Intrauterine fetal demise: Difference between revisions

Latest revision as of 02:19, 8 August 2020

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
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
- Placental abruption
- Placental insufficiency

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
- Expectant management
  - Expected to deliver in 1-2 weeks
  - Counsel the patient
  - Follow coagulation status to monitor for DIC
Evaluate the fetus after delivery
Counsel and reassure the parents
Prevent breast milk
- First-line: cabergoline once
- Last-line: bromocriptine

@@ Line 1: / Line 1: @@
-== Definition ==
+== 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: &gt;7 days, yellow liver
-* Spontaneous abortion if less than 20 weeks gestation
+*Death of fetus in the uterus antepartum after 20 weeks gestation
-== Etiology ==
+**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: &gt;7 days, yellow liver
+*Spontaneous abortion if less than 20 weeks gestation
+===Etiology===
-* Idiopathic, most commonly
-* Maternal
-** Diabetes
-** Antiphospholid syndrome
-** TORCH syndrome
-** Preeclampsia
-** Quite rinse rupture
-** Porphyria
-* Fetal
-** Multiple gestation
-** Growth restriction
-** Hydrocephalus
-* Placental
-** Abruption
-** Insufficiency
+*Idiopathic, most commonly
-== Risk factors ==
+*Maternal
+**[[Diabetes mellitus]]
+**[[Antiphospholid antibody syndrome]]
+**[[TORCH syndrome]]
+**[[Preeclampsia]]
+**Quite rinse rupture (??)
+**[[Porphyria]]
+*Fetal
+**[[Multiple gestation]]
+**[[Intrauterine growth restriction]]
+**[[Hydrocephalus]]
+*Placental
+**[[Placental abruption]]
+**[[Placental insufficiency]]
+===Risk factors===
-* African-American
-* Maternal infertility
-* Maternal age &gt;40 years
-* Male fetus
-* Multiple gestation
-* Multiparty
+*African-American
-== Clinical Presentation ==
+*Maternal infertility
+*Maternal age &gt;40 years
+*Male fetus
+*Multiple gestation
+*Multiparty
+==Clinical Manifestations==
-* Decreased fetal movement
-* Absent fetal heart beat
+*Decreased fetal movement
-== Investigations ==
+*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
+*Ultrasound for diagnosis
-== Management ==
+**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
+*Diagnose with ultrasound
-* Deliver the fetus, preferably vaginally
+*Assess risk of DIC
-** Induction (preferred)
+*Deliver the fetus, preferably vaginally
-*** First-line:
+**Induction (preferred)
-**** Misoprostol 25-50mcg q4
+***First-line:
-**** If no progress after 24h, consider Caesarian section
+****[[Misoprostol]] 25-50 mcg q4h
-*** Second-line: oxytocin
+****If no progress after 24h, consider Cesarean section
-** Expectant management
+***Second-line: [[oxytocin]]
-*** Expected to deliver in 1-2 weeks
+**Expectant management
-*** Counsel the patient
+***Expected to deliver in 1-2 weeks
-*** Follow coagulation status to monitor for DIC
+***Counsel the patient
-* Evaluate the fetus after delivery
+***Follow coagulation status to monitor for [[DIC]]
-* Counsel and reassure the parents
+*Evaluate the fetus after delivery
-* Prevent breast milk
+*Counsel and reassure the parents
-** First-line: carbigoline once
+*Prevent breast milk
-** Last-line: bromocriptine
+**First-line: [[cabergoline]] once
+**Last-line: [[bromocriptine]]
 [[Category:Obstetrical medicine]]