Causes of Intrauterine Fetal Death during COVID-19 outbreak in a Tertiary Care Hospital in Lahore, Pakistan

  • Mahwish Saif cpsp
  • Arfa Bin Saqib
Keywords: Intrauterine death, Intrauterine Growth retardation, Fetal death, Stillbirth, Pregnancy Induced Hypertension, Gestational Diabetes Mellitus, Covid-19, Fetal Hydrops, Amniotic Fluid Index, Placental Abruption.

Abstract

Objective: To assess the frequency of IUDs and their possible causes since the Covid-19 pandemic.
Material and Methods:
Study design: Cross-sectional study
Setting: Department of Obstetrics and Gynaecology, Shalamar Hospital, Medical and Dental College, Lahore, Pakistan.
Duration of study: 15/03/2020 to 15/06/2020
This is a cross-sectional single-center study. The relevant details about IUDs like age, parity, social status, booked status, comorbidities, and social status were entered into a Performa and the data analyzed.
Results: The Intrauterine death rate from the study was 41.99 fetal deaths per 1000 live births (Total births: 643, IUDs: 27) while the mean age of the mothers was 29.67 with a minimum age of 22 years and a maximum of 37 years. According to the risk factors associated with the IUD, 11.1% had Pregnancy Induced hypertension, 11.1% had Pre-Eclampsia, 22.2% had Gestational Diabetes Mellitus and 22.2% Pregnancy Induced Hypertension and Gestational Diabetes Mellitus and 33.3% had no comorbidities. Amongst all the patients 33.3% of cases were unbooked.
Conclusion: We conclude that in the last one year the fetal deaths per 1000 at Shalamar Hospital were around 28.57 per 1000 live births, during the last 3 months they gone up to 41.99 fetal deaths per 1000 live births. The leading cause(s) for IUDs in Pregnancy during the Covid-19 were pandemic Induced Hypertension and Gestational Diabetes Mellitus, which cumulatively account for 44.4% cases but 33.3% cases had no co-morbidities and still ended up in an Intra-Uterine death, which may or may not have been influenced by a Covid-19 infection. From the looks of it, Non-clinical reasons seem to have a higher probability of increasing the IUD rate but clinical effects of the Covid-19 infection can also not be ruled out completely, further studies are required into the pathogenesis and the effect of Covid-19 on pregnancy.

