FETAL DEATH

ADRIAN SETIAWAN,M.D.

 Definition : include only those dead fetuses and

neonates at after 19 weeks , or if gestational age is not available, weighing 350 grams or more Causes of Fetal Death : fetal, placental, and maternal.

Fetal causes
Fetal 25 to40 percent :

- Chromosomal anomalies - Nonchromosomal birth defects - Non imune hydrops - Infections viruses (CMV, Parvovirus B19,rubella, varicella), bacteria (ascending bacteria, syphilis), protozoa(toxoplasmosis)

Placental causes 25to 40%

Prematurely ruptured membranes

Abruption
Fetomaternal hemorhage Cord accident

Placental insufficiency
Intrapartum asphyxia Previa

Twin-twin transfusion syndrome

Chorioamnionitis

Maternal causes 5 to 10%

Diabetes, Hypertensive disorders,obesity

Thyroid disease, renal disease

Thrombophilias, antiphospholipid antibodies Smoking, age > 35, illicit drugs, alcohol

Infections, sepsis
Preterm labor, abnormal labor, posterm Uterine rupture

Protocol for examination of stillbirth

Infant description :

- malformation - skin staining - degree of maceration - color-pale

 Umbilical cord :

- prolapse - entanglement-neck,arms,legs - hematomas - number of vessels - length - wharton jelly-normal, absent

 Amniotic fluid :

- color-meconium, blood - consistency - volume

 Placenta :

- weight - staining-meconium - adherent clots -structural abnormalities- circumvallate,accessory lobes,velamentouse - edema-hydropic changes

 Membranes :

- stained meconium - thickening

 Psychological Aspects

Fetal death is psycologically traumatic for the woman and her family. The woman experiencing a stillbirth or even an early miscarriage is at risk for postpartum depression and should be closely monitored.

- Pregnancy After previous stillbirth There are very few conditions associated with recurrent stillbirth - Knowledge of the cause of fetal death results in a more precise calculation of individual recurrence risk and in many cases allows a mangement plan to be made