Intrauterine fetal demise: Difference between revisions
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− | == |
+ | == Background == |
+ | === Definition === |
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− | * Death of fetus in the uterus antepartum after 20 weeks gestation |
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− | ** Also called intrauterine fetal demise (IUFD) |
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− | * Compared to stillbirth, where death is ante- or peripartum after 20 weeks gestation |
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− | ** Fresh: delivered within 24h of fetal death |
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− | *** Zero degree: red skin suggests less than 8h dead |
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− | ** Macerated: delivered after 24h of fetal death |
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− | *** First degree: peeling skin suggests more than 8h from death |
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− | *** Second degree: 2-7 days, effusion of skin |
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− | *** Third degree: >7 days, yellow liver |
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− | * Spontaneous abortion if less than 20 weeks gestation |
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+ | *Death of fetus in the uterus antepartum after 20 weeks gestation |
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− | == Etiology == |
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+ | **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 |
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+ | ***Zero degree: red skin suggests less than 8h dead |
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+ | **Macerated: delivered after 24h of fetal death |
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+ | ***First degree: peeling skin suggests more than 8h from death |
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+ | ***Second degree: 2-7 days, effusion of skin |
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+ | ***Third degree: >7 days, yellow liver |
||
+ | *Spontaneous abortion if less than 20 weeks gestation |
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+ | ===Etiology=== |
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− | * Idiopathic, most commonly |
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− | * Maternal |
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− | ** Diabetes |
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− | ** Antiphospholid syndrome |
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− | ** TORCH syndrome |
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− | ** Preeclampsia |
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− | ** Quite rinse rupture |
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− | ** Porphyria |
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− | * Fetal |
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− | ** Multiple gestation |
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− | ** Growth restriction |
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− | ** Hydrocephalus |
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− | * Placental |
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− | ** Abruption |
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− | ** Insufficiency |
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+ | *Idiopathic, most commonly |
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− | == Risk factors == |
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+ | *Maternal |
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+ | **[[Diabetes mellitus]] |
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+ | **[[Antiphospholid antibody syndrome]] |
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+ | **[[TORCH syndrome]] |
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+ | **[[Preeclampsia]] |
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+ | **Quite rinse rupture (??) |
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+ | **[[Porphyria]] |
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+ | *Fetal |
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+ | **[[Multiple gestation]] |
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+ | **[[Intrauterine growth restriction]] |
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+ | **[[Hydrocephalus]] |
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+ | *Placental |
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+ | **[[Placental abruption]] |
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+ | **[[Placental insufficiency]] |
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+ | ===Risk factors=== |
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− | * African-American |
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− | * Maternal infertility |
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− | * Maternal age >40 years |
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− | * Male fetus |
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− | * Multiple gestation |
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− | * Multiparty |
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+ | *African-American |
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− | == Clinical Manifestations == |
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+ | *Maternal infertility |
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+ | *Maternal age >40 years |
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+ | *Male fetus |
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+ | *Multiple gestation |
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+ | *Multiparty |
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+ | ==Clinical Manifestations== |
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− | * Decreased fetal movement |
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− | * Absent fetal heart beat |
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+ | *Decreased fetal movement |
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− | == Investigations == |
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+ | *Absent fetal heart beat |
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+ | ==Investigations== |
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− | * Ultrasound for diagnosis |
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− | ** Spalding sign: overlapping fetal skull bones |
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− | ** Robert sign: gas in the heart and vessels |
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− | * Assess for DIC |
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− | ** Platelets |
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− | ** Fibrinogen |
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− | ** INR/PTT |
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− | * To investigate etiology |
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− | ** CBC |
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− | ** Blood glucose or HbA1c |
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− | ** Lupus anticoagulant |
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− | ** VDRL and TORCH screen |
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− | ** Placental culture |
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− | * Examine the fetus after delivery for signs of trisomies, hydrocephalus |
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− | ** X-ray |
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− | ** MRI |
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− | ** Autopsy |
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+ | *Ultrasound for diagnosis |
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− | == Management == |
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+ | **Spalding sign: overlapping fetal skull bones |
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+ | **Robert sign: gas in the heart and vessels |
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+ | *Assess for DIC |
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+ | **Platelets |
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+ | **Fibrinogen |
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+ | **INR/PTT |
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+ | *To investigate etiology |
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+ | **CBC |
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+ | **Blood glucose or HbA1c |
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+ | **Lupus anticoagulant |
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+ | **VDRL and TORCH screen |
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+ | **Placental culture |
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+ | *Examine the fetus after delivery for signs of trisomies, hydrocephalus |
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+ | **X-ray |
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+ | **MRI |
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+ | **Autopsy |
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+ | ==Management== |
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− | * Diagnose with ultrasound |
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+ | |||
− | * Assess risk of DIC |
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+ | *Diagnose with ultrasound |
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− | * Deliver the fetus, preferably vaginally |
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+ | *Assess risk of DIC |
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− | ** Induction (preferred) |
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+ | *Deliver the fetus, preferably vaginally |
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− | *** First-line: |
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+ | **Induction (preferred) |
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− | **** Misoprostol 25-50mcg q4 |
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+ | ***First-line: |
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− | **** If no progress after 24h, consider Caesarian section |
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+ | ****[[Misoprostol]] 25-50 mcg q4h |
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− | *** Second-line: oxytocin |
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+ | ****If no progress after 24h, consider Cesarean section |
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− | ** Expectant management |
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+ | ***Second-line: [[oxytocin]] |
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− | *** Expected to deliver in 1-2 weeks |
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+ | **Expectant management |
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− | *** Counsel the patient |
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+ | ***Expected to deliver in 1-2 weeks |
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− | *** Follow coagulation status to monitor for DIC |
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+ | ***Counsel the patient |
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− | * Evaluate the fetus after delivery |
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+ | ***Follow coagulation status to monitor for [[DIC]] |
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− | * Counsel and reassure the parents |
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+ | *Evaluate the fetus after delivery |
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− | * Prevent breast milk |
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+ | *Counsel and reassure the parents |
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− | ** First-line: carbigoline once |
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+ | *Prevent breast milk |
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− | ** Last-line: bromocriptine |
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+ | **First-line: [[cabergoline]] once |
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+ | **Last-line: [[bromocriptine]] |
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[[Category:Obstetrical medicine]] |
[[Category:Obstetrical medicine]] |
Latest revision as of 22:19, 7 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
- 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