Fetal Demise

Fetal Demise = Stillbirth = Late Pregnancy Loss

• Death of fetus after 20wks and/or Weight < 500g
• Loss of Fetal Movement
• Dx w/ultrasound: No cardiac activity

Stillbirth and neonatal mortality rates increase steadily after 37 weeks,

approaching 1 in 300 at 42 weeks and increasing severalfold as the 44th
week approaches (Beckmann et al.)

Frequency: 6.05 per 1000 US births (NVSR, 2006)

Up to 60% of stillbirths have no identifiable etiology.

Causes Associated w/Mother
• Prolonged pregnancy (>42 wk)
• Diabetes (poorly controlled)
• Systemic lupus erythematosus
• Antiphospholipid syndrome
• Infection
• Hypertension
• Preeclampsia
• Eclampsia
• Hemoglobinopathy
• Advanced maternal age
• Rh disease
• Uterine rupture
• Maternal trauma or death
• Inherited thrombophilias
Causes Associated w/Fetus
• Multiple gestations
• Intrauterine growth restriction
• Congenital abnormality
• Genetic abnormality
• Infection (ie, parvovirus B19, CMV, Listeria)
• Hydrops
Causes Associated w/Placenta
• Cord accident
• Abruption
• Premature rupture of membranes
• Vasa previa
• Fetomaternal hemorrhage
• Placental insufficiency
Weakly Associated Causes
• African American race
• Advanced maternal age
• History of fetal demise
• Maternal infertility
• History of small for gestational age infant
• Small for gestational age infant
• Obesity
• Advanced Paternal age
Workup:
• Diabetes testing using hemoglobin A1C and a fasting blood glucose
• Syphilis screening using the VDRL or rapid plasma reagent test
• Thyroid function testing (ie, TSH, FT4)
• Urine toxicology screening
For Parents: Grief
• Grief packet: includes referrals for counseling, support groups, and
other resources.
• Preservation of keepsakes such as photos, footprints, or a lock of hair
(PGH offers footprints and baby blanket)
• Spiritual support
• Offer the options of immediate induction of labor/delivery versus
expectant management
For Parents: Planning Future Pregnancy
• Antenatal surveillance with NST (non-stress test), biophysical profiles
beginning at approximately 32 weeks gestation
• Ultrasound surveillance to follow fetal growth
• Fetal kick counts
• Frequent visits, documentation of fetal heart tones and reassurance
Question:
• Most common inherited thrombophilic disorder that can lead to
stillbirth (fetal demise)?
Factor V Leiden
• A mother with FVL disorder = increased risk of fetal demise (death of
fetus past 20wks)