Journal Club

IUFD
 
 Critically critique/
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Systematic
Review
PICO Question
How should safely induced women with intrauterine fetal death who
have had a single previous cesarean birth ?
• P: Women with IUFD & Previous C/S
• I: Induction of labor
• C: type of Induction of IOL
• O: Safely induced women
Background
• Intrauterine fetal demise
(IUFD) is the medical term
for a fetus that dies at or
after the 20th week or
second trimester of
gestation. IUFD differs from
a miscarriage, which occurs
before the 20th week of
pregnancy.
 Common causes of IUFD include:

- Maternal : Hypertension , DM ,
Infection, post Term, abnormal labor
)
- Fetus : Birth defects , blood transfer
from baby to mother (feto-materna
hemorrhage)Genetic disorder of the
fetus
- Placenta : placental abruption&
Previa ,Umbilical cord issues,
Underdeveloped or damaged
placenta (placental dysfunction)
Pathophysiology
• MSB > 8 hours
• FSB < 8 hours
Diagnosis & Investigation
• Diagnosis : Absent Fetal Movement , soft uterus , No FHR in CTG and
Ultrasound .
• Investigation :
• CBC , ABO and RH
• Kleihauer–Betke test
• HbA1c , RBS ,FBS
Complication :
• Psychological Upset
• Infection ( sepsis )
• Blood coagulation disorder ( DIC )
 Treatment
• As per study :
Outcome Treatment

High Risk of Uterine rapture Misoprostol (prostaglandin E1 )Vaginally

Effective and safe Misoprostol (prostaglandin E1 )Orally

Safe and effective Misoprostol AND Mifepristone

Not effective and high risk for Uterine Oxytocin Protocol alone
Rapture

Effective and safe Oxytocin Protocol with ripening foley

balloon
Limitation
• The study did not show the doses of the medication used in IOL .
• The study did not mention any percentage regarding safety used of
induction methods
Conclusion
• Delivery after an earlier CS remains a challenge especially if a fetal
demise complicates the new pregnancy. The choice must be made
between an induction for vaginal delivery and a CS. A vaginal
delivery is both effective and safe. If an induction is needed, oral
solution of misoprostol or Misoprostol AND Mifepristone is the best
methods to induce women in such cases .
References
• Jouko .P& Risto .E. Delivery after fetal death in women with earlier
cesarean section. 2021.
Delivery after fetal death in women with earlier cesarean section. A
review (ejog.org)