TABLE OF CONTENTS

TABLE OF CONTENTS.......................................................................................i
CHAPTER I PRELIMINARY
1.1 Background........................................................................................................1
1.2 Problem formulation...........................................................................................2
1.3 Purpose of writing..............................................................................................2
CHAPTER II DISCUSSION
2.1 Definition of IUFD (Intra uterine fetal Death)....................................................3
2.2 causes of IUFD...................................................................................................4
2.3 factors that influence the occurrence of IUFD....................................................4
2.4 Management of fetal death in utero..................................................................10
CHAPTER III CLOSING
3.1 conclusions.......................................................................................................13
3.2 advice...............................................................................................................13
REFERENCES
 CHAPTER I

PRELIMINARY

1.1 Background
Pregnancy is an event that is always eagerly awaited by married couples.
At present, in general a mother already understands how she should better
maintain the condition of the body for the smooth pregnancy and fetal
development in the womb. Even so, things that can interfere with the process of
pregnancy are still unavoidable. One of them is the death of the fetus in the
womb.

There are many factors that can cause fetal death in the womb. In
developed countries with established health systems, deaths from congenital
disorders are prominent cases, whereas in developing countries there are many
prominent factors such as infections, non-prime antenatal care, low economic
status, and many others. (4)

The definition of fetal death according to the World Health Organization

(WHO) and the American College of Obtetricians and Gynecologists has
recommended that fetal death is death at 22 weeks of gestation or more and fetal
weight of 500 grams or more. Meanwhile, according to the WHO Expert
Committee on the Prevention of Perinatal Morbidity and Mortality (19709)
recommends that in statistical calculations implanted fetal death is fetal death at
birth weight above 1000 grams.
1.2 Problem formulation
1. What is meant by IUFD?
2. What causes IUFD?
3. What are the factors that influence the occurrence of IUFD?
4. What is the handling of IUFD?

1.3 Purpose of writing

1. To find out the meaning of IUFD ?
2. To find out the cause of IUFD
3. To find out the factors that influence the occurrence of IUFD
4. To find out the handling of IUFD
 CHAPTER II

DISCUSSION

2.1 Definition of IUFD (Intrauterine fetal Death)

Fetal death in the womb is fetal death when each is in the womb
that weighs 500 grams and gestational age of 20 weeks or more (Achadiat,
2004). (4)

Fetal death in the womb is the result of conception before it is

completely removed from the mother regardless of the age of the
pregnancy. Death is assessed by the fact that after being separated from the
mother the fetus does not breathe or shows no signs of life, such as heart
rate, umbilical cord pulsation, or muscle contraction (Monintja, 2005)
Whereas according to WHO, fetal death is fetal death at the time of heavy
birth body <1000 grams.

According to Wiknjosastro (2005) in the book Midwifery, fetal

death can be divided into 4 groups namely:

1. Group I: Death before pregnancy reaches the full 20 weeks.

2. Group II: Death after pregnant women 20 to 28 weeks.
3. Group III: Death after pregnancy more than 28 weeks (late foetal
death)
4. Group IV: Death which cannot be classified into the three groups
above
2.2 causes of IUFD
In more than 50% of cases, the etiology of fetal death in the womb
is not found or the exact cause is unknown. Several causes can cause fetal
death in utero, among others.

1. Bleeding: placenta previa and placental abruption.

2. Preeclampsia and eclampsia
3. Disorders of blood disorders.
4. Infectious diseases and infectious diseases
5. Urinary tract disease
6. Endocrine disease: diabetes mellitus
7. Malnutrition

2.3 factors that influence the occurrence of IUFD

Factors Affecting Fetal Death in the Womb:

1. Mother's Factor
a) Age
As the age of the mother increases, there is also a change
in the development of the organs of the body, especially the
reproductive organs and the emotional or psychological changes
of a mother. This can affect pregnancy which does not directly
affect the life of the fetus in the womb. A good reproductive age
for a pregnant woman is the age of 20-30 years (Wiknjosastro,
2005). At the age of young mothers the reproductive organs and
emotions are not mature enough, this is due to the decline of
reproductive organs in general (Wiknjosastro, 2005).