References

1. Blencowe H, Cousens S, Jassir FB, Say L, Chou D, Mathers C, Hogan D, Shiekh S, Qureshi ZU, You D, Lawn JE. National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis. The Lancet Global Health. 2016 Feb 1;4(2):e98-108.
2. E McClure EM, Saleem S, Pasha O, Goldenberg RL. Stillbirth in developing countries: a review of causes, risk factors and prevention strategies. The journal of maternal-fetal & neonatal medicine. 2009 Jan 1;22(3):183-90.
3. Goldenberg RL, Kirby R, Culhane JF. Stillbirth: a review. The journal of maternal-fetal & neonatal medicine. 2004 Aug 1;16(2):79-94.
4. Goldenberg RL. Factors influencing perinatal outcomes. Annals of the New York Academy of Sciences. 2004 Dec;1038(1):227-34.
5. King JC. Strategies to reduce maternal mortality in developed countries. Current Opinion in Obstetrics and Gynecology. 2013 Apr 1;25(2):117-23.
6. D. Kim and A. Saada, " The social determinants of infant mortality and birth outcomes in Western developed nations: a cross-country systematic review," International Journal of Environment Res Public Health, vol. 10, no. 6, pp. 2296-2335, 2013.
7. de Graaf JP, Steegers EA, Bonsel GJ. Inequalities in perinatal and maternal health. Current Opinion in Obstetrics and Gynecology. 2013 Apr 1;25(2):98-108.
8. Kiely JL, Paneth N, Susser M. Fetal death during labor: an epidemiologic indicator of level of obstetric care. American journal of obstetrics and gynecology. 1985 Dec 1;153(7):721-7.
9. Lawn J, Shibuya K, Stein C. No cry at birth: global estimates of intrapartum stillbirths and intrapartum-related neonatal deaths. Bulletin of the World Health Organization. 2005;83:409-17.
10. Jokhio AH, Winter HR, Cheng KK. An intervention involving traditional birth attendants and perinatal and maternal mortality in Pakistan. New England Journal of Medicine. 2005 May 19;352(20):2091-9.
11. World Health Organization. The World health report: 2005: make every mother and child count. World Health Organization; 2005.
12. World Health Organization. Perinatal mortality: a listing of available information. World Health Organization; 1996.
13. Fikree FF, Gray RH. Demographic survey of the level and determinants of perinatal mortality in Karachi, Pakistan. Paediatric and perinatal epidemiology. 1996 Jan;10(1):86-96.
14. Fikree FF, Azam SI, Berendes HW. Time to focus child survival programmes on the newborn: assessment of levels and causes of infant mortality in rural Pakistan. Bulletin of the World health Organization. 2002;80:271-6.
15. Blencowe H, Cousens S, Jassir FB, Say L, Chou D, Mathers C, Hogan D, Shiekh S, Qureshi ZU, You D, Lawn JE. National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis. The Lancet Global Health. 2016 Feb 1;4(2):e98-108.
16. Ronsmans C, Etard JF, Walraven G, Høj L, Dumont A, De Bernis L, Kodio B. Maternal mortality and access to obstetric services in West Africa. Tropical Medicine & International Health. 2003 Oct;8(10):940-8.
17. Hameed K, Kadir M, Gibson T, Sultana S, Fatima Z, Syed A. The frequency of known diabetes, hypertension and ischaemic heart disease in affluent and poor urban populations of Karachi, Pakistan. Diabetic medicine. 1995 Jun;12(6):500-3.
18. George A. Persistence of high maternal mortality in Koppal district, Karnataka, India: observed service delivery constraints. Reproductive health matters. 2007 Jan 1;15(30):91-102.
19. Paul VK, Sachdev HS, Mavalankar D, Ramachandran P, Sankar MJ, Bhandari N, Sreenivas V, Sundararaman T, Govil D, Osrin D, Kirkwood B. Reproductive health, and child health and nutrition in India: meeting the challenge. The Lancet. 2011 Jan 22;377(9762):332-49.
20. Della Gatta AN, Rizzo R, Pilu G, Simonazzi G. Coronavirus disease 2019 during pregnancy: a systematic review of reported cases. American journal of obstetrics and gynecology. 2020 Jul 1;223(1):36-41.
21. Schwartz DA, Graham AL. Potential maternal and infant outcomes from coronavirus 2019-nCoV (SARS-CoV-2) infecting pregnant women: lessons from SARS, MERS, and other human coronavirus infections. Viruses. 2020 Feb;12(2):194.
22. Shanes ED, Mithal LB, Otero S, Azad HA, Miller ES, Goldstein JA. Placental pathology in COVID-19. American journal of clinical pathology. 2020 Jun 8;154(1):23-32.
23. E. Michael, "Small study identifies placental abnormalities in pregnant women with COVID-19," Healio, 09 June 2020. [Online]. Available: https://www.healio.com/news/primary-care/20200609/small-study-identifies-placental-abnormalities-in-pregnant-women-with-covid19. [Accessed 26 June 2020].
24. J. Connors and J. Levy, "COVID-19 and its implications for thrombosis and anticoagulation," Ash Publications, 04 June 2020. [Online]. Available: https://ashpublications.org/blood/article/135/23/2033/454646/COVID-19-and-its-implications-for-thrombosis-and. [Accessed 26 June 2020].
25. RCOG, "Coronavirus infection and pregnancy," Royal College of Obstetricians & Gynaecologists, 26 June 2020. [Online]. Available: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy/. [Accessed 28 June 2020].
Published
2021-08-31
How to Cite
1.
Saif M, Saqib A. Causes of Intrauterine Fetal Death during COVID-19 outbreak in a Tertiary Care Hospital in Lahore, Pakistan. JRMC [Internet]. 31Aug.2021 [cited 25Oct.2021];25(1):56-0. Available from: http://www.journalrmc.com/index.php/JRMC/article/view/1640