Definition: is fetal death after 24 weeks’ gestation but before the onset of labour. It
complicates about 1% of pregnancies.
Diagnosis:
•
Absence of uterine growth
•
Loss of fetal movement
•
Disappearance of the signs & symptoms of pregnancy
•
Fetal heart cannot be detected using Doppler device
•
X-ray ÆSpalding sign overlapping and disalgnment of the skull bones.
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Robert’s sign : the presence of gas in the fetal heart and great vessels.
-
A cropadsign:( angulations of the fetal spine, exaggeration of fetal
spinal curvature .
•
U/S Æ100% accurate Dx(-ve fetal movement&-ve heart movement).
Causes OF IUFD:
Maternal
1. APL syndrome: auto immune disease maternalAbs attack PhL of cell
membrane of maternal Bd vessel & placenta.
2. DM: if poorly controlled .
3. HPT &PET :decrease placental Bd supply by spasim ,thrombosis & placental
separation( Ap)
4. Maternal infection; any disease causing fever & sepsis. TORCHS cause
cong.abn&if severe FD.
5. Post term pregnancy
6. Drugs
7. Thrombophilia
8. Cyanotic heart disease
Intra- uterine fetal death
9. Unexplained placental insufficiency occur in successive pregnancies ,the
placenta is small but normal in other aspects.
Fetal causes:
1. Chromosomal anomalies
2. Birth defects &gengticsyndroms
3. Non immune hydrops
4. Haemolyticdisease : e.g. RH iso-immunization ,If the fetal anaemia is sever
enough, fetal hydropes ,HF and subsequent demise follows.
Placental:
1. Abruption
2. Cord accidents is more with abnormal lie or breech ,In these conditions true
knot or constriction of the cord a round a limb or neck will occur.
3. Twin to twin transfusion S
4. Chrioamnionitis.
Pathological anatomy:
1. The fetus is usually born in a macerated condition. Maceration occurs
rapidly, and may be advanced within 24 hours of fetal death.
2. The whole body is softened and toneless.
3. The cranial bones are loosened and easily moveable on one another.
4. The liquor amni and the fluid in all the serous cavities contain blood
pigments.
Complications of IUFD:
1. Infection and chorioaminitis: when the membrane is ruptured.
2. Hypofibrinoginemia or DIC, when the fetus is dead more than 4 weeks.
3. PPH.
4. Psychological upset of the mother.
Management
✦ Conservative approach:About 80% of the a pt experience spontaneous onset
of labour within 2-3 weeks of fetal death.
✦ Active approch by induction of labour is indicated for:
1. An emotional burden on the mother.
2. Slide possibility of chorioaminitis.
3.
10risk of DIC if death > 4 weeks.
4. Signs & symptoms of hypofilbrinogenemia.
✦ F/U: to determine cause of death. Screening for diseases, infections (TORCH),
and chromosomal anomalies. Manage next pregnancies as high-risk.
The way of induction of labour is by :
1. Prostaglandin E2 vaginal suppositories or prostaglandin E1 analogs
( misoprostol ) oral rectal or vaginal.
2. Oxytocin infusion.
3. Intra-amniotic injection of hypertonic solution of urea.
✦ Amniotomy is not done because of the risk of infection.