Background and Objective: In developing countries, intrauterine fetal death (IUFD) is regarded as one of the major adverse birth outcomes, with a wide range of etiological factors contributing to its occurrence. Considering the clinical and public health significance of this issue, the present study was conducted to determine of predictive factors associated with IUFD.

Materials and Methods: This retrospective cohort study was conducted from June to July 2024, collecting data on 2,951 pregnant women with a gestational age of 22 weeks or more, who were admitted to Dr. Shariati Hospital and had completed their pregnancies during 2022–2023. A total of 3,292 births were recorded, of which 122 resulted in IUFD. Collected information from hospital’s delivery registries and recorded included maternal demographic characteristics, medical and obstetric histories, and fetal factors. For data analysis, independent t-tests, chi-square, and Fisher’s exact tests were employed. To determine Hazard Ratio of IUFD, survival analysis and Cox proportional hazards regression (both univariate and multivariate) as well as cumulative survival curves were used. Data analysis was performed by SPSs (version 22) and Randomizer (version (4.4.1).

Results: The incidence of IUFD was 37 per 1,000 births. Univariate Cox proportional hazards regression analysis demonstrated statistically significant associations between IUFD and maternal residence, multiple pregnancy in the current pregnancy (p < 0.001). Multivariate Cox regression analysis further revealed significant associations between IUFD and multiple pregnancy in the current pregnancy (p < 0.001) as well as mother’s residence (p = 0.01).