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Genital Infections in the Aetiology of Late Fetal Death: an Incident Case-referent Study
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*Department of Obstetrics and Gynecology, Central Hospital Maputo, Mozambique
**Department of Microbiology, Faculty of Medicine, Eduardo Mondlane University Maputo, Mozambique
***Department of Pathology, Central Hospital Maputo, Mozambique
Department of Obstetrics & Gynaecology, Akademiska Hospital S-751 85 Uppsala, Sweden
Department of Obstetrics & Gynaecology, Ullevàl University Hospital N-0407 Oslo, Norway
Women with prelabour fetal death in the third trimester were recruited in order to study the association between intra-uterine death and maternal genital colonization of bacteria. Fifty-eight women with verified fetal death were compared with a group of 58 women matched for age, parity and gestational length (the first referent group) and with women delivering liveborn neonates (second referent group). Cultures from the vagina, the endocervix, the amnioric fluid, the placenta, the conjunctivae of the newborn and the secretion of gastric aspirate of the newborn were carried out. Blood was taken for haemoglobin, thick film (malaria) and syphilis and HIV serology. Cases were more affected by previous stillbirths than first referents (OR = 11.88). Preterm delivery was significantly more common in cases than in second referents (OR = 57.70). Cases had significantly more often < 3 ANC visits (OR = 2.81). Cases had a lower body mass index than first referents (OR = 238). Temperature 
37°C was 12 times more frequent in cases than in first referents (OR=21.20) and four times more frequent than in second referents (OR=6.60). Average birth weight among stillborns was 1954 g and in liveborns 3223 g (P = 0.001). The corresponding prevalence of LBW was 78% in cases and 0% among second referents (P< 0.001). Histological chorioamnionitis was significantly prevalent in cases than in second referents (OR = 4.97). Syphilis was significantly more common in cases than in first (OR = 7.71) and in second referents (OR = 5.30). In the vaginal and endocervical cultures no clearcut pattern was demonstrated, though E. colt was found in 25% of cardiac blood among stillborns at sterile autopsy.
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