Intrauterine fetal demise
From IDWiki
Background
Definition
- Death of fetus in the uterus antepartum after 20 weeks gestation
- Also called intrauterine fetal demise (IUFD)
- Compared to stillbirth, where death is ante- or peripartum after 20 weeks gestation
- Fresh: delivered within 24h of fetal death
- Zero degree: red skin suggests less than 8h dead
- Macerated: delivered after 24h of fetal death
- First degree: peeling skin suggests more than 8h from death
- Second degree: 2-7 days, effusion of skin
- Third degree: >7 days, yellow liver
- Fresh: delivered within 24h of fetal death
- Spontaneous abortion if less than 20 weeks gestation
Etiology
- Idiopathic, most commonly
- Maternal
- Diabetes mellitus
- Antiphospholid antibody syndrome
- TORCH syndrome
- Preeclampsia
- Quite rinse rupture (??)
- Porphyria
- Fetal
- Placental
Risk factors
- African-American
- Maternal infertility
- Maternal age >40 years
- Male fetus
- Multiple gestation
- Multiparty
Clinical Manifestations
- Decreased fetal movement
- Absent fetal heart beat
Investigations
- Ultrasound for diagnosis
- Spalding sign: overlapping fetal skull bones
- Robert sign: gas in the heart and vessels
- Assess for DIC
- Platelets
- Fibrinogen
- INR/PTT
- To investigate etiology
- CBC
- Blood glucose or HbA1c
- Lupus anticoagulant
- VDRL and TORCH screen
- Placental culture
- Examine the fetus after delivery for signs of trisomies, hydrocephalus
- X-ray
- MRI
- Autopsy
Management
- Diagnose with ultrasound
- Assess risk of DIC
- Deliver the fetus, preferably vaginally
- Induction (preferred)
- First-line:
- Misoprostol 25-50 mcg q4h
- If no progress after 24h, consider Cesarean section
- Second-line: oxytocin
- First-line:
- Expectant management
- Expected to deliver in 1-2 weeks
- Counsel the patient
- Follow coagulation status to monitor for DIC
- Induction (preferred)
- Evaluate the fetus after delivery
- Counsel and reassure the parents
- Prevent breast milk
- First-line: cabergoline once
- Last-line: bromocriptine
