The Iranian Journal of Obstetrics, Gynecology and Infertility

The Iranian Journal of Obstetrics, Gynecology and Infertility

Predictive Factors of Intrauterine Fetal death in Pregnant Women: A Retrospective Cohort Study

Document Type : Original Article

Authors
Fereshteh Bagheri 1
Maryam Keshavarz 2
Fatemeh Sarvi 3
Mohammadreza Jafari 4
1 M.Sc. in Midwifery Counseling, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
2 Professor, Department of Midwifery and Reproductive Health, Reproductive Science and Technology Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
3 Assistant Professor, Department of Public Health, School of Health, Larestan University of Medical Sciences, Larestan, Iran.
4 General Practitioner, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
10.22038/ijogi.2026.91996.6579
Abstract
Introduction: In developing countries, intrauterine fetal death (IUFD) or stillbirth is regarded as one of the major adverse birth outcomes, with a wide range of etiological factors contributing to its occurrence. The present study was conducted with aim to evaluate the predictive factors associated with IUFD.
Methods: In this retrospective cohort study conducted from June to July 2024, data on 2,951 pregnant women with a gestational age of 22 weeks or more, who were admitted to Dr. Shariati Hospital and had pregnancy termination, were collected. A total of 3,292 births were recorded, of which 122 resulted in stillbirth. Maternal demographic characteristics, medical and obstetric histories, and fetal factors were extracted from hospital’s delivery registries. Data were analyzed using SPSS (version 22) and Randomizer (4.4.1 version) and independent t-test, chi-square, and Fisher’s exact test. 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.
Results: The incidence of IUFD was 37 per 1,000 births. Univariate Cox proportional hazards regression analysis demonstrated statistically significant associations between IUFD and mothers’ residence, also multiple pregnancy in the current pregnancy (p<0.001). The cumulative survival curve, adjusted for the model variables, indicated that the highest risk of IUFD occurred between 22 and 30 weeks of gestation, with a slower decline in risk observed between 30 and 38 weeks.
Conclusion: More attention to providing high-quality prenatal care—particularly between 22 and 30 weeks of gestation—to mothers with multiple pregnancies and those residing in non-urban areas, who may have limited access to adequate antenatal services, could help prevent intrauterine fetal death.
Keywords
Hazard Ratio
Intrauterine Fetal Death
Predictive Factors
Subjects
1.        Da Silva FT, Gonik B, McMillan M, Keech C, Dellicour S, Bhange S, et al. Stillbirth: case definition and guidelines for data collection, analysis, and presentation of maternal immunization safety data. Vaccine 2016; 34(49):6057-68.
2.        Abebe H, Shitu S, Workye H, Mose A. Predictors of stillbirth among women who had given birth in Southern Ethiopia, 2020: A case-control study. PloS one 2021; 16(5):e0249865.
3.        Thakur SK, Dangal G. Factors associated with intrauterine fetal death at Paropakar maternity women’s hospital. Kathmandu University Medical Journal 2022; 20(3):260-3.
4.        Sadighi J, Tavousi M, Montazeri A, Mozafari Kermani R, Eslami M, Rostami R, et al. Fertility indicators and its correlates among women in Iran. Payesh (Health Monitor) 2020; 19(6):645-72.
5.        Kasa GA, Woldemariam AY, Adella A, Alemu B. The factors associated with stillbirths among sub-saharan African deliveries: a systematic review and meta-analysis. BMC Pregnancy and Childbirth 2023; 23(1):835.
6.        Asare M, Laar AS. Accessing the prevalence of stillbirth rate and associated factors among women who delivered in a rural hospital: A retrospective cross-sectional analysis. Int J Health Sci Res 2016; 6(1):341-7.
7.        Dattani S, Spooner F, Ritchie H, Roser M. Child and infant mortality. Our World in Data 2023.
8.        World Health Organization. Stillbirth rate (per 1000 total births) [Internet]. Geneva: World Health Organization; 2021 [cited 2026 Aug 27]. Available from: https://www.who.int/data/gho/data/indicators/indicator-details/GHO/stillbirth-rate-(per-1000-total-births)
9.        Jamie AH. Prevalence and determinants of stillbirth in attended deliveries in university hospital, Eastern Ethiopia in 2021. Casp J Reprod Med 2022; 8(1):9-14.
10.     Gozidehkar Z, Ghalenoei AA, Ghotbi F, Ashkriz S, Karbalaei Taher H. Risk factors related to stillbirth in pregnant mothers: a case-control study. The Iranian Journal of Obstetrics, Gynecology and Infertility 2023; 26(2):74-83.
11.     Tabatabaei SM. The pre-pregnancy risk factors of stillbirth in pregnant Iranian women: A population-based case-control study. Health Scope 2019.
12.     Maleki Z, Ghaem H, Seif M, Foruhari S. Incidence and maternal-fetal risk factors of stillbirth. A population-based historical cohort and a nested casecontrol study. Annali di Igiene, Medicina Preventiva e di Comunità 2021; 33(3):231.
13.     Mulatu T, Debella A, Feto T, Dessie Y. Determinants of stillbirth among women who gave birth at Hiwot Fana Specialized University Hospital, Eastern Ethiopia: A facility-based cross-sectional study. SAGE Open Medicine 2022; 10:20503121221076370.
14.     Welegebriel TK, Dadi TL, Mihrete KM. Determinants of stillbirth in Bonga General and Mizan Tepi University Teaching Hospitals southwestern Ethiopia, 2016: a case–control study. BMC research notes 2017; 10(1):713.
15.     Khatibi T, Hanifi E, Sepehri MM, Allahqoli L. Proposing a machine-learning based method to predict stillbirth before and during delivery and ranking the features: nationwide retrospective cross-sectional study. BMC pregnancy and childbirth 2021; 21(1):202.
16.     Cunningham FG, Leveno KJ, Dashe JS, Hoffman BL, Spong CY, Casey BM. Williams obstetrics. 26nd ed. New York: McGraw Hill Medical; 2022.
17.     Smith GC, Fretts RC. Stillbirth. The Lancet 2007; 370(9600):1715-25.
18.     Boskabadi H, Maamouri GA, Tabatabaie A, Ayati S, Hassanzadeh M, Davarnia M, et al. Study of the Incidence, and Maternal and fetal risk factors for intra uterine fetal death. Journal of Mazandaran University of Medical Sciences 2015; 24(122):332-56.
19.     Miller CB, Wright T. Investigating mechanisms of stillbirth in the setting of prenatal substance use. Academic forensic pathology 2018; 8(4):865-73.
20.     Nankali A, Hematti M, Mahdavi Z. Study of the factors associated with stillbirth in pregnant women admitted in Imam Reza Teaching Hospital in Kermanshah (2011–2014). Iran J Obstet Gynecol Infertil 2017; 20(1):1-9. doi:10.22038/ijogi.2017.8617. 
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 29, Issue 4
June 2026
Pages 54-67