b) Parity
Good parity is 2-3 children, which is a safe parity against
the threat of mortality and morbidity both for the mother and
fetus. Pregnant women who have given birth more than 5 times or
 grandemultipara, have a high risk in pregnancy such as
hypertension, placenta previa, and others that will result in fetal
death (Saifuddin, 2002).

c) Antenatal Examination
Every pregnant woman faces the risk of life-threatening
complications, therefore, every pregnant woman requires at least
4 visits during the antenatal period.
 One visit during the first trimester (1-3 months gestational
age)
 One visit during the second trimester (4-6 months gestational
age).
 Two visits during the third trimester (gestational age 7-9
months).
Regular and early antenatal examination in a pregnant
woman is very important so that abnormalities that may occur in
pregnant women can be treated and treated immediately.

d) Complications / Diseases
 Anemia
The results of conceptions such as the fetus, placenta
and blood require large amounts of iron for the production of
blood grains of growth, which is as much as iron weight. This
amount is 1/10 of all iron in the body. The occurrence of
anemia in pregnancy depends on the amount of iron in the
liver, spleen and bone marrow.
According to Manuaba (2003), Hb inspection and
supervision can be carried out using sahli tools, can be
classified as follows:
a) Normal: 11 gr%
b) Mild anemia: 9-10 gr%
 c) Moderate anemia: 7-8 gr%
d) Severe anemia: <7 gr%.
 Pre-eclampsia and eclampsia
In pre-eclampsia, blood vessel spasm occurs
accompanied by salt and water retention. If all the arterioles
in the body experience spasm, the blood pressure will rise, in
an effort to overcome the increase in peripheral pressure so
that tissue oxygen can be sufficient. Then the blood flow
decreases to the placenta and causes disruption of fetal
growth and due to lack of oxygen occurs fetal distress
(Mochtar, 2004).
 Placental abruption
Placental abruption is a condition in which the
placenta that is normal is independent of attachment before
the fetus is born. Placental abruption can occur due to a
sudden drop in blood by spasm from the arteries leading to
the intervirale space so anoxemia from the distal tissue
occurs. Before this happens necrotic, blood loss spasm
returns to flow into the intervilli, but the distal blood vessels
had been so fragile, easy to rupture the occurrence of a
hematoma that gradually releases the placenta from the
uterus. So that blood flow to the fetus through the placenta is
absent and there is fetal death (Wiknjosastro, 2005).
 Diabetes mellitus
Diabetes mellitus is a hereditary disease with the
characteristics of lack or not the formation of insulin, due to
high blood sugar levels and affects the body's overall
metabolism and affects the growth and development of the
fetus. Generally women with diabetes escape a large baby
(macrosomia). Macrosomia can occur due to glucose in the
bloodstream, a pancreas that produces more insulin to cope
 with high sugar levels. Glucose turns into fat and the baby
becomes large. Large babies or macrosomia cause problems
during childbirth and sometimes die before birth (Stridje,
2000).
 Rhesus Iso-Immunization
If a person with rhesus negative blood is given rhesus
positive blood, then the rhesus antigen will make blood
recipients form antirhesus antibodies. If a second positive
rhesus blood transfusion is given, the antibodies look for and
attach to the negative rhesus blood cell and break it down so
that this anemia occurs is called rhesus iso-immunization.
This can just happen in early pregnancy, but slowly
according to the development of pregnancy. In the
bloodstream, antihresus antibodies meet with normal positive
rhesus red blood cells and cover so that they break apart
releasing substances called bilirubin, which accumulate in the
blood, and partly exclude them into the amniotic sac along
with baby's urine. If many red blood cells are destroyed then
the baby becomes anemic until it finally dies (Llewelyn,
2005).
 Infection in pregnancy
Pregnancy does not change a mother's resistance to
infection, but the severity of each infection is related to its
effect on the fetus. Infection has direct and indirect effects on
the fetus. The indirect effect arises because it reduces blood
oxygen to the placenta. The direct effect depends on the
ability of the causative organism to penetrate the placenta and
infect the fetus, which can result in the death of the fetus in
utero (Llewellyn, 2001).
 Premature rupture of membranes
 Premature rupture of membranes is the biggest cause
of premature labor and fetal death in the womb. Premature
rupture of membranes is rupture of membranes before there
are signs of labor, and wait for an hour before labor signs
have not begun.
Premature rupture of membranes causes a direct
connection between the outside world and the room in the
uterus, thus facilitating infection. One function of the
membranes is to protect or become a barrier to the outside
world and the room in the uterus, thereby reducing the
chance of infection. The longer the latent period, the greater
the likelihood of infection in the uterus, labor prematurity
and further increase the incidence of morbidity and maternal
death and fetal death in the womb (Manuaba, 2003).
 Latitude
The latitude is a condition in which the fetus crosses
in the uterus with the head on one side while the buttocks are
on the other side. At latitude with normal pelvic size and full
moon, spontaneous labor cannot occur. If labor is left without
help, it will cause fetal death. The shoulder enters the pelvis
so that the pelvic cavity is completely filled with the shoulder
and other body parts. The fetus cannot descend further and is
pinched in the pelvic cavity. In an effort to expel the fetus,
the lower uterine segment widens and thins out, so that the
boundary between these two parts is getting higher and
higher and there is a pathological retraction loop that can
result in fetal death (Wiknjosastro, 2005). (4)

