Define IUFD
Fetal death after 20 weeks gestation but before onset of labor
What is the MC cause of IUFD
Unkown
Give RF for IUFD:
- IUGR
- hydrops fetalis
- umbilical cord accident
- infection
- hemorrhage
- DM, APS, thrombophilia, HTN
Fetal cause of IUFD:
- infection
- hydrops
- isoimmunisation
- hemorrhage
- twin to twin
- asphyxia
- IUGR
Umbilical cause of IUFD:
- prolapse
- loop or knot
- velamentous insertion
Placental cause of IUFD:
- abruptio, previa, vasa previa
- infarction
- insufficency
Amniotic fluid cause of IUFD:
- chorioaminitis
- oligo and polyhydraminos
Uterus cause of IUFD:
- Rupture
- anomalies
How to diagnose IUFD clinically
1- Absent fetal movement
2- small for date uterus
3- non-detectable fetal heart
How to confirm IUFD
US showing lack of fetal movement or absence of cardiac activity
How to manage IUFD
- between 14-28w
- after 28w
- expectancy or IOL
- misoprostol followed by oxytocin
What is the % of patients experiencing spontaneous labor after 2-3 weeks of fetal demise
80%
What are the alternatives if patient with IUFD did not go into spontanous labor?
- IOL
- Dilation & evacuation
What are the indications of IOL in patients w\IUFD
Emotional burden, chorioaminitis, DIC (retained dead fetus)
What to give to induce labor in IUFD
- Vaginal suppository of PG E2 (dinoprostone) = 12th to 28th weeks
- misoprostol PG E1
What should physician do when they are in the period of watchful expectancy?
monitoring of Fibrinogen, Hct, platelet
What does decrease in fibrinogen levels indicate in IUFD
Consumptive coagulopathy
How to clarify diagnosis of consumptive coagulopathy
1- high PT and ApTT
2- fibinogen-fibrin degredation products
3- decreased platelt
How to follow up patients with IUFD
- TORCH, parvovirus, listeria culute
- anticardiolipin
- family hx of thrombophilia
- fetal chromosomal and autopsy
- kleihaur betke test (fetomaternal hemorrhage)
