Sudden Fetal Death Managed by Cesarean Delivery: Case Report and Literature Review

Background: Sudden fetal death (stillbirth) is common in low-income countries although it has always been underreported. There are few published studies in medical literature regarding the situation in Cameroon. It is often difficult to determine with certainty the cause of fetal death in Cameroon. We are describing the case of sudden fetal death managed at the Douala General Hospital and highlighting the pitfalls of etiologic diagnosis. Case presentation: MC, a 30-year-old G2P0010, blood group O rhesus positive, unemployed, Jehova witness and married lady of the Bassa tribe of Cameroon was admitted to our department at 32 3/7 weeks gestation because of reduced fetal movements of two days onset. This was her second antenatal care visit and she had no previous ultrasound scan. Her medical history is consistent with a spontaneous abortion at 6 weeks’ gestation (no pathology or genetic studies done) and threatened abortion at 19 2/7 weeks gestation during the current pregnancy that was managed with bedrest. She has secondary level of education. On examination the blood pressure was 108/85 mmHg and body mass index (BMI) was 25 kg/m2. Her temperature was 37.50C and pulse rate was 80 beats per minute. There was milk letdown on breast expression. The uterine height was 30 cm and the lie was longitudinal. The fetal heart tones were absent. The diagnosis of Sudden Fetal Death (SFD) with myoma previa was confirmed at ultrasonography. Her hemoglobin level was 9.2 g/dL and she underwent cesarean delivery with myomectomy. The etiologic diagnosis was never obtained despite verbal autopsy and post mortem clinical examination of the macerated fetus. No autopsy was done on fetus. Conclusion: Sudden fetal death is a tragic obstetric accident. In our setting, verbal autopsy, ultrasonography and post mortem examination of the fetus are the cornerstones for an etiologic diagnosis. Management should be with a multidisciplinary team for better outcomes. Maternal anemia may be a contributing factor of stillbirth but the etiologic diagnosis of SFD is seldom made in our setting.