Fetal Wastage in the Second-Trimester of Pregnancy: An Obstetric Approach

Objectives; To analyze the clinical causative factors of fetal wastage in the second trimester at Inchon Severance Hospital and to identify the changing pattern of them last 14 years. Methods; During the 14 years(l983-1996) there were 6080 total births with 101 fetal losses comprising 72 stillbirths, 27 termination of pregnancy and 2 neonatal death. The classification of this research was based on a modified Aberdeen classification(Baird & Thomson, 1969) and additional small modification revised by Whitefield(l986). The results of the survey were divided into two periods: namely first 9 years(l983~1991) and later 5 years(l992-1996) to compare the changing patterns of causes. Results; The most common causes of fetal losses in later 5 years were fetal abnormalities(23 losses: 37.1 %). On the other hands, unexplained intrauterine fetal death(17 losses: 43.6 %) in first 9 years. The next most frequent cause was spontaneous preterm labor(22 losses: 23.2 %), followed by maternal disease(10 losses: 10.5 %), hypertension(6 losses: 6.3 %), antepartum hemorrhage(5 losses: 3.1 %), trauma(2 losses: 2.1 %) and intrauterine growth retardation(2 losses: 2.1 %). Losses associated with unexplained intrauterine fetal death tend to decrease in the later 5 years. The most common predisposing factors of spontaneous preterm was the cervical incompetence. Conclusions; With the recent advanced methods for early prenatal diagnosis such as ultrasound, the fetal abnormalities seemed to be one of the commonest causes of fetal wastage. The cervical incompetence causing predisposing factor of spontaneous preterm were increasing and seemed to be the effects of the voluntary abortion for family planning. Although unexplained intrauterine fetal death decline in later 5 years, it has to be investigated these losses through postmortem examination or screening marker at risk of women.restrictio