Revista Chilena de Obstetricia y Ginecología (Jan 2005)
ESTUDIO ANÁTOMO-CLÍNICO DE LAS CAUSAS DE MUERTE FETAL
Abstract
Objetivo: Conocer la causa de muerte fetal, mediante antecedentes clínicos maternos, análisis de los hallazgos de la autopsia fetal y estudio de la placenta. Material y Método: Se analizaron retrospectivamente 299 muertes fetales ocurridas entre las 22 y 42 semanas de gestación en un período de 5 años. Se incluyeron 279 casos con estudio histopatológico de la placenta y autopsia fetal. Se hizo la siguiente clasificación de causas primarias de muerte fetal: 1) Hipoxia fetal extrínseca, incluye asfixia aguda y shock: a) patologías placentarias, b) patologías del cordón umbilical, c) enfermedades maternas, d) causas no determinadas. 2) Anomalías congénitas. 3) Infecciones ascendentes. 4) Traumatismo del parto. 5) Hidrops fetal. No se clasificaron fetos macerados o placentas con alteraciones involutivas. Se establecieron tres grupos según la edad gestacional en que ocurrió la muerte fetal: 22-29 semanas, 30-36 semanas y 37-42 semanas. Resultados: Se conoció la causa de muerte fetal en 79,2% de los casos. Las causas más frecuentes fueron hipoxia fetal extrínseca 43,5%: insuficiencia placentaria 9,0%, hipertensión arterial 8,6%, desprendimiento placentario 6,1%, infarto placentario 5,7% y patología del cordón umbilical 4,3%. Anomalías congénitas 16,5%, infección bacteriana ascendente 16,1%, traumatismo del parto 2,2% e hidrops fetal 1,4%. Causa desconocida 20,8%. En gestaciones Objective: To know cause of fetal death through clinical maternal history, autopsy finding of the stillborn fetus and histological examination of the placenta. Method: There were analysed retrospectively 299 cases of fetal death between 22 and 42 week gestation in a 5 year period. There were included 279 cases with histopathological examination of the placenta and fetal tissue from autopsy. The following classification was made for primary fetal death: 1) Extrinsic fetal hypoxia, including acute asphyxia and shock: a) placental pathology, b) umbilical cord pathology, c) maternal disease, d) non determined cause. 2) Congenital anomalies, 3) Ascending infection, 4) Birth trauma, 5) Fetal hydrops. Cases with macerated fetus or placental involutive changes were not included. Three groups were established, using gestational age for fetal death: 22-29 weeks, 30-36 weeks, 37-42 weeks. Results: It could be know cause of fetal death in 79.2% of the cases. The most frequent were extrinsic fetal hypoxia 43.5%: placental insufficiency 9%, maternal hypertensive disease 8.6%, abruptio placentae 6.1%, placental infarcts 5.7% and umbilical cord pathologies 4.3%. Congenital anomalies 16.5%, ascending infections 16.1%, birth trauma 2.2% and fetal hydrops 1.4%. In 20.8% of cases the cause of fetal death could not be know. In gestations of less than 30 weeks main causes were: ascending infections 33.3%, placental pathology 17.7% and congenital anomalies 15.6%. Between 30 and 36 weeks gestations main causes were placental pathology 34.8%. Between 37 and 42 weeks gestation main causes were placental pathology 19.7%, post term pregnancy (not determined cause of fetal hypoxia) 15.5%, umbilical cord pathology 11.3% and maternal diabetes 8.5%. Conclusions: The analysis of findings obtained from fetal autopsy, placental histopathological examination and maternal clinical history allows clarifying most causes of fetal death and planified future pregnancies
