Name of students : Miss.

Sonali moreshwar dikondwar

Venue :pooja nursing college bhandara

Date :

Group : 4th year BSc

Topic : intra uterine death

Method of teaching : Demonstration method

Audio visual aids : chart, board, bulletin board ,leaflet

Previous knowledge : The students have somewhat previous knowledge regarding the
intra uterine death
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Activity

1 2 min Definition of
DEFINITION Lecture cum chart . students will
intra uterine discussion able to define
death Intrauterine fetal death refers to
Intra Uterine
babies with no signs of life in utero death

after 24 completed weeks of

gestation or weighing > 500gm.

2 10 min Enlist causes CAUSES

The RCOG guideline NO. 55 states that
parents should be told that no specific
cause is found in 50% cases
Maternal
Fetal
placental
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Lecture cum board Students will
discussion able to tell
MATERNAL causes
Obesity
Maternal age
Smoking
Infection
Thyroid disease
Anemia
RH incompatibility
Autoimmune disorder
Hyperpyrexi
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Definition of Abruption Lecture cum . able to define
uterine prolapse discussion definition of
thrombophebitis
Uterine
prolapse
FETAL
Multiple gestation
IUGR
Congenital abnormality
Infection
Hydrops
Birth deffect
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Time Aids
Activity

PLACENTAL CAUSE Lecture

cum
Abruption discussion
• Cord accidents Placental
insufficiency

Placenta previa
TTTS
Chorioamnionitis
PROM
Feto-maternal hemorrhage Iatrogenic- ECV, Drug overdoses
USG (100%) Associated
features can be noted
(oligo,
Absence of fetal Decreased fundal hydrops) • Straight- X-ray
movements height abdomen (obsolete)
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Lecture
Loss of signs & No fetal Robert's sign : Appearance cum
discussion
symptoms of movements/ of gas shadow (in 12 hours)
pregnancy FCA
Spalding sign: Collapse
skull bones (usually
appears
7 days after )
Ball sign : Hyperflexion of
the spine
HISTORY EXAMINATION Helix sign : Gas in umbilical
arteries
Crowding of the ribs
shadow
INVESTION
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3 5 min Describe
DIAGNOSIS Lecture cum board Students will
diagnosis of discussion able to
intra uterine • Real-time ultrasonography is essential for
death Intra Uterine
the accurate diagnosis of IUFD. death

• A second opinion should be obtained

whenever practically possible.
Mothers should be prepared for the
possibility of passive fetal

movement. If the mother reports passive

fetal movement after the scan to diagnose
IUFD, a repeat scan should be offered.
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4 5 min Describe Lecture cum Bulletin Students will

investigation of INVESTIGATION OF THE discussion board able to
intra uterine describes intra
death CAUSE Uterine death

Clinical assessment and laboratory tests

should be recommended to assess
maternal wellbeing (including
coagulopathy) and to determine the cause
of death, the chance of recurrence and
possible means of avoiding further
pregnancy complications.
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5 20 min Describe MANAGEMENT Lecture cum chart Students will

management of discussion able to
intra uterine LABOUR AND BIRTH describe Intra
death Uterine death
• Recommendations about labour and birth should
take into

account the mother's preferences as well as her

medical condition and previous intrapartum
history.
Women should be strongly advised to take
immediate steps

towards delivery if there is sepsis, preeclampsia,

placental abruption or membrane rupture, but a
more flexible approach can be discussed if these
factors are not present.
Vaginal birth is the recommended mode of
delivery for most women
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• More than 85% of women with an IUFD Lecture cum

discussion
labour spontaneously within three weeks
of diagnosis
Vaginal birth can be achieved within 24
hours of induction of labour for IUFD in
about 90% of women
• Caesarean birth might occasionally be
clinically indicated by virtue of maternal
condition.
•
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Lecture cum
INDUCTION OF LABOUR discussion
Misoprostol can be used in
preference to prostaglandin E2
because of equivalent safety
and efficacy with lower cost
Women should be advised that
vaginal misoprostol is as effective
as oral therapy but associated with
fewer adverse effects.
Misoprostol can be safely used for
induction of labour in women with
a single previous LSCS and an IUFD
but with lower doses
Women with more than two
LSCS deliveries or atypical scars
should be advised that the
safety of induction of labour is
unknown
Mechanical methods of induction
might increase the risk of a
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Lecture cum
INTRAPARTUM ANTIBIOTIC discussion
PROPHYLAXIS

