Factors associated to fetal death in Cuiabá, Mato Grosso

a population based case-control study in a ratio of 1:3 (300:900), was based on secondary data on Live Births and Mortality Information Systems. A hierarchical logistic regression was used.

Results:

remains independently associated to fetal death: low maternal schooling (OR=1.58, CI95%=1.02;2.47), low weight (OR=5.59, CI95%=3.22;9.70) gestational age <37 weeks (OR=9.34, CI95%=5.38;16.21), previous fetal death (OR=6.65, CI95%=4.35;10.15). The type of cesarean delivery remained as a protective factor (OR=0.35, CI95%=0.24;0.54). The main causes of fetal deaths were by unspecified cause (15.4%), followed by maternal hypertensive disorders (14.7%). The fetal mortality rate (TMF) decreased from 10.0 in 2006 to 7.5 deaths per thousand births in 2010 (decreased 24.5%). The TMF during the study period was below the goal set for 2030 by the World Health Organization.

Conclusions:

approximately one third of fetal deaths causes were potentially avoidable. Factors such as low maternal schooling, low birth weight, prematurity and previous fetal death history constitute as main determinants for fetal deaths in Cuiaba and suggests that socioeconomic situation still determines quality care for pregnant women and that actions should be directed to improve prenatal care.

Key words:
Fetal death; Risk factors; Health Information Systems; Fetal mortality

Variables	N	%	Incompleteness (%)
Maternal age (years) n=385			4.2
< 20	80	20.8
20-34	260	67.5
≥ 35	45	11.7
Schooling (years) n=354			11.9
< 8	126	35.6
>8	228	64.4
Type of pregnancy n=400			0.5
Singleton	384	96.0
Multiple 96.0	16	4.0
Type of delivery n=396			1.5
Vaginal	275	69.4
Cesarean	121	30.6
Duration of pregnancy (weeks) n=396			1.5
< 37	294	74.2
37-41	95	24.0
≥ 42	07	1.8
Place of occurrence n=399			0.7
Hospital	392	98.2
Other	07	1.8
Gender n=401			0.2
Males	227	56.6
Females	174	43.4
Birth weight (grams) n=391			2.7
< 2500	285	72.9
≥ 2500	106	27.1
Death related to birth n=401			0.2
Before	390	97.3
During	11	2.7

The Basic Cause (CID-10)	N	%
Cause of fetal death not specified (P95)	62	15.4
Fetus and newborn affected by maternal hypertension disorders (P00.0)	59	147
Fetus and newborn affected by other forms of placenta abruption and bleeding (P02.1)	48	11.9
Intrauterine hypoxia not specified (P20.9)	33	8.2
Fetus and newborn affected by premature rupture of the membranes (P01.1)	28	7.0
Intrauterine hypoxia diagnosed before the beginning of labor (P20.0)	27	6.7
Fetus and newborn affected by other morphological abnormalities and functional of the placenta and the not specified (P02.2)	17	4.2
Fetus and newborn affected by other compression of umbilical cord (P02.5)	14	3.5
Fetus and newborn affected by maternal kidney and the urinary tract diseases (P00.1)	11	2.7
Fetus and newborn affected by oligohydramnios (P01.2)	10	2.5
Fetus and newborn affected by the mother's infectious and parasitic diseases (P00.2)	08	2.0
Fetus and newborn affected by maternal trauma (P00.5)	07	1.7
Anencephaly (Q00.0)	05	1.2
Fetus and newborn affected by the use of drugs that cause dependency by the mother (P04.4)	04	1.0
Fetus and newborn affected by other circulatory diseases and respiratory diseases of the mothers (P00.3)	04	1.0
Congenital malformations not specified (Q89.9)	04	1.0
Other causes	61	15.2
Total	402	100.0

Variables	Cases		Controls		OR gross	CI95%	p
	n (300) %		n (900) %
Maternal schooling (years )
≥ 8	199	21.5	725	78.4	1.0	1.57; 2.81	<0.001
< 8	101	36.5	175	63.4	2.1
Type of hospital
Private	253	23.2	836	76.7	1.0	1.62; 3.63	<0.001
Non Private	47	42.3	64	57.6	2.4
Type of delivery
Vaginal	212	35.0	393	64.9	1.0	0.24; 0.43	<0.001
Cesarean	88	14.7	507	85.2	0.3
Age (years)
< 35	266	24.3	828	75.6	1.0	0.96; 2.26	0.078
≥ 35	34	32.0	72	67.9	1.4
Type of pregnancy
Singleton	289	24.7	881	75.3	1.0	0.83; 3.75	0.135
Multiple	11	36.6	19	63.3	1.7
Gestational age (weeks)
≥ 37	77	8.5	827	91.4	1.0	23.06;46.68	<0.001
< 37	223	75.3	73	24.6	32.8
Birth weight (grams)
≥ 2500	84	9.2	827	90.7	1.0	20.58; 41.24	<0.001
< 2500	216	74.7	73	25.2	29.1
Gender
Female	150	25.0	450	75.0	1.0	0.77; 1.30	1.000
Male	150	25.0	450	75.0	1.0
Mother's occupation
Housewife	123	24.8	372	75.1	1.0	0.78; 1.32	0.919
Other	177	25.1	528	74.8	1.0
Live children
Do not have	105	22.2	367	77.7	1.0	0.88;1.53	0.284
Have	176	24.9	529	75.0	1.1
Previous episode of fetal death
Never had	120	13.6	758	86.3	1.0	5.73; 10.40	<0.001
Had	165	55.0	135	45.0	7.7

Model/Variable	Model I		Model II (n=1200)		Model III (n=1178)
	1, 2 and 3 isolated		1 + 2		1+2+3
	OR_a	CI95%	OR_a	CI95%	OR_a	CI95%
1. Block I (distal determinant) Maternal schooling
≥ 8 years	1.0		1.0		1.0
< 8 years	2.1	1.57; 2.81	1.8	1.39; 2.54	1.5 1.02; 2.47

2. Block II (intermediate determinant)
Type of delivery
Vaginal	1.0		1.0		1.0
Cesarean	0.3	0.24; 0.42	0.3	0.26; 0.45	0.3	0.24; 0.54

3. Block III (proximal determinants)
Birth weight
> 2500 grams	1.0				1.0
< 2500 grams	6.2	3.68; 10.62			5.5	3.22; 9.70
Gestational age
≥ 37 weeks	1.0				1.0
< 37 weeks	8.5	5.09; 14.50			9.3	5.38; 16.21
Previous episode of fetal death
Never had	1.0				1.0
Had	7.2	4.77; 10.93			6.6	4.35; 10.15

Instituto de Medicina Integral Prof. Fernando Figueira Rua dos Coelhos, 300. Boa Vista, 50070-550 Recife PE Brasil, Tel./Fax: +55 81 2122-4141 - Recife - PR - Brazil
E-mail: revista@imip.org.br

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[TFN1] Pearson adjustable test (p=0.06) and Hosmer-Lemeshow test (p=0.16) indicate a good adjustment of the model; OR_a= adjusted odds ratio; CI95%=Confidence Interval 95%; SUS=Unified Health System.