Australian and New Zealand Journal of Obstetrics and Gynaecology 2007; 47: 383– 388 © 2007 The Authors 383 Journal compilation © 2007 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists Blackwell Publishing Asia Original Article Fetal death during antenatal care Maternal risk factors associated with fetal death during antenatal care in low-resource tertiary hospitals Olufemi T. OLADAPO, 1 Daniel A. ADEKANLE 2 and Bankole O. DUROJAIYE 1 1 Maternal and Fetal Health Research Unit, Department of Obstetrics and Gynaecology, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria, and 2 Department of Obstetrics and Gynaecology, College of Health Sciences, Ladoke Akintola University of Technology, Osogbo, Osun State, Nigeria Abstract Background: Data on maternal characteristics that could predict antepartum fetal death in women receiving antenatal care in resource-constrained settings are limited. Aims: To identify maternal sociodemographic and clinical risk factors for antepartum fetal death among women receiving antenatal care in a developing country setting. Methods: Case-control analyses of risk factors in the occurrence of singleton fetal death before labour at two university hospitals in south-west Nigeria over 4–5 years. A total of 46 cases and 184 controls were compared for 31 sociodemographic and clinical risk factors. Unconditional multivariate logistic regression analysis was applied to determine independent risk factors. Level of significance was set at P < 0.05. Results: The incidence of antepartum fetal death among women receiving antenatal care was 10.8 per 1000 total births during the period. Significant risk factors at univariate level include proteinuria, pregnancy-induced hypertension, pre-existing hypertension, reduced weight gain per week, previous antepartum fetal death, antepartum haemorrhage, previous miscarriage, symphysiofundal height–gestational age disparity = 4 cm and perception of reduced fetal movements. The independent risk factors were proteinuria (adjusted OR 4.23, CI: 1.57–11.42), pregnancy-induced hypertension (adjusted OR 8.24, CI: 3.01–22.51) and perceived reduction in fetal movements (adjusted OR 7.17, CI: 1.57–45.76). Conclusions: The identified factors should serve as potential targets for antenatal interventions to prevent antepartum fetal death in these institutions. Awareness of these factors should stimulate appropriate risk assessment geared towards the prevention of antepartum fetal deaths by clinicians in these centres and centres in similar setting. Key words: antenatal care, fetal death, Nigeria, stillbirth. Introduction Antepartum fetal demise constitutes an immense psychological trauma to the expectant mother and may undermine her confidence in orthodox pregnancy care, especially when the attending clinician cannot provide a reasonable explanation. Unlike in fetal deaths following intrapartum complications, the factors responsible for prenatal fetal demise may not be apparent to either the mother or her caregiver, and may remain unexplained despite extensive investigations. 1 It is, however, essential that the cause of death be determined where possible as precise knowledge of the cause would serve as the basis for counselling affected parents, prevention of recurrence and treatment of previously undiagnosed medical conditions. Unfortunately, only few centres in Nigeria have adequate facilities to perform the recommended investigations in cases of fetal deaths. Likewise, fetal autopsy that can significantly increase the likelihood of discovering the presumed cause, 2 is rarely performed because of scarce human and material resources and strong cultural misconception. 3 Regardless of these limitations, it is the duty of obstetricians practising in resource-constrained settings to devise means of limiting antepartum stillbirths, especially among patients who receive antenatal care. While most reports on perinatal Correspondence: Dr Olufemi T. Oladapo, Department of Obstetrics and Gynaecology, Olabisi Onabanjo University Teaching Hospital, P.M.B. 2001 Sagamu, Ogun State, Nigeria. Email: tixon_y2k@hotmail.com DOI: 10.1111/j.1479-828X.2007.00761.x Received 23 March 2007; accepted 03 July 2007.