Women with sepsis should be treated with

intravenous broadspectrum antibiotic
therapy (including antichlamydial agents).
Routine antibiotic prophylaxis
should not be used
WOMEN LABOURING WITH A
SCARRED UTERUS
Women undergoing VBAC should be
closely monitored for features of scar
rupture.
Oxytocin augmentation can be
used for VBAC, but the
decision should be made by a
consultant obstetrician.
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Lecture cum
PUERPERIUM discussion

Women should be cared for in an

environment that provides adequate safety
according to individual clinical
circumstance
• Some women have acute medical
problems after birth, e.g.
sepsis, pre-eclampsia, etc., with continuing
critical care needs.
• Heparin thromboprophylaxis should be
discussed with a haematologist if the
woman has DIC.
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Lecture cum
LACTATION discussion
Women should be advised that dopamine
agonists successfully suppress lactation in a
very high proportion of women and are
well tolerated by a very large majority;
cabergoline is superior to bromocriptine.
Dopamine agonists should not be given to
women with hypertension or pre-
eclampsia.
Estrogens should not be used to suppress
lactation.
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Lecture cum
POSTMORTEM discussion

EXAMINATION
• Parentsshould be offered full postmortem
examination to help explain the cause of
an IUFD.
Parents should be advised that
postmortem examination provides more
information than other (less invasive) tests.
Attempts to persuade parents to choose
postmortem must be avoided;
individual, cultural and religious beliefs
must be respected.
Written consent must be obtained for any
invasive procedure on the baby including
tissues taken for genetic analysis.
Parents should be offered a description of
what happens during the procedure.
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6 5 min Describe legal Lecture cum bulletin Students will
issue LEGAL ISSUES discussion board able to
Obstetricians and midwives should be describe legal
issue of intra
aware of the law related to stillbirth. Uterine death

The following practice guidance is derived

from statute and code of practice.
• Stillbirth must be medically certified by a
fully registered doctor or midwife.
The doctor or midwife must have been
present at the birth or examined the baby
after birth.
Police should be contacted if there is
suspicion of deliberate action to cause
stillbirth.
The baby can be registered as
indeterminate sex awaiting further tests.
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7 5 min describe folloew

FOLLOW UP Lecture cum chart Students will
up of intra discussion able to
uterine death describe
The wishes of the woman and her partner follow up of

should be considered when arranging Intra Uterine

follow-up death

• Women should be offered general

prepregnancy advice

Women should be advised to avoid weight

gain
Parents can be advised that the absolute
chance of adverse events with a pregnancy
interval less than 6 months remains low
and is unlikely to be significantly increased
compared with conceiving later
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8 5 min Definition of
BIBLIOGRAPHY Lecture cum Power point
uterine prolapse discussion
1. DC Dutta’s “TEXT BOOK OF OBSTETRICS AND
GNNACOLOGY” 7th edition
Jaypee brother’s publication pvt Ltd page no-158 to
177.
2. Nima Bhaskar “TEXT BOOK OF MIDWIFERY AND
OBSTETRICAL NURSING”
2nd edition Emmess medical publishers Page no-
3. Kamini Rao “TEXT BOOK OF MIDWIFERY AND
OBSTETRICS FOR NURSES”
Elesevir publication page no- 291 to 295.
4. DC Dutta’s “TEXT BOOK OF OBSTETRICS INCLUDING
PERINATOLOGY
AND CONTRACEPTION” Jaypee brother’s publication
pvt Ltd page no-159 to 168.
5. Mudaliar and menon’s “TEXT BOOK OF CLINICAL
OBSTETRICS” 12thedition universities press page no-138
to 146.
6. Tushar kar “TEXT BOOK OF DO’S AND DONT’S IN
OBSTETRICS AND
GYNACOLOGY PRACTICE” Jaypee brother’s publication