Intrauterine Fetal Death: Prepared By: Roshni Adhikari Roshani Sunar Sabina Ranabhat Sadhana Devkota

Intrauterine
Fetal Death
Prepared by :
Roshni Adhikari
Roshani Sunar
Sabina Ranabhat
Sadhana Devkota
Introduction
• When the baby is less than 500 grams with gestational period less
than 22 weeks and if death occurs, it is missed abortion and not
considered as intrauterine fetal death.
• After 22 weeks with weight greater than 500 grams is intrauterine
fetal death.
• Definition: Death of the fetus after the period of viability in the
uterus,either in antepartum period(during pregnancy) or intrapartum
period( during labor) is intrauterine fetal death (iufd).
Etiology
• Th fetal death is related to maternal (5-10%), placental(20-35%) or fetal
(25-40%) conditions.
A. Maternal condition:
- Hypertensive disorders in pregnancy.
- Diabetes
- Maternal infections( malaria, hepatitis, influenza, toxoplasmosis,syphilis).
- Hyperpyrexia(temperature >39.4°C).
- Abnormal labor (prolonged or obstructed)
- Post term pregnancy.
Cont’d...
B. Fetal condition: C. Placental condition:
- IUGR - Antepartum hemorrhage
- Infection(viral or bacterial) - Cord accident
- Rh incompatibility - Placental insufficiency
- Hydrops fetalis - Twin to twin transfusion
syndrome.
Diagnosis
• Symptoms- absence of fetal movements , which were previously
noted by the patient.
• Per abdomen-
I. Gradual retrogression (decrease) of fundal height and it becomes
smaller then period of gestation.
II. Fetal movements aren’t felt during palpation.
III. Fetal heart should isn’t heard.
IV. Cardiotocography(CTG) flat trace.
V. Egg shell crackling of fetal head is a late feature.
Cont’d
• Investigations-
A. Ultrasonograpy : collapsed cranial bones, abnormal fetal head
shape, reduced or absent amniotic fluid.
B.X-ray (abdomen): the following features may be found either singly
or in combination.
• Splading sign – the overlapping of the cranial bones on one another
is due to liquefaction of brain matters & softening of ligamentous
structure supporting the vault.
( It usually appears 7 days after death).
Cont’d
• Hyperflexion of the spine- in some cases, hyperflexion of the neck is
seen.
• Crowding of the ribs
• Robert’s sign – Appearance of the gas shadow in the chamber of
heart and great vessels.
Management
• Missed abortion ( before 22 weeks) is usually managed by dilatation
and evacuation.
• For IUFD, we have two different approaches :
I.Expectant management : About 80 % of patients will experience
spontaneous onset of labour within 2 -3 weeks of fetal demise. The
remaining patient not delivered spontaneously we can deliver them by
induction .
Cont’d
II. Induction of labour :
-The justification for this is to avoid : -
•Emotional burden on the mother of carrying dead fetus.
•10% risk of DIC if the fetus retained for 5 weeks.
•Small possibility of intrauterine infection .
-Induction is carried by prostaglandin E2 supp. if the cervix is
unfavorable ,intravenous oxytocin if the cervix is favorable .
Cont’d
• Prepare for Caesarean section (If Placenta praevia, Previous two LSCS
and Transverse lie)
# Post delivery management :-

- psychological support
- sedation
- suppression of lactation {Bromocriptine}
- evaluation of still born foetus, placenta - membranes & amniotic fluid
Prevention
• Preconceptional counseling and care is essential to prevent its
occurrence in the high-risk group.
• Prenatal diagnosis —CVS or amniocentesis in selected cases .
• To screen the “at-risk mothers” during antenatal care. Careful
assessment of fetal well-being to terminate pregnancy with the
earliest evidences of fetal compromise .
Complications
• Psychological – trauma to mother and family(increased anxiety and
postpartum depression).
• Coagulation disorders- defibrination syndrome if fetus remains more
than 4 weeks(silent DIC- 10-20%).
• Abnormal uterine contractions
• Retained placenta
• Postpartum hemorrhage
A baby of intrauterine
fetal death in PAHS of
32 weeks of gestation.

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