Late fetal death associated with unrecognized pregnancy: case report, narrative literature review, and public health implications
DOI:
https://doi.org/10.70577/asce.v5i3.852Keywords:
stillbirth; unrecognized pregnancy; cryptic pregnancy; prenatal care; fetal growth restriction.Abstract
Introduction: Late fetal death continues to be a major global public health problem, with nearly two million cases annually, primarily in low- and middle-income countries. Unrecognized pregnancy is a rare condition that increases the risk of adverse obstetric outcomes due to the lack of prenatal care and delays in identifying risk factors. The objective was to describe a case of late fetal death associated with an unrecognized pregnancy and to analyze its clinical and public health implications.
Methodology: A clinical case report was conducted, supplemented by a narrative review of the literature. The information was obtained from the medical record, laboratory tests, obstetric ultrasound, and pathological evaluation of the placenta.
Clinical Case: A 39-year-old multiparous woman, a user of hormonal contraceptives, who was unaware of her pregnancy and presented with abdominal pain. Clinical and ultrasound evaluation confirmed intrauterine fetal death. Spontaneous vaginal delivery resulted in the delivery of a 36-week-old male fetus with intrauterine growth restriction and advanced maceration. Maternal tests revealed mild anemia, and the placenta showed uteroplacental insufficiency.
Conclusions: The combination of an unrecognized pregnancy, lack of prenatal care, advanced maternal age, obesity, anemia, intrauterine growth restriction, and placental insufficiency likely contributed to the fatal outcome. Timely diagnosis of pregnancy, universal access to prenatal care, and early identification of risk factors are essential strategies for reducing preventable fetal mortality.
Downloads
References
1. Lawn JE, Blencowe H, Waiswa P, Amouzou A, Mathers C, Hogan D, et al. Stillbirths: rates, risk factors, and acceleration towards 2030. Lancet. 2016;387(10018):587-603. doi:10.1016/S0140-6736(15)00837-5. DOI: https://doi.org/10.1016/S0140-6736(15)00837-5
2. GBD 2021 Stillbirths Collaborators. Global, regional, and national stillbirths at 20 weeks' gestation or longer, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2024;403(10436):1570-1584. doi:10.1016/S0140-6736(23)02439-4.
3. Flenady V, Middleton P, Smith GC, Duke W, Erwich JJ, Khong TY, et al. Stillbirths: the way forward in high-income countries. Lancet. 2011;377(9778):1703-17. doi:10.1016/S0140-6736(10)62310-1. DOI: https://doi.org/10.1016/S0140-6736(11)60064-0
4. Pons A, Sepúlveda E, Leiva J. Muerte fetal: enfoque clínico y epidemiológico. Rev Med Clin Las Condes. 2014;25(6):945-52. doi:10.1016/S0716-8640(14)70638-8. DOI: https://doi.org/10.1016/S0716-8640(14)70638-8
5. Aminu M, Unkels R, Mdegela M, Utz B, Adaji S, van den Broek N. Causes of and factors associated with stillbirth in low- and middle-income countries: a systematic review. BMC Pregnancy Childbirth. 2014;14:303. doi:10.1186/1471-2393-14-303. DOI: https://doi.org/10.1111/1471-0528.12995
6. Smith GC. Life-course approaches to stillbirth prevention. Lancet. 2017;390(10098):1202-4. doi:10.1016/S0140-6736(17)31515-0.
7. Silver RM, Varner MW, Reddy UM, Goldenberg R, Pinar H, Conway D, et al. Work-up of stillbirth: a review of the evidence. Obstet Gynecol. 2007;109(1):115-24. doi:10.1097/01.AOG.0000259315.07232.e7.
8. Fretts RC. Etiology and prevention of stillbirth. Am J Obstet Gynecol. 2015;213(5):597-604. doi:10.1016/j.ajog.2015.03.020. DOI: https://doi.org/10.1016/j.ajog.2015.03.020
9. Gardosi J, Madurasinghe V, Williams M, Malik A, Francis A. Maternal and fetal risk factors for stillbirth: population based study. BMJ. 2013;346. doi:10.1136/bmj.f108. DOI: https://doi.org/10.1136/bmj.f108
10. Dudley DJ. Diabetic-associated stillbirth: incidence, pathophysiology, and prevention. Obstet Gynecol Clin North Am. 2007;34(2):293-307. doi:10.1016/j.ogc.2007.03.001. DOI: https://doi.org/10.1016/j.ogc.2007.03.001
11. Ananth CV, Basso O, et al. Hypertensive disorders and risk of stillbirth. Obstet Gynecol. 2015;125(1):109-18. doi:10.1097/AOG.0000000000000567. DOI: https://doi.org/10.1097/AOG.0000000000000567
12. Tennant PWG, Rankin J, Bell R. Maternal obesity and risk of stillbirth. BJOG. 2014;121(1):152-60. doi:10.1111/1471-0528.12570.
