Factors associated with fetal mortality in the triethnic population in texas, 1993 through 1995.

We examined the underlying causes of fetal deaths reported for 1993 through 1995 in relation to the mother's ethnicity, reproductive history, and medical factors listed on birth and fetal death certificates. The overall fetal mortality rate (FMR) was 6.3 per 1000 live births plus fetal deaths, and 5.6, 5.9, and 9.8 per 1000, respectively in pregnancies of white, hispanic, and black women. Preterm birth (low birth weight) was a major predictor (or consequence) of fetal death, and extremes of maternal age, increased parity, and plural pregnancies were also associated with increased FMRs, especially in black women. The underlying causes reported on fetal death certificates were complications of the placenta, cord, and membranes (36%); ill-defined conditions arising in the perinatal period (23%); fetus affected by maternal complications of pregnancy (10%); fetus affected by maternal conditions unrelated to pregnancy (6%); and short gestation and unspecified low birth weight (5%); 14% of fetal deaths were associated with congenital abnormalities. Factors reported most frequently were premature rupture of the membranes, disorders of amniotic fluid volume, pregnancy-associated hypertension, diabetes, anemia, previous preterm or small-for-gestational-age births, incompetent cervix, chronic hypertension, and sexually transmitted diseases. More than 40% of fetal deaths were not associated with any medical risk factor. FMRs associated with maternal anemia, cardiac disease, pregnancy-associated hypertension, eclampsia, and previous birth weighing more than 4 kg were at least 1.5 times higher in pregnancies of black women than in the other 2 ethnic groups. The underlying causes of fetal death provide few targets for their primary prevention; preventive efforts might better be directed to the closer surveillance and care of pregnant women with demographic, reproductive, and medical factors associated with increased risk.