significantly more common in pregnancies complicated by intrapartum fetal death. Using a GEE model; shoulder dystocia (aOR =23.8 , 95% CI 9.9-57.3, p < 0.005), uterine rupture (aOR =19.0 95% CI 7.0-51.4, p < 0.05), preterm delivery (aOR=11.9, 95%CI 8.6-16.5, p < 0.001), placental abruption (aOR=6.2, 95% CI 4.1-9.4, p < 0.001), fetal malpresentation (aOR =3.6 , 95% CI 2.6-4.9, p< 0.005) and congenital malformations (aOR= 2.6 95% CI 1.9-3.5 , p < 0.05) were all independent risk factors for intrapartum fetal death. Weekend deliveries were not at increased risk of intrapartum fetal death.

Conclusion: Several independent risk factors were identified for intrapartum fetal death, with shoulder dystocia demonstrating the highest risk after controlling for confounders.  Unfortunately most risk factors are neither preventable nor predictable and as of today despite major progress in technology, interventions to decrease the rate of intrapartum fetal death remain elusive.