Intrauterine Fetal Death: Epidemiology, Clinical Features, Management, and Prognosis at Pikine National Hospital Center (January 2018-May 2023), Dakar, Senegal
Background: Intrauterine fetal death (IUFD) remains a major public health concern, particularly in low- and middle-income countries, where access to quality antenatal care and timely obstetric management may be limited. Understanding the epidemiological profile, etiological factors, and outcomes of IUFD is essential to improve preventive strategies and maternal care. Objective: To describe the epidemiological, clinical, etiological, therapeutic, and prognostic aspects of intrauterine fetal death at the Pikine National Hospital Center in Dakar, Senegal. Methods: A retrospective descriptive and analytical study was conducted over a period of five years and five months, from January 2018 to May 2023, in the Department of Obstetrics and Gynecology of the Pikine National Hospital Center. All cases of intrauterine fetal death occurring during the study period were included. Data were collected from obstetric records, delivery registers, and neonatal files. Sociodemographic characteristics, obstetric history, pregnancy follow-up, etiologies, modes of delivery, maternal complications, and fetal characteristics were analyzed. Statistical analysis was performed using R software, with a significance threshold set at p < 0.05. Results: During the study period, 616 cases of intrauterine fetal death were recorded among 25,138 deliveries, corresponding to a frequency of 2.4%. The mean maternal age was 28 years (range: 16 - 49 years), with women aged 25 - 34 years being the most represented. Most patients were multigravida (40.9%) and multiparous (27.6%), with a predominance of low educational level and low socioeconomic status. More than half of the patients (53.4%) were referred from other health facilities. The majority of IUFDs occurred before term (77.9%) and in singleton pregnancies (94.8%). Labor was induced in 57.2% of cases, mainly using misoprostol. Vaginal delivery was achieved in 77.3% of patients. Macerated stillbirths accounted for 82.2% of cases, and fetal weight was below 2500 g in 51.4%. The leading etiologies were placental abruption (29.8%), preeclampsia (15.0%), and gestational hypertension (10.0%). A statistically significant association was found between IUFD and placental abruption, which increased the risk of fetal death fourfold. Maternal complications were observed in 42.7% of cases, predominantly infections (23.5%) and hemorrhages (12.9%), with no maternal deaths reported. Conclusion: Intrauterine fetal death remains frequent at the Pikine National Hospital Center and is largely associated with
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