2. Fetal Factors
 Congenital abnormalities
 Congenital abnormalities are abnormalities in the
growth of infant structures that arise from the life of the
conception of the egg. Congenital abnormalities can be an
important cause of fetal death in the womb, or stillbirth.
Babies with congenital anomalies, generally will be born as
low birth weight babies and often as babies for their
pregnancy.
Viewed from the morphological form, congenital
abnormalities can be in the form of a deformity or a form of
malformity. A congenital abnormality in the form of
anatomic deformity may still have the same arrangement but
the shape will be abnormal. These events are generally
closely related to mechanical causative factors or to the
occurrence of oligohydramnios. While the form of congenital
malformity, anatomic structure and shape will change.
Congenital abnormalities can be identified through
ultrasonography, amniotic fluid examination, and fetal blood
(Kadri, 2005).
 Intranatal infection
Infection through this method is more common than
other methods. Germs from the vagina rise and enter the
amniotic cavity after rupture of the membranes. Premature
rupture of membranes has an important role in the onset of
placentitis and amnionitis. Infection can also occur even
though the membranes are still intact, for example in old
parturition and vaginal examinations are often performed.
The fetus is infected by inhalation of septic fluid, resulting in
congenital pneumonia or because of germs that enter its
bloodstream and cause septicemia. Intranatal infection can
also occur by direct contact with germs found in the vagina,
such as blenorrhoea and oral thrush (Monintja, 2006).
  Cord abnormality
The umbilical cord is very important so that the fetus
is free to move in the amniotic fluid, so that its growth and
development go well. In general, the umbilical cord has a
length of about 55 cm.
Umbilical cord that is too long can cause a twist in the
neck, thus disrupting blood flow to the fetus and causing
asphyxia until the fetal death in the womb.

2.4 Management of fetal death in utero

a. Therapy
1.While waiting for a definitive diagnosis, the mother will
experience shock and fear thinking that her baby has died. At this
stage the midwife acts as a motivator to increase the mother's
mental readiness in accepting all the possibilities.
2.Definitive diagnosis can be made by collaborating with
obstetricians through the results of ultrasound and the abdominal
radiograph, so the midwife should make a referral.
3.Waiting for spontaneous labor is usually safe, but research by
Radestad et al (1996) shows that it is recommended to induce as
soon as possible after the diagnosis of death in utero. They found a
strong link between waiting more than 24 hours before the onset of
labor and anxiety symptoms. Then the termination of pregnancy is
often done.
 Termination of pregnancy if uterine size does not exceed 12
weeks of pregnancy.
1. Preparation:
a) Situation that is possible is Hb> 10 gr%, good blood
pressure.
 b) Performed laboratory tests, namely: examination of
platelets, fibrinogen, clotting time, bleeding time, and
protombin time.
2. Actions:
a) Vacuum curettage
b) Sharp curettage
c) Sharp dilation and curettation

