IUFD

Question 1

What are the causes of IUFD?

Answer 1

• unexplained 35-40%
• infections
• maternal risk factors
• fetal risk factors: chromosomal anomalies, cord accidents, feto-maternal hemorrhage, IUGR
• paternal risk factors: father > 40 years

Question 2

What is the clinical picture of IUFD?

Answer 2

Symptoms
- regression of pregnancy symptoms
- absent fetal movements
- abdominal/pelvic pains
- vaginal bleeding
- vaginal discharges

Signs
- abdominal examination -> signs of trauma, change contour, rigidity & tenderness, uterine contractions, symphysis-fundal height, absent fetal tone & movements, no FHS
- vaginal examination -> bleeding, discharges, cervical state

Question 3

What investigations are done for confirmation of diagnosis of IUFD?

Answer 3

1- confirm IUFD: ultrasonography
2- diagnosis of etiology
3- detection of possible complications: coagulation profile & INR (DIC), Kleihauer test (Rh isoimmunization)

Question 4

What are the ultrasound findings in IUFD?

Answer 4

1- absent fetal heart beats
2- Spalding sign (+ve 7 days after death)
3- fetal scalp & skin edema
4- Ball sign: hyperflexion & angulation of fetal spine
5- oligohydramnios
6- Robert’s sign (gas shadow within heart or greater vessels)

Question 5

How should detection of etiology be done?

Answer 5

Maternal tests
- CRP, urine, & bile salts
- Kleihauer test or flow cytometry
- serology & culture for antibodies & infection
- RBS & HbA1c for occult maternal DM
- thyroid function tests

Fetal tests
- blood sample & placental swab for culture
- fetal & placental tissue for karyotyping
- post-mortem examination

Paternal Test
- blood sample for karyotype if CFMF is detected

Question 6

How is IUFD managed?

Answer 6

• if < 22 weeks (missed abortion)
  1- medical TOP: misoprostol or PGE2 vaginal tab
  2- if medical failed: hysterotomy
• if > 22 weeks (IUFD)
  1- expectant management for maximum of 2 weeks if woman is well
  2- C section if medical TOP failed

Question 7

Why shouldn’t labour be delayed more than 2 weeks?

Answer 7

• value of post-mortem may be reduced
• appearance of baby may deteriorate
• she will need testing or DIC twice weekly & CRP

Question 8

Who should be treated with intra-partum antimicrobial therapy?

Answer 8

women with sepsis -> treat with IV broad spectrum antibiotics

Question 9

What is fetal maceration?

Answer 9

• blistering & peeling of fetal skin (12-24hrs after death)
• ligaments are softened
• vertebral column in liable to sag
• skull bones overlap each other at the sutures (7 days after death)

Question 10

What should be given to mother during purperium?

Answer 10

• thrombo-prophylaxis -> heparin
• dopamine agonists to suppress lactation -> cabergoline, bromocriptine
• counseling for future pregnancy

Question 11

What are the contraindications for dopamine agonists?

Answer 11

women with pregnancy induced hypertension -> increases BP -> intracranial hemorrhage