Wichihiufklh

GENERAL OBJECTIVE
At the end of the lesson, the students should be to

demonstrate an understanding of intra uterine fetal death.
INTRA-UTERINE FETAL
DEATH
At the end of the lesson the students should be able to:
1. Define Intra-uterine fetal death.

2. State the causes of fetal death..
3. State the signs and symptoms of fetal death.
4. State the investigations done to confirm fetal death.
5. Discuss the management of fetal death.
6. State the complications of fetal death.
7. State the preventive measures of IUFD.
SPECIFIC OBJECTIVE:
Intra uterine fetal death is the death of the fetus
before birth and is also called an abortion.
If fetal death occur later in pregnancy i.e. at
20weeks of gestation or more are sometimes
called as still births.
DEFINITION
• A large percentage of IUDs after 20weeks are due to fetal
anoxia from placental insufficiency.
• The predisposing factors are divided into:
CAUSES/PREDISPOSING
FACTORS OF FETAL DEATH
DURING PREGNANCY
• Chronic conditions such as diabetes, TB, Cardiac
diseases and chronic anaemia.
• Sexual transmitted diseases such syphilis
• Accidents or trauma during pregnancy leading to
antepartum haemorrhage and uterine rupture.
• When the cord is tightly wound around the fetal neck or
body.
• Oligohydramnios
• Rhesus incompatibility ( iso- immunization).
DURING LABOUR
• Prolonged labour.
• Malpresentations.
• Anaesthetics.
• Precitate labour.
• Obstructed labour
HISTORY
• The mother reports of not feeling fetal movements, no
abdominal growth and a brownish vaginal discharge.
CLINICAL FEATURES
• Size of the uterine is less than that suggested expected
EDD.
SIGNS AND SYMPTOMS

• No fetal heart can be heard using Pinard”s stethescope.
• An improvement in maternal condition will be noticed in
case of diabetes mellitus, gestational proteinuric
hypertension.
• The signs of pregnancy subside: the breasts soften and
may secrete discharge and no further nausea.
• Decrease in maternal weight.
• The soft collapsed skull can be felt on vaginal
examination.
• The fetus slumps in the lower pole of the uterus, often in
a transverse lie.
• Placental function Tests reveals low levels of HPL.
• Ultra sound reveals the following:
-No fetal heart, limb movements and no breaths.
-The bi- parietal cephalometry show no increase in growth
at weekly interval.
INVESTIGATION TO
CONFIRM IUFD
• There is a double skeleton outline.
• Loss of fetal structure with a collapsed thorax and mis-
shapen skull.
• There is an abnormal reduction in liquor.
• X-ray: Spalding’s sign-This is overlapping of the cranial
bones due to shrinkage of the brain.
SPECIFIC OBSTETRICAL MANAGEMENT
• The client is referred to an Obstetrician once fetal death
is suspected who will confirm the condition.
• Ensure psychological support to the client and her
partner.
MANAGEMENT OF IUFD
1. Confirmation of the fetal death.
2. Decide whether it is an intra-uterine or an extra-uterine
pregnancy
3. Determine the cause of fetal death.
4. Consider the effects on the mother both psychological
and physical.
PRINCIPLES OF
OBSTETRICAL MANAGEMENT
5. Decide on the time and the mode of delivery.
• There is no physical urgency in management but it can be
upsetting for the mother to know that she is carrying
around a dead fetus.
• If she does not go in spontaneous labour within 3 weeks
after fetal death, induction of labour is done.
• After delivery, the baby is examined and weighed.
• Ask the family if they want to bury or not, and if is to
incinerate let them put it in written.
• If the doctor wishes to investigate the cause of death, the
placenta and membranes are sent in suitable container to
the laboratory.
GENERAL MANAGEMENT
AFTER DELIVERY
• Ensure psychological support to the family, listen to their
concerns.
• Discharge the mother after 24-48hrs if the condition is
satisfactory.
• Encourage the mother to attend post natal clinic in six
weeks as this will provide her an opportunity for family
planning.
1. Intra uterine infections.
2. Septiceamia.
3. Infertility due to infection
COMPLICATIONS OF IUFD
4. Mental trauma
5. Post partum Haemorrhage
6. Disseminated Intravascular Coagulation: This is a rare
complication, which is due to the thromboplatins that are
liberated from degenerating placenta and the fetus.
• Some measures can be taken during antenatal period
while others are inevitable.
• The inevitable include; severe chromosomal or genetic
defects, implantation of the ovum in the abnormal places,
abnormalities of the genital tract and by accidents.
PREVENTION OF IUFD
The measures taken for those prevented causes are as
follows:
• Good antenatal care: Ensure early detection of the
predisposing causes of intra uterine death and the
correct management of these conditions.
• I.E.C on the importance of having a balanced diet and
supplement.
• Early treatment of sexual transmitted infections.
• Good management during labour and induction of labour.
• Genetics counseling.
THANK YOU.

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GENERAL OBJECTIVE

At the end of the lesson, the students should be to

1. Define Intra-uterine fetal death.

SIGNS AND SYMPTOMS

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