Intra Uterine Fetal Death (IUFD) refers to fetal deaths weighing 500 grams or more occurring either during pregnancy or labor. The causes can be categorized into maternal, fetal, placental, iatrogenic, and idiopathic factors, with diagnosis typically involving history, signs, and investigations such as ultrasound and blood tests. Management includes expectant management, induction of labor, and addressing complications, with specific indications for early delivery based on psychological or medical concerns.
Intra Uterine Fetal Death (IUFD) refers to fetal deaths weighing 500 grams or more occurring either during pregnancy or labor. The causes can be categorized into maternal, fetal, placental, iatrogenic, and idiopathic factors, with diagnosis typically involving history, signs, and investigations such as ultrasound and blood tests. Management includes expectant management, induction of labor, and addressing complications, with specific indications for early delivery based on psychological or medical concerns.
Intra Uterine Fetal Death (IUFD) refers to fetal deaths weighing 500 grams or more occurring either during pregnancy or labor. The causes can be categorized into maternal, fetal, placental, iatrogenic, and idiopathic factors, with diagnosis typically involving history, signs, and investigations such as ultrasound and blood tests. Management includes expectant management, induction of labor, and addressing complications, with specific indications for early delivery based on psychological or medical concerns.
Intra Uterine Fetal Death (IUFD) refers to fetal deaths weighing 500 grams or more occurring either during pregnancy or labor. The causes can be categorized into maternal, fetal, placental, iatrogenic, and idiopathic factors, with diagnosis typically involving history, signs, and investigations such as ultrasound and blood tests. Management includes expectant management, induction of labor, and addressing complications, with specific indications for early delivery based on psychological or medical concerns.
• Placental insufficiency Etiology IV. Iatrogenic causes:
• External cephalic version (ECV)
• Drugs like quinine
V. Idiopathic – In 25 – 35% cases
Morbid pathology • Dead fetus undergoes an aseptic degenerative process: maceration
• Epidermis = 1st structure to undergo changes.
Hence, there is blistering & peeling off of the skin – occurs 12 – 24 hrs following death • Fetus : swollen & dusky red in colour • Aseptic autolysis of ligamentous structures & liquefaction of brain matter and other viscera occur • Skull bones overlap, collapsed cranial bones Diagnosis I. History:
• Loss of symptoms of pregnancy
• Failure to gain weight & uterine enlargement
• Cessation of fetal movements
Diagnosis II. Signs:
• Retrogression of breast changes
• Per abdomen: • Gradual decrease in fundal height, becomes < than period of amenorrhea • Uterine tone is ↓, flaccid uterus • Braxton-hicks contraction not easily felt • Fetal movements not felt during palpation • FHS absent • Egg-shell crackling feel of the fetal head (late feature) Diagnosis III. Investigations:
A. USG:
• Gives earliest diagnosis
• Findings: Lack of fetal movements & cardiac activity during a 10 minutes observation Oligohydramnios Collapsed cranial bones Diagnosis III. Investigations:
B. Straight X-ray abdomen (rarely done):
• Spalding sign (7 days after death): - irregular overlapping of cranial bones on one another (due to liquefaction of brain matter & softening of ligamentous structures supporting the vault)
• Roberts’s sign (12hrs following death):
- appearance of gas shadow in the chambers of the heart & great vessels - Note: provides conclusive evidence
• Ball sign: - Hyperflexion of the spine
• Crowding of ribs shadow
Diagnosis III. Investigations:
C. Blood: • Blood fibrinogen and aPTT estimated periodically (when fetus is retained >2weeks) Recommended investigations for stillbirth:
Mother Infant Placenta Umbilical cord
• Hematological: • Look for • Look for • Look for - ABO and Rh malformations malformations entanglement grouping, Kleihauer- • Meconium • Number of blood Betke test staining? vessels - VDRL, TORCH • Weight screening - U&E, creatinine, TFTs, - Post-prandial blood sugar, HbA1c - Anticardiolipin Abs, Thrombophilia studies
• Urine: - Casts and pus cells Complications Psychological upset Infections • If rupture of membranes infection by Cl.welchii (presence of dead tissue favors their growth)
Blood coagulation disorders
• DIC • Occurs if fetus retained > 4 weeks • Due to gradual absorption of thromboplastin liberated from dead placenta & decidua, into the maternal circulation
Complications during labour:
• Uterine inertia • Retained placenta • Postpartum haemorrhage Management – Prevention Note: Conditions that increase risk of recurrence of IUFD:
• Screening of ‘At-risk mothers’ during antenatal care
• Assessment of fetal well being
Management Expectant management (Non-interference) (Fibrinogen level is done weekly)
For 7 – 10 days
If refractory case or if early delivery Spontaneous expulsion within 2
indicated weeks (80% cases)
•Hospitalise •Induce labour Management Indications for early delivery:
1) Psychological upset
2) Uterine infection
3) Falling fibrinogen level
4) Tendency of prolongation of pregnancy >2weeks
Management – Method of delivery (Should always be done by medical induction of labour) Cases where delivery is indicated
Cervix favourable Cervix not favourable
Oxytocin infusion Prostaglandins: Start with 5-10 units of oxytocin in 500ml of 1. PGE2 gel vaginally Ringer’s lactate (can then be 2. PGE1 tab 25-50 µg vaginally /orally ↑ upto 40 units)
Fails Fails
Repeat oxytocin & Supplement with
supplement with oxytocin prostaglandin Fetus delivered Management – Method of delivery Caesarean section:
