Intrauterine infection within the causes of perinatal mortality

Introduction. Intrauterine infections are of particular importance to perinatal mortality as they are preventable causes. This is meant to be the base to create efficient medical and preventive interventions to reduce perinatal losses.

Aim. This study was conducted to assess a share of intrauterine infections in the structure of causes of perinatal deaths.

Materials and methods. 62 autopsy reports were analyzed using materials of the pathology department of Khabarovsk Kray Perinatal Center as of 2018, including 35 cases of antenatal fetal death in inevitable miscarriage, 11 cases of induced medical abortions, and 9 cases of intranatal fetal death. In addition, 7 death cases of newborns who died in the early neonatal period were studied. Postmortem examination was performed to the accepted standards, including morphological analysis of autopsy material.

Results. Respiratory disorders come first as the cause of stillbirths (90.9% of cases). Congenital anomalies of internal organs, placenta, membranes and umbilical cord rank second (56.4% of cases). Infectious inflammation of secundines were found in 54.5% of cases. Immediate cause of death in the early neonatal period was found to be respiratory disorders resulting from prior disease or concurrent diseases (anomalies of internal organs, congenital infection, and hemolytic disease of newborns). In all cases of early perinatal death, an infectious condition was identified as primary, concurrent (28.5% - 2 cases out of 7) or background disease (100% of secundines infection).

Conclusion. Congenital infections have been found to be a significant factor in perinatal mortality. Thorough analysis of causes of death, better etiologic verification of congenital infections and morphological diagnosis of autopsy material will enable to assess a risk of recurrent fetal and neonatal loss in subsequent pregnancies, and contribute to the improvement of medical and preventive interventions.

1. Blencome H., Cousens S., Jassir F.B., Say L., Chou D., Matherts C., Hogan D., Shiekh S., Qureshi Z.U., You D., Lawn J.E.National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis. Lancet Glob. Health 2016; 4(2):e98-e108. doi:10/1016/s2214-109x(15)00275-2

2. World Health Organization. Making every baby count: audit and review of stillbirths and neonatal deaths. Geneva: WHO; 2016. Available at: https://apps.who.int/iris/bitstream/handle/10665/250124/WHO-RHR-16.11-eng.pdf;jsessionid=71704D64C9EBB258D3F6F107A57627D3?sequence=l

3. World Health Organization. Every newborn: an action plan to end preventable deaths. Geneva: WHO; 2014. Available at: https://apps.who.int/iris/bitstream/handle/10665/127938/9789241507448_eng.pdf?sequence=1

4. Nasyrov R.A., Melnikova VF., Kracnogorskaia O.L., Popova E.D., Narkevich T.A., Sidorova N.A., Paneiakh M.B., Fedotova E.H. Principles autopsy in cases of perinatal death. Pediatrician (St. Petersburg) 2018; 9(3):85-105. doi: 10.1786/PED9385-105 (in Russian).

5. Shchegolev A.I., Pavlov K.A., Dubova E.A., Frolova O.G. Stillbirth rates in the subjects of the Russian Federation in 2010. Archive of Pathology = Arkhiv Patologii 2013; 75(2):20-24 (in Russian).

6. Boronina I.V., Shaposhnikova L.V, Stepanov D.S., Oshanova L.S., Neretina A.F. Retrospective analysis of antenatal death of fetuses with a birth weight of less than 1000g in the Voronezh Region. Archive of Pathology = Arkhiv Patologii 2016;3:32-35 (in Russian). doi:10.17116/patol201678332-36

7. Tumanova U.N., Shchegolev A.I. Placental lesions the cause of stillbirth (review). International Journal of Applied and Fundamental Research 2017; 3(Pt 1):77-81 (in Russian).

8. International statistical classification of diseases and related health problems, 10th revision. Vol.2: Instruction manual; 2010 edition. Geneva: WHO. Available at: https://icd.who.int/browse10/Content/statichtml/ICD10Volume2_en_2010.pdf

9. Uelina G.A., Rymashevskiy A.N. Morphological and microbiological parallel ways of placenta’s infection in antenatal fetal death. Modern Problems of Science and Education 2012; 6:282-258 (in Russian).

10. Zinserling V.A. A.VZinserling (Tsinzerling) School of Infectious Pathology: Advances and prospective. Archive of Pathology = Arkhiv Patologii 2014; 76(1):3-9 (in Russian).

11. Ivakhnishina N.M., Kozharskya O.V, Ostrovskaya O.V., .Nagovitsyna E.B., Vlasova M.A., Muraya E.M., Suprun S.V Placental infection in habitual miscarriage. Bulleten' fiziologii i patologii dyhania = Bulletin Physiology and Pathology of Respiration 2015; (56):88-93. (in Russian).