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Intrauterine Fetal Death PowerPoint Presentation

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Description : This medical presentation defines intrauterine fetal death, explains the incidence and the impact of intrauterine fetal death, explains how to identify a patient at risk of its occurrence, enables you to diagnose such a condition and identify complications, and manage intrauterine fetal death.

Tags : Intrauterine fetal death, utero, fetal skeleton, intra-partum history, Vaginal birth

Published on : Feb 02, 2021 | Views : 3999 | Downloads : 37

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Intra-uterine fetal death By Dr. Abeer Elshabacy MD Obstet.& Gyne.
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Objectives By the end of this lecture learners should be able to : 1- define intrauterine fetal death 2-know the incidence and the impact of intrauterine fetal death 3- identifies patient at risk of its occurrence 4- be able to diagnose such a condition , and can identifies complications 5-mange intrauterine fetal death.
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DEFINITION Intrauterine fetal death refers to fetal death in utero after 24 completed weeks of gestation or weighing < 500 grams .
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INCIDENCE: 4.5/1000 births
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IMPACTS : Emotionally challenging for: • Doctors • Parents • Increases medico-legal risk • Indicator of country’s health care.
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CAUSES No specific cause is found in 50% cases. Maternal causes: 5-10 % Fetal causes: 25-40% Placental causes: 20-35%
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DIAGNOSIS History : Absence fetal movements , Loss of signs & symptoms of pregnancy Examination : Decreased fundal height, and absent fetal movement. Investigations : Real-time ultrasonography is essential for the accurate diagnosis of IUFD ( absent fetal cardiac pulsation , collapsed head and collapsed fetal skeleton ), X-ray is diagnostic but obsolete. A second opinion should be obtained
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COMPLICATIONS • Post Partum Hemorhage • BLOOD COAGULATION DISORDERS • PSYCHOLOGICAL UPSET • INFECTIONS ( purpural sepsis )
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INVESTIGATIONS 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. TESTS RECOMMENDED FOR WOMEN • CBC, blood group, ESR • plasma fibrinogin • Coagulation profile • PIH profile • Kleihauer test, CRP, maternal ( serology , bacteriology, thyroid function teste, and HbA1c).
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LABOUR AND BIRTH Maternal medical condition and previous intra-partum history should be taken in consideration in deciding route of birth. If there is sepsis, preeclampsia, placental abruption or membrane rupture, immediate termination of pregnancy should be advised 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. Spontaneous vaginal delivery occurs within three weeks of diagnosis in <85% of cases. In about 90% of women vaginal birth occurs within 24 hours Caesarean birth might be indicated if there is maternal indication.
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INDUCTION OF LABOUR Misoprostol and prostaglandin E2 can be used for termination of pregnancy with equivalent safety and efficacy with lower cost of Misoprostol. Vaginal misoprostol is as effective as oral therapy with fewer adverse effects. Misoprostol can be safely used for induction of labor 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 labor is unknown Mechanical methods of induction might increase the risk of ascending infection in the presence of IUFD
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INTRAPARTUM ANTIBIOTIC PROPHYLAXIS Women with sepsis should be treated with intravenous broad- spectrum antibiotic therapy (including anti-chlamydial agents) but 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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PUERPERIUM • 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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LACTATION Women should be advised to use dopamine agonists to suppress lactation it is well tolerated as cabergoline which is found to be superior to bromocriptine in suppression of lactation. 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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POSTMORTEM EXAMINATION Parents should be offered full postmortem examination to help explain the cause of an IUFD. Postmortem examination should include external examination with birth weight, histology of relevant tissues and skeletal X-rays. Pathological examination of the cord, membranes and placenta should be recommended whether or not postmortem examination of the baby is requested. The examination should be undertaken by a specialist perinatal pathologist. Parents who decline full postmortem might be offered a limited examination (sparing certain organs).
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FOLLOW UP The wishes of the woman and her partner should be considered when arranging follow-up Women should be offered general pre-pregnancy 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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Summary Fetal death is an emotional issue for both the patient and the physician and may result on significant complications. The most serious complication is hypo-fibrinogenemia which may lead to life threatening coagulopathy. Ultrasound provides the most reliable method of confirming the diagnosis.
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