 Termination of pregnancy if uterine size is more than 12

weeks to 20 weeks
a) Intravaginal 200 mg Misoprostol, which can be repeated
1 time 6 hours after the first administration.
b) Installation of laminaria rods 12 hours beforehand.
c) The combination of maturation of the laminaria stem
with misoprostol or 10 IU drops of oxytocin in 500 cc
5% dextrose from 20 drops per minute to a maximum of
60 drops per minute.
Note: do curettage if there is still a network.

 Termination of pregnancy if more than 20 - 28 weeks

a) Intravaginal 100 mg Misoprostol, which can be repeated
1 time 6 hours after the first administration.
b) Installation of laminaria rods for 12 hours.
c) Provision of 5 IU oxytocin drops in 5% dextrose from 20
drops per minute to a maximum of 60 drops per minute.
d) Combination of the first and third methods for living and
dead fetuses.
e) A combination of the second and third ways for a dead
fetus.
 Note: A hysterotomy is performed when attempting to dilute the
vaginal discharge is considered unsuccessful or as indicated by the
mother, with the consulent's knowledge.

 Termination of pregnancy if more than 28 weeks of

pregnancy
a) Intravaginal 50 mg Misoprostol, which can be
repeated 1 time 6 hours after the first administration.
b) Installation of 100 cc metrolisa 12 hours before
induction for cervical maturation (not effective if
done on KPD).
c) Provision of 5 IU drops of oxytocin in 5% dextrose
from 20 drops per minute to a maximum of 60 drops
for primi and multigravida, 40 drops for 2 pumpkin
multigravida grandes.
d) The combination of the three ways above.
Note: SC is performed if vaginal delivery is unsuccessful, or if an
indication of the mother or fetus is obtained to complete labor.

b. Check Repeat (Follow Up)

Home visits are carried out on days 2, 6, 14, or 40 days.
Postpartum examination as usual. Reviewing the psychological
state, the state of lactation (stopping ASI), and the use of
contraceptives.
 CHAPTER III

CLOSING

3.1 conclusions
Intra-Uterine Fetal Death (IUFD), the death that occurs when the
gestational age is more than 20 weeks or in the second trimester and or
weighs 500 grams. Another opinion that says the death of the fetus in
pregnancy is the death of the fetus in pregnancy before the birth process
takes place at 28 weeks of gestation and above or the weight of the fetus
1000 grams and above. The several factors causing IUFD are factors from
the mother, namely: age, parity, and concomitant diseases during
pregnancy, while from the fetus, namely: congenital abnormalities and
intranatal infections, as well as from the placenta. There are 2 kinds of
handling of fetal death in the womb, namely: active treatment and passive
treatment. (3)

3.2 advice
Actually, risk factors and complications of IUFD can be prevented
if pregnant women routinely check their pregnancy to a doctor or other
health care place, so that if pregnancy complications are found it can be
treated early and is expected to prevent the occurrence of IUFD.

Efforts to prevent fetal death, especially those that are near or near
term, are if the mother feels fetal movement is decreasing, not moving, or
fetal movement is too hard, ultrasound examination needs to be done.
Watch for placental abruption. In gamelli with T + T (twin to twin
transfusion) prevention is done by coagulation of anastomotic vessels
(Sarwono, 2008).
 REFERENCES

Saifuddin, Abdul Bari. 2009. Obstetrics. Jakarta: PT

BinaPustakaSarwonoPrawirohardjo (1)

Cunningham, F. Gary [et.al ...]. 2005. Williams Obstetrics. Jakarta: EGC (2)

L., K. Varney, helen. 2006. Midwifery care textbooks. Jakarta: EGC (3)

Dr. Rosfanty. Journal of intra uterine fetal death. (4)

Masruroh, S.ST. Journal of intra uterine fetal death. (5)