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IUD

An IUFD is fetal death that occurs after 24 weeks of gestation but before the onset of labor. It complicates about 1% of pregnancies. Causes include maternal conditions like APL syndrome, diabetes, infections, and placental issues. Fetal causes include genetic anomalies, birth defects, and hydrops. Management involves either waiting 2-3 weeks for spontaneous labor or inducing labor medically if there are risks like infection or DIC. The follow up includes determining the cause of death and managing future pregnancies as high risk.

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81 views9 pages

IUD

An IUFD is fetal death that occurs after 24 weeks of gestation but before the onset of labor. It complicates about 1% of pregnancies. Causes include maternal conditions like APL syndrome, diabetes, infections, and placental issues. Fetal causes include genetic anomalies, birth defects, and hydrops. Management involves either waiting 2-3 weeks for spontaneous labor or inducing labor medically if there are risks like infection or DIC. The follow up includes determining the cause of death and managing future pregnancies as high risk.

Uploaded by

ahmed shorsh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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IUFD

Definition: is fetal death after 24 weeks’ gestation but


before the onset of labour
It complicates about 1% of pregnancies
Diagnosis
-Absence of uterine growth
-Loss of fetal movement
- Disappearance of the signs & symptoms of pregnancy
- Fetal heart cannot be detected using Doppler device
X-ray Spalding sign overlapping and disalgnment of the
skull bones.
Robert’s sign : the presence of gas in the fetal heart and
great vessels.
Acropad sign:( angulations of the fetal spine, exaggeration
of fetal spinal curvature .
U/S 100% accurate Dx(-ve fetal heart movement)
Causes OF IUFD
Maternal
•APL syndrom: auto immune disease maternal Abs attack
PhL of cell membrane of maternal Bd vessel & placenta.
•DM: if poorly controlled .
•HPT &PET :decrease placental Bd supply by
spasim ,thrombosis & placental separation( AP).
•Maternal infection; any disease causing fever & sepsis.
TORCHS cause cong.abn & if severe FD.
•Post term pregnancy
•Drugs
•Thrombophilia
•Cyanotic heart disease
Unexplained placental insufficiency occur in successive
pregnancies ,the placenta is small but normal in other
aspects.
Causes OF IUFD
Fetal causes
•Chromosomal anomalies
•Birth defects & genitic syndroms
•Non immune hydrops
• Haemolytic disease : e.g. RH iso-immunization ,If the
fetal anaemia is sever enough, fetal hydropes ,HF and
subsequent demise follows.
Placental
•Abruption
•Cord accidents is more with abnormal lie or breech ,In
these conditions true knot or constriction of the cord
around a limb or neck will occur.
•Twin to twin transfusion Syndrom
•Chrioamnionitis
Pathological anatomy:
1- The fetus is usually born in a macerated
condition. Maceration occurs rapidly, and
may be advanced within 24 hours of fetal
death.
2- The whole body is softened and toneless.
3- The cranial bones are loosened and easily
moveable on one another.
4- The liquor and the fluid in all the serous
cavities contain blood pigments.
Complications of IUFD:
1- Infection and chorioaminitis: when the
membrane is ruptured.
2- Hypofibrinoginemia or DIC, when the fetus
is dead more than 4 weeks.
3- PPH.
4- Psychological upset of the mother.
Management
- Conservative approch:
About 80% of the a pt experience spontaneous onset of
labour with in 2-3 weeks of fetal death.

- Active approch by induction of labour is indicated for:


1- An emotional burden on the mother.
2- Slide possibility of chorioaminitis.
3- 10% risk of DIC if death > 4 weeks.
4- Signs & symptoms of hypofilbrinogenemia.

F/U: to determine cause of death. Screening for diseases,


infections (TORCH), and chromosomal anomalies.
Manage next pregnancies as high-risk
The way of induction of labour is by :
- Prostaglandin E2 vaginal suppositories or
prostaglandin E1 analogs ( misoprostol ) oral
rectal or vaginal.
- Oxytocin infusion.
- Intra-amniotic injection of hypertonic
solution of urea.
- Amniotomy is not done because of the risk
of infection.

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