13. Aune D, Saugstad OD, Henriksen T, Tonstad S. Maternal body mass index and risk of fetal death, stillbirth, and infant death: a systematic review and meta-analysis. JAMA. 2014;311(15):1536-46. doi:10.1001/jama.2014.2269. DOI: https://doi.org/10.1001/jama.2014.2269
14. McPherson JA, Odibo AO, Shanks AL, et al. Hypertension in pregnancy and risk of stillbirth. Am J Obstet Gynecol. 2016;214(2):261.e1-261.e9. doi:10.1016/j.ajog.2015.08.024. DOI: https://doi.org/10.1016/j.ajog.2015.08.024
15. Redline RW. Placental pathology in stillbirth. Placenta. 2009;30(Suppl A). doi:10.1016/j.placenta.2008.09.015. DOI: https://doi.org/10.1007/978-1-4419-1069-1_22
16. Bukowski R. Placental insufficiency and fetal demise. Semin Perinatol. 2014;38(3):119-24. doi:10.1053/j.semperi.2013.11.003. DOI: https://doi.org/10.1053/j.semperi.2013.11.003
17. Salafia CM, Vintzileos AM, Silberman L, Bantham KF, Vogel CA. Placental lesions associated with stillbirth. Placenta. 2010;31(9):749-56. doi:10.1016/j.placenta.2010.04.011. DOI: https://doi.org/10.1016/j.placenta.2010.04.011
18. Baergen RN. Placental pathology and stillbirth. Arch Pathol Lab Med. 2015;139(5):698-703. doi:10.5858/arpa.2013-0677-RA.
19. Pinar H, Goldenberg RL, Koch MA, Heim-Hall J, Hawkins HK, Shehata BM, et al. Placental findings in stillbirths. Pediatr Dev Pathol. 2014;17(1):1-9. doi:10.2350/13-03-1316-OA.1.
20. Rac MWF, Revell PA, Eppes CS. Viral infections during pregnancy and stillbirth risk. Obstet Gynecol. 2014;123(1):118-26. doi:10.1097/AOG.0000000000000106. DOI: https://doi.org/10.1097/AOG.0000000000000106
21. Lawn JE, Blencowe H, Waiswa P, et al. Infections as causes of stillbirth. Lancet. 2016;387(10018):1483-92. doi:10.1016/S0140-6736(16)30369-7. DOI: https://doi.org/10.1016/S0140-6736(16)00039-8
22. Heazell AEP, Siassakos D, Blencowe H, et al. Stillbirth prevention and bereavement care. BMJ Med. 2023;2. doi:10.1136/bmjmed-2022-000262. DOI: https://doi.org/10.1136/bmjmed-2022-000262
23. Bhutta ZA, Yakoob MY, Lawn JE, et al. Stillbirth prevention and interventions. Lancet. 2014;384(9957):347-70. doi:10.1016/S0140-6736(14)60792-3. DOI: https://doi.org/10.1016/S0140-6736(14)60792-3
24. Okwaraji YB, et al. Risk of stillbirth by fetal size: a systematic review and meta-analysis. BJOG. 2024. doi:10.1111/1471-0528.17890. DOI: https://doi.org/10.1111/1471-0528.17890
25. American College of Obstetricians and Gynecologists. Management of stillbirth. Obstetric Care Consensus No. 10. Obstet Gynecol. 2020;135(3). doi:10.1097/AOG.0000000000003700. DOI: https://doi.org/10.1097/AOG.0000000000003719
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Cruz M. Zerna Bravo, Ramón M. Vargas Vera, Byron G. Alcívar Zerna, Shayra J. Álvarez Reyes, James F Calan Estrada, Martha Placencia Ibadango
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Eres libre de:
- Compartir : copiar y redistribuir el material en cualquier medio o formato
- Adaptar : remezclar, transformar y desarrollar el material
- El licenciante no puede revocar estas libertades siempre y cuando usted cumpla con los términos de la licencia.
En los siguientes términos:
- Atribución : Debe otorgar el crédito correspondiente , proporcionar un enlace a la licencia e indicar si se realizaron cambios . Puede hacerlo de cualquier manera razonable, pero no de ninguna manera que sugiera que el licenciante lo respalda a usted o a su uso.
- No comercial : no puede utilizar el material con fines comerciales .
- CompartirIgual — Si remezcla, transforma o construye sobre el material, debe distribuir sus contribuciones bajo la misma licencia que el original.
- Sin restricciones adicionales : no puede aplicar términos legales ni medidas tecnológicas que restrinjan legalmente a otros hacer algo que la licencia permite.
