Date Published: April 29, 2019
Publisher: Public Library of Science
Author(s): Marley Carvalho Feitosa Martins, Francisco Edson de Lucena Feitosa, Antonio Brazil Viana Júnior, Luciano Lima Correia, Flávio Lúcio Pontes Ibiapina, Rodolfo de Carvalho Pacagnella, Francisco Herlânio Costa Carvalho, Sharon Mary Brownie.
The objective of this study was identify the association between delays in the care provided to pregnant women and the fetal death outcome, in a tertiary reference maternity hospital in the Northeastern Brazil. A case-control study, with 72 cases of fetal death and 144 controls (live births) in women admitted to the Obstetrics Service of the Assis Chateaubriand Teaching Maternity Hospital, in Fortaleza, Ceará. Controls were matched (2:1) by the approximate gestational age of the case. The groups were compared using the three delays model of obstetric care. The Pearson’s Chi-square test and the Fisher’s exact test were used to compare the groups. P <0.05 was considered statistically significant. The Group with fetal death had a smaller number of prenatal consultations (> 6 consultations: 27.8% in cases, 40.3% in controls, p = 0.003), less risk classification of pregnancy (41.7% vs 55.9%, p = 0.048), less guidance about the health facility for delivery (44.5% vs 64%, p = 0.009), lower frequency of cesarean sections (25.4% vs 65.7%) and higher frequency of hemorrhagic syndromes (33.3% vs 19.4%, p = 0.024) and syphilis (15.3% vs 4.2%, p = 0·004). Variables that persisted significantly associated with fetal death in the logistic regression were: Refusal of assistance (OR = 4.07, IC 95%: 1.08–15.3), Absence or inadequacy of prenatal care (OR = 2.69, IC 95%: 1.07–6.75), Delay in diagnosis (OR = 10.3, IC 95%: 2.58–41.4) and Inadequate patient conduct (OR = 4.88; IC 95%: 1.43–16.6). Despite of having a higher frequency of obstetric complications, gestations with fetal death are more prone to delays in obstetric care.
According to international estimates, Brazil is in an intermediate range of fetal mortality rate: five to 14.9 deaths per thousand births. However, the low quality of the information and the under-registration of fetal deaths in the official systems compromise the real dimensioning of the problem. In many health services, there are still no routines for the analysis of the occurrence of fetal death, as well as lack of specific investments for its reduction. This reality results in the difficulty of knowing the factors that cause the death of these fetuses, making it difficult to develop intervention measures .
A case-control study was carried out from the prospective surveillance of cases of fetal death and live births in women admitted to the Obstetrics Service of the Assis Chateaubriand Teaching Maternity Hospital of the—Federal University of Ceará.
In 2017 there were 5,038 births, of which, 4,929 were born alive and 109 stillborn; yielding a rate of 21.6 stillbirths per 1,000 births. Of the cases analyzed, 86.1% occurred in the antepartum period (before labor) and 13.9% in the intrapartum period (during labor and delivery). Regarding gestational age, 25% of fetal deaths occurred before the 28th week of gestation and 75% occurred after the 28th week of pregnancy, considered as “late fetal death”.
The present study indicates that despite having a higher prevalence of obstetric complications women with fetal death are more likely to refuse obstetric care and are subject to further delays in obstetric care, especially delays in diagnosis and inadequate conducts for their health problem.