El método de clasificación de mortinatos "condición Obstétrica Relevante de la Muerte Fetal" (CORM) reduce la frecuencia de muerte fetal de causa inexplicable

Abstract

Introduction: Stillbirth is the main contributor to perinatal mortality. Aim: To analyze the efficiency of the method for classification of fetal death (FD), "obstetric condition relevant to the death (OCRD). Methods: Retrospective cohort study of the FD that occurred in the Maternity Hospital of San Borja Arriarán for ten years. The data comes from the reports of the stillborn audits. We applied the classification method OCRD, which uses placental biopsy, clinical and laboratory data analyzed by a single obstetrician and a single pathologist. Results: 56,130 births and 479 FD occurred. FD rate, 8.5 per 1000 births. We identified 93.5% of the obstetric conditions of FD and 6.5% were unexplained. The most frequent were: ascending bacterial infection (ABI) 24.9%, congenital anomaly 18.0%, and placental pathology 14.0%. The intrauterine fetal growth restriction (IUGR) was present in 49.7% of the stillbirths, the majority 93.7%, was secondary to primary obstetric condition. Asphyxia during delivery was 0.8% of the stillbirths and occurred in term pregnancies. Preterm birth (PB) represented 80% of FD cases. The most frequent condition associated with PB was ABI (38.5% and 38.2% of the FD less than 30 weeks and less than 1000 grams respectively). Conclusions: The OCRD stillbirth classification method is more efficient than conventional methods in detecting the cause of MF because it identifies most of the obstetric conditions responsible for FD. It is reproducible, requires histopathological study of the placenta and not fetal autopsy. It allows developing guidelines of prevention for cause.