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    Intra Uterin Fetal Death

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    anojan
    This document discusses intra-uterine death (IUD), defined as a baby delivered with no signs of life after 24 completed weeks of pregnancy. It outlines the potential causes of IUD including fetal, placental, maternal, and unexplained factors. Fetal causes include genetic anomalies, birth defects, infections, and cord accidents. Placental causes include abruption, insufficiency, and infection. Maternal causes include medical conditions like diabetes and hypertension. The diagnosis of IUD involves assessing fetal movement, heart rate, and ultrasound findings. Evaluating the fetus, placenta, and maternal and obstetric history helps determine the cause. Management includes breaking the news sensitively, delivering the baby, investigating the cause,

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    Intra Uterin Fetal Death

    Uploaded by

    anojan
    169 views15 pages
    This document discusses intra-uterine death (IUD), defined as a baby delivered with no signs of life after 24 completed weeks of pregnancy. It outlines the potential causes of IUD including fetal, placental, maternal, and unexplained factors. Fetal causes include genetic anomalies, birth defects, infections, and cord accidents. Placental causes include abruption, insufficiency, and infection. Maternal causes include medical conditions like diabetes and hypertension. The diagnosis of IUD involves assessing fetal movement, heart rate, and ultrasound findings. Evaluating the fetus, placenta, and maternal and obstetric history helps determine the cause. Management includes breaking the news sensitively, delivering the baby, investigating the cause,

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    This document discusses intra-uterine death (IUD), defined as a baby delivered with no signs of life after 24 completed weeks of pregnancy. It outlines the potential causes of IUD including fetal, placental, maternal, and unexplained factors. Fetal causes include genetic anomalies, birth defects, infections, and cord accidents. Placental causes include abruption, insufficiency, and infection. Maternal causes include medical conditions like diabetes and hypertension. The diagnosis of IUD involves assessing fetal movement, heart rate, and ultrasound findings. Evaluating the fetus, placenta, and maternal and obstetric history helps determine the cause. Management includes breaking the news sensitively, delivering the baby, investigating the cause,

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pptx, pdf, or txt
    169 views15 pages

    Intra Uterin Fetal Death

    Uploaded by

    anojan
    This document discusses intra-uterine death (IUD), defined as a baby delivered with no signs of life after 24 completed weeks of pregnancy. It outlines the potential causes of IUD including fetal, placental, maternal, and unexplained factors. Fetal causes include genetic anomalies, birth defects, infections, and cord accidents. Placental causes include abruption, insufficiency, and infection. Maternal causes include medical conditions like diabetes and hypertension. The diagnosis of IUD involves assessing fetal movement, heart rate, and ultrasound findings. Evaluating the fetus, placenta, and maternal and obstetric history helps determine the cause. Management includes breaking the news sensitively, delivering the baby, investigating the cause,

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    of 15

    INTRA UTERINE

    DEATH
    Dr.P.S.Hettipathirana
    MBBS(COL),MD(Obs & Gyn),MRCOG(UK)
    Senior lecturer/ Consultant Obstetrician & Gynaecologist

    Definition:
    Baby delivered with no signs of life, known

    to have died after 24 completed weeks of


    pregnancy
    (In Sri Lanka 28 weeks for statistical
    purposes)

    Causes
    Fetal
    Placental
    Maternal
    Unexplained

    Causes
    Fetal causes
    Chromosomal & Genetic anomalies
    Birth defects
    Non immune hydrops
    Infections CMV,rubella, parvo B19,Herpes,malaria
    Cord accidents

    Placental
    Abruption
    Placental insufficiency
    Intrapartum asphyxia
    Twin to twin transfusion Syndrome
    Chrioamnionitis

    Causes
    Maternal
    Antiphospholipid antibody
    Diabetes
    Hypertention
    Trauma
    Abnormal labor Sepsis
    Acidosis/ Hypoxia
    Uterine rupture
    Post term pregnancy Drugs
    Thrombophilia Cyanotic heart disease
    Epilepsy Severe anemia

    Unexplained - majority

    Diagnosis
    Absence of uterine growth
    Loss of fetal movement
    Absence of fetal heart Pinnard/CTG
    Disappearance of the signs & symptoms of

    pregnancy
    Imaging Spalding sign

    U/S 100% accurate

    Diagnosis

    History

    Family history
    Recurrent abortions
    deep vein thrombosis/ Pulmonary emboloism
    Congenital anomalies, Abnormal karyotype
    Maternal History
    Maternal medical conditions
    Deep vein thrombosis/Pulmonary embolism
    Diabetes mellitus
    Hypertention
    Thrombophilia
    SLE,Autoimmune disease
    Severe Anemia
    Epilepsy
    Consanguinity

    Past Obstetric History


    Baby with congenital anomaly
    hereditary condition
    IUGR
    Placental abruption
    Intra uterine death
    Recurrent abortions
    Current Pregnancy
    Maternal age
    Hypertention,DM
    Smooking , alcohol, or drug abuse
    Abdominal trauma
    Cholestasis
    Placental abruption
    PROM or PPROM

    Evaluation of IUD fetus


    Infant description

    Malformation
    Degree of maceration
    Colour - pale,plethoric
    Umbilical cord

    Entanglement-neck, arms, ,legs


    Hematoma or stricture,Number of vessels
    Placenta
    Weight
    Adherent clots
    Structural abnormality
    Velamentous insertion
    odema/ hydropic changes

    MANAGEMENT
    Breaking the bad news
    Delivery
    Investigation cause/complications
    Psychological counseling
    Rh negative Anti D immunoglobulin

    (Rhogam) at the time of diagnosis

    Investigation
    Cause
    FBC
    Blood Gp & antibody screen
    HbA1 C
    Kleihauer Betke test look for feto maternal haemorrhage
    Serological screening for Rubella,CMV, Toxoplasma
    Syphylis, Herpes & Parvovirus
    Thrombophilia screening (antithrombin III,Protein C & S , factor IV
    leiden, lupus anticoagulant, anticardiolipin antibodies)
    Fetal and placental autopsy

    Maternal Complication
    Coagulation tests

    -DIC

    DELIVERY
    Immediate delivery
    sepsis,ruprured membranes,placental abruption,eclampsia

    Expectant approach:
    80% goes into spontaneous labour within 2-3 weeks
    Risk DIC if wait for > 4 weeks
    Emotional burden

    Active approach:
    emotional burden, risk of chorioamnionitis, and risk of DIC (if >5wks)
    Induction of labour can be initiated at any time.

    DELIVERY
    Always try to achieve vaginal delivery
    Unless contraindicated eg : Placenta previa

    Methods
    ARM & syntocinon
    Prostaglandin
    Misoprostol

    Post partum
    Suppression of Lactation
    Bromocriptine
    Cabergoline

    Counselling Bereavement care

    THANK YOU

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