Unexplained intrauterine death near term.

In Victoria, in 1984, intrauterine hypoxia of unknown aetiology accounted for 59 of the 252 perinatal deaths of infants with a birth-weight of 2,500 g or more. These unexplained deaths occur in approximately 1 in 1,000 pregnancies near term, and in more than 90% of cases the infants are neither small nor large for dates (tables 1 and 2). In 27 of the 59 cases, a fetoplacental function test (oestriol assay, cardiotocography) had been performed, and in 6 glucose tolerance had been tested either before or after the fetal death occurred. We endorse recent recommendations that all pregnant women should be screened for gestational diabetes at approximately 24-28 weeks' gestation as a possible means of reduction in the number of intrauterine deaths of mature infants. Consideration of these cases indicates that induction of labour should not be deferred after 37-38 weeks' gestation in high risk pregnancies, merely because tests of fetoplacental function are normal--i.e. laboratory tests should not outweigh clinical judgment especially in high risk pregnancies! It is considered that the cost of identification of these infants at risk of 'unexplained death', if possible, is likely to be justified by the fact that they are mature and apparently normal.