Maternal risk factors associated with fetal death during antenatal care in low-resource tertiary hospitals

BACKGROUND: Data on maternal characteristics that could predict antepartum fetal death in women receiving antenatal care in resource-constrained settings are limited. Aims: To identify maternal sociodemographic and clinical risk factors for antepartum fetal death among women receiving antenatal care in a developing country setting. METHODS: Case-control analyses of risk factors in the occurrence of singleton fetal death before labour at two university hospitals in south-west Nigeria over 4-5 years. A total of 46 cases and 184 controls were compared for 31 sociodemographic and clinical risk factors. Unconditional multivariate logistic regression analysis was applied to determine independent risk factors. Level of significance was set at P < 0.05. RESULTS: The incidence of antepartum fetal death among women receiving antenatal care was 10.8 per 1000 total births during the period. Significant risk factors at univariate level include proteinuria, pregnancy-induced hypertension, pre-existing hypertension, reduced weight gain per week, previous antepartum fetal death, antepartum haemorrhage, previous miscarriage, symphysiofundal height-gestational age disparity = 4 cm and perception of reduced fetal movements. The independent risk factors were proteinuria (adjusted OR 4.23, CI: 1.57-11.42), pregnancy-induced hypertension (adjusted OR 8.24, CI: 3.01-22.51) and perceived reduction in fetal movements (adjusted OR 7.17, CI: 1.57-45.76). CONCLUSIONS: The identified factors should serve as potential targets for antenatal interventions to prevent antepartum fetal death in these institutions. Awareness of these factors should stimulate appropriate risk assessment geared towards the prevention of antepartum fetal deaths by clinicians in these centres and centres in similar setting.