Intrauterin fosterdød - epidemiologi

Sist oppdatert: 11.11.2024
Utgiver: Norsk gynekologisk forening
Versjon: 1.2
Forfattere: Katariina Laine, Johanne Kolvik Iversen, Ashi Sarfraz Ahmad, Julie Victoria Holm Tveit, Linda Björk Helgadóttir, Gitta Turowski (patolog), Regine Barlinn (mikrobiolog)
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Epidemiologi 

Forekomst av intrauterin fosterdød etter svangerskapsvarighet ≥ 22+0 uker er kraftig redusert over tid i Norge 1. I 1999 var forekomsten 5,4 per 1000 fødsler og i 2022 var forekomsten 2,7 per 1000 fødsler. Forekomsten har vært stabil siden 2017 2.

 

Over 60% av IUFD skjer før uke 37. I Norge forekommer de fleste intrauterine dødsfall før fødselen. Andelen intrapartum død er også kraftig redusert og utgjør under 5% av IUFD, dvs 0,16 promille av alle fødsler 34.

 

Risiko for IUFD øker gradvis med økende svangerskapsvarighet, kalkulert av pågående svangerskap (fetus at risk; ongoing pregnancy) 56.

 

Forekomsten av IUFD i Norge er lavere enn i de fleste andre land 7. Dette gjenspeiles også når man studerer enkelte risikofaktorer. Studier fra andre land kan rapportere høyere forekomst av IUFD ved enkelt-risikofaktorer enn i Norge. Man bør derfor tolke studier og resultater fra andre land med forsiktighet.

Risikofaktorer 

Risikofaktorer for IUFD kan være pregravide maternelle faktorer eller svangerskapsrelaterte faktorer. Ved å kombinere maternelle faktorer og svangerskapsrelaterte faktorer kan man identifisere gravide med høyest risiko 891011. Individualisert fødselsomsorg og identifisering av risikofaktorer kan redusere IUFD i høy-inntektsland 812.

 

Maternell alder og kroppsmasseindeks (KMI) er kontinuerlige variabler og risikoen for IUFD øker med økende alder og KMI. Ulike studier bruker ulike verdier i analysene, (for eksempel cut-off 35 år eller 40 år; eller ulike grader av overvekt og fedme), noe absolutt og entydig grense kan dermed ikke fastslås.

 

Mors opplevelse av reduserte forsterbevegelser/lite liv er assosiert med økt risiko for IUFD, sammenliknet med kvinner som ikke har opplevd/rapportert lite liv, (OR 2.36-5.53) 12131415 . Gjentagende episoder med reduserte fosterbevegelser/lite liv er også assosiert med økt risiko for IUFD (OR 2.51-5.11) 1416. Kombinasjon av lite liv med andre risikofaktorer for IUFD kan øke risikoen ytterligere, vennligst se Lite liv. Perinatalkomiteene i Norge har observert sammenheng mellom mors opplevelse av lite liv og IUFD.

 

Perinatalkomiteene i Norge rapporterer også at suboptimal svangerskaps- og fødselsomsorg kan være medvirkende til IUFD.

Risikofaktorer med referanselitteratur 

Maternelle pre-gravid risikofaktorer:

Lav sosioøkonomisk status/ lav utdanning 171819

Mors fødeland i sør Asia eller Afrika sør for Sahara 2021

Innvandrere med kort botid i Norge 20

Høy alder 6171922

Ung alder < 20 22

Overvekt og adipositas 19

Diabetes type 1 41020

Kronisk hypertensjon 19

SLE 232425

Antifosfolipidsyndrom 2627

 

Ikke økt risiko for IUFD

Svangerskapsdiabetes 28293031

Reumatoid artritt 3233343536

Hypothyreose 3738

Hyperthyreose 3940

 

Obstetrisk anamnese (komplikasjoner ved tidligere svangerskap):

Intrauterin fosterdød 1941

Preterm fødsel 917

Placentaløsning 42

Multiple spontanaborter 17

SGA 691719

 

Svangerskapsrelaterte risikofaktorer

Placentaløsning 6171943

Overtidig svangerskap 22

Assistert befruktning 19

Velamentøs festet navlesnor 4445

Single umbilical artery 46

 

Føtale risikofaktorer:

Føtal veksthemming 6171947

Mors opplevelse av reduserte fosterbevegelser (lite liv) 1213141516

Medfødte misdannelser 174348

Tvillingsvangerskap 6

 

Maternelle risikofaktorer:

Preeklampsi, svangerskapshypertensjon 617

Intrahepatisk kolestase 49

Røyking 1719

Narkotikabruk 19

Hemokonsentrasjon med høy Hb-nivå under svangerskapet 50

Alvorlige maternelle infeksjoner i svangerskapet (pneumoni, sepsis, primær malaria, Covid-19), korionamnionitt 51

 

Organisatoriske risikofaktorer

Suboptimal fødselsomsorg 115253

Manglende svangerskapskontroller 12

Endringslogg 

Kapittelet ble sist oppdatert etter Obstetrisk guidelinemøte april -24 (revisjon påbegynt ifm OGM 2023, men ikke godkjent, derfor jobbet videre til 2024).

Før dette ifm full revisjon av Veileder i fødselshjelp 2020.

Tidligere utgaver av kapitlene finnes her: https://www.legeforeningen.no/foreningsledd/fagmed/norsk-gynekologisk-forening/veiledere/arkiv-utgatte-veiledere/

Endringer etter sept -24 finnes i metodebok, se øverst i kapittelet.

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