Intrauterine Fetal Demise (IUFD)
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on Jul 26, 2012 Says :
good ppt for managing the risks of fetal deaths..
on Jul 06, 2012 Says :
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Slide 1 :
Intrauterine Fetal Demise (IUFD) Dr. Sanjay Rakibe Vithai Hospital Panchwati, nashik 9960125555
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Intrauterine Fetal Demise Definition: is fetal death after 20 weeks’ gestation but before the onset of labour. Complicates 1% of pregnancies Definition: dead fetuses or newborns weighing > 500gm Or > 20 wks gestation 4.5/ 1000 total births
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Etiology: The cause is unknown in 50% of cases Known causes include: HTN in pregnancy, D.M, Rh isoimmunization, Fetal congenital anomalies, Umbilical cord accidents, Prenatal infections, Ante partum hemorrhage, Thrombophilias
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Fetal causes 25-40% Chromosomal anomalies Birth defects Non immune hydrops Infections Placental 25-35% Abruption Cord accidents Placental insufficiency Intrapartum asphyxia P Previa Twin to twin transfusion S Chrioamnionitis Maternal 5-10% Antiphospholipid antibody DM HPT Trauma Abnormal labor Sepsis Acidosis/ Hypoxia Uterine rupture Post term pregnancy Drugs Thrombophilia Cyanotic heart disease Epilepsy Severe anemia Unexplained 25-35% Causes OF IUFD
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A systematic approach to fetal death is valuable in determining the etiology 1-History A-Family history Recurrent abortions Congenital anomalies Abnormal karyotype Hereditary conditions Developmental delay B-Maternal History I-Maternal medical conditions DM HPT Thrombophilia Autoimmune disease Severe Anemia Epilepsy Consanguinity Heart disease II-Past OB Hx Baby with congenital anomaly / hereditary condition IUGR Gestational HPT with adverse sequele Placental abruption IUFD Recurrent abortions
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Current Pregnancy Hx Maternal age Gestational age at fetal death HPT DM/ Gestational DM Smooking , alcohol, or drug abuse Abdominal trauma Placental abruption PROM or prelabor SROM Specific fetal conditions Nonimmune hydrops IUGR Infections Congenital anomalies Chromosomal abnormalities Complications of multiple gestation Placental or cord complications Large or small placenta Hematoma Edema Large infarcts Abnormalities in structure, length or insertion of the umbilical cord Cord prolapse Cord knots Placental tumors 1-History
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2-Evaluation of still born infants Infant description Malformation Skin staining Degree of maceration Color-pale ,plethoric Umbilical cord Prolapse Entanglement-neck, arms,legs Hematoma or stricture Number of vessels Length Amniotic fluid Color-meconium, blood Volume Placenta Weight Staining Adherent clots Structural abnormality Velamentous insertion Edema/ hydropic changes Membranes Stained Thickening
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3-Investigations Maternal investigations CBC Bl Gp & antibody screen HB A1 C Serological screening for Rubella CMV, Toxo, Sphylis, Herpes & Parovirus Karyotyping of both parents (RFL, Baby with malformation Hb electrophorersis Antiplatelet anbin tibodies Throbophilia screening (antithrombin Protein C & S , factor IV leiden, Factor II mutation, , lupus anticoagulant, anticardolipin antibodies) DIC Fetal investigations Fetal autopsy Karyotype (spcimen taken from cord blood, intracardiac blood, body fluid, skin, spleen, Placental wedge, or amniotic Fluid) Fetography Radiography Placental investigations Chorionocity of placenta in twins Cord thrombosis or knots Infarcts, thrombosis,abruption, Vascular malformations Signs of infection Bacterial culture for Ecoli, Listeria.
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Diagnosis If the mother reports absence of fetal movements or if fetal heart tone is not detected by doppler devise. Absence of uterine growth Serial ß-hcg Loss of fetal movement Absence of fetal heart Disappearance of the signs & symptoms of pregnancy X-ray ?Spalding sign Robert’s sign Confirmation by Ultrasonography?100% accurate Diagnosis
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Spalding sign Robert’s sign
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Management Expectant approach: 80% goes into spontaneous labour within 2-3 weeks Active approach: b/o emotional burden, risk of chorioamnionitis, and 10% risk of DIC (if >5wks) Induction of labour can be initiated at any time. F/U: to determine cause of death. Screening for diseases, infections (TORCH), and chromosomal anomalies. Manage next pregnancies as high-risk
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Psychological aspect & counseling A traumetic event Post-partum depression Anxiety Psychotherapy Recurrence 0-8% depending on the cause of IUFD
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