IUFD

INTRA UTERINE FETAL COM PLICATIONS

 Definition
◦Antepartum death occurring after 28 weeks but
before birth and retained within the uterus
◦Intrauterine fetal death: is the clinical term for the
death of a baby in the uterus, during pregnancy and
before birth.
◦The term is usually used for pregnancy losses that
happen after the 20th week of gestation.
 IMPACTS

Emotionally challenging for:

- HCW
- Parents
◦ Increases medical legal risk
◦ Indicator of country’s health care system
 AETIOLOGY
MATERNAL CAUSES
◦ Preeclampsia/ eclampsia
◦ A.P.H.
◦Diabetes
◦Severe anemia
◦Hyperpyrexia/Malaria
◦ TORCH infections
◦ Rh-incompatibility
 FOETAL CAUSES

• Multiple gestation
• IUGR
• Congenital anomalies
• Infections
• Hydrops (immune & non-immune)
• Birth Defects
 PLACENTAL CAUSES

• Abruption
• Cord accidents
• Placental insufficiency
• Placenta previa
• Chorioamnionitis
• PROM
• Feto-maternal hemorrhage
 DIAGNOSIS
◦Symptoms: Absence of foetal movements
◦Signs: Retrogression of the positive breast changes
◦Per abdomen
- Gradual retrogression of the height of the uterus
- Uterine tone is diminished
- Foetal movement are not felt during palpation
- Foetal heart sound is not audible
 INVESTIGATIONS
• USG (100%) + Associated features can be noted(
oligohydromnios, hydrops)
• Straight- X-ray abdomen (obsolete)
-Robert’s sign : Appearance of gas shadow (in 12 hours)
Spalding sign: Collapse skull bones (usually appears 7
days after )
 Ct……
◦Ball sign : Hyper flexion of the spine
◦ Helix sign : Gas in umbilical arteries
◦Crowding of the ribs shadow
 Management
• Depends on:
- Single or multiple gestation
- Gestation age at death
- Parents wish (varied response)
◦ Expectant approach
- 80% goes in labour with in 2-3 weeks
- Emotional burden, risk of Chorioamnionitis & DIC
Active approach
 Induction of labour
◦Fetal death <28weeks
-Mifepristone 200 mg followed by Misoprostol
400 μg 4 - 6 hourly most effective with shortest I-D
interval
• Fetal death >28weeks
- Cervical ripening (mechanical or chemical)
followed by Oxytocin induction
 Pain Management
• Higher doses of narcotics are available to the patient
and often a morphine is sufficient for successful pain
control
◦Should a patient desire superior pain control to
intravenous narcotics, epidural anesthesia should be
offered
 Post delivery
◦ Emotional support & Counseling as they are at
increased risk of PPD
◦Keep in non maternity ward
◦ Suppression of lactation (tight breast support,
dopamine agonists, estrogen)
◦ Counsel for future pregnancy, early ANC visit,
preconceptional testing
◦ Assurance in cases of non recurring causes
◦ Contraceptive counseling
 Complications
◦Infection
◦ PPH
◦ Retained placenta
◦ Abruption
◦ DIC
◦ Shock, renal failure
◦ Sepsis
◦ Maternal death
When you loose a person you love so much,
surviving the loss is difficult”