Pregnancies with an outcome of fetal death present higher risk of delays in obstetric care: A case-control study

The objective of this study was identify the association between delays in the care provided to pregnant women and the fetal death outcome, in a tertiary reference maternity hospital in the Northeastern Brazil. A case-control study, with 72 cases of fetal death and 144 controls (live births) in women admitted to the Obstetrics Service of the Assis Chateaubriand Teaching Maternity Hospital, in Fortaleza, Ceará. Controls were matched (2:1) by the approximate gestational age of the case. The groups were compared using the three delays model of obstetric care. The Pearson's Chi-square test and the Fisher's exact test were used to compare the groups. P <0.05 was considered statistically significant. The Group with fetal death had a smaller number of prenatal consultations (> 6 consultations: 27.8% in cases, 40.3% in controls, p = 0.003), less risk classification of pregnancy (41.7% vs 55.9%, p = 0.048), less guidance about the health facility for delivery (44.5% vs 64%, p = 0.009), lower frequency of cesarean sections (25.4% vs 65.7%) and higher frequency of hemorrhagic syndromes (33.3% vs 19.4%, p = 0.024) and syphilis (15.3% vs 4.2%, p = 0·004). Variables that persisted significantly associated with fetal death in the logistic regression were: Refusal of assistance (OR = 4.07, IC 95%: 1.08–15.3), Absence or inadequacy of prenatal care (OR = 2.69, IC 95%: 1.07–6.75), Delay in diagnosis (OR = 10.3, IC 95%: 2.58–41.4) and Inadequate patient conduct (OR = 4.88; IC 95%: 1.43–16.6). Despite of having a higher frequency of obstetric complications, gestations with fetal death are more prone to delays in obstetric care.