still birth

INTRAUTERINE DEATH(STILL BIRHT)

Baby delivery at 24wk complete with no sign of life

CAUSES

1. FETAL
Cord accident
Fetofetal transfusion
Feto maternal haemorrhage
Chromosomal and genetic diseases
Structural abnormalities
Infection
Anemia of fetal origin

2. DIRECT MATERNAL EFFECTS

Obstetric. Cholestasis
Metabolic disturbances(DM Ketoacidosis)
Reduced oxygen saturation: Cystic fibrosis, Sleep apnea
Uterine abnormalities, Ascherman syndrome
Antibodies production: Rh, Platelet, Alloimmunization, Congenital heart block


DIAGNOSIS

↓ FM

Routine U/S
Abruption or ruptured membrane
Color Flow Mapping is definitive

U/S FINDINGS

Spalding sign(overlapping of fetal skull bone)
Oligohydromnia
Fetal hydrops
Negative fetal heart

INVESTIGATIONS

Kleihauer test→ feto maternal he
Full blood count with platelet→ Basic line in case of bleeding abnormality may suggestive
Blood gr, Antibody screen→ Iso immunization
Anticardiolipin antibodies IgG IgM, Lupus anticoagulant Antiphospholipid syndrome
HbA1C→ DM
Urea & Creatinin→Renal dis. PE
LFT, Uric acid→ PE, Obstetric cholestasis, Acute fatty liver
Bile acid→ Obstetric cholestasis
Syphilis, Parvavirus CMV Toxop serology→ Trans placental transfusion of infection


HOW TO DELIVER?

The risk of coagulation problem secondary to retained dead fetus is small

Estimated risk is 25% if the fetus has been retained for wks. Therefore, given that over 90% of women will deliver spontaneously within 3 wks, conservative management is an option that can be offered
Vaginal delivery is the best option unless there is obstetric indications

INDUCTION OF LABOR

A standard protocol for mifepristol induction is shown below.
• Mifepristone: 200 mg 24 – 48 hr before induction
• Mifepristol: 200 mg p.v. then 200 mg orally/3 - hr( maximum of 4 oral doses in 2 hr)
• In gestation of 3 wk or more 100 mg of misopristol is effective

Prevention of Rh iso immunization

Contraception
Psychological support
Follow up