fetal death
DESCRIPTION
fetalTRANSCRIPT
7/17/2019 Fetal Death
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FETAL DEATH
NUSWIL BERNOLIAN
FETOMATERNAL DIVISION
DEPARTMENT OF OBSTETRIC ANDGYNAECOLOGY
DR MOH. HOESIN GENERAL HOSPITAL
PALEMBANG
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DEFINITION
WHO: a death bef!e"#$%ete e&$'%()* !
e&t!a"t)* f!# the #the! fthe $!d'"t f "*"e$t)*+)!!e($e"t),e f d'!at)* f
$!e-*a*".
M)"hae% /. Pa)da(+ Na0%) H((a)*.
E#b!*)" a*d feta% de#)(e. C!ea( a*dRe(*)12( #ate!*a% a*d feta% #ed)")*e.
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Ce*te!( f! D)(ea(e C*t!%a*d P!e,e*t)* a*d the
V)ta% Stat)(t)"( Re$!t(O*% th(e dead fet'( a*d*e*ate( b!* at afte! 76
8ee1(+ ! )f -e(tat)*a% a-e )(*t a,a)%ab%e+ 8e)-h)*- 95 -! #!e ;Ma"D!#a* a*d
<)!#ee!+ 4556=The ab(e*"e f ()-*( f %)fe at! afte! b)!th
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EPIDEMIOLOGY
USA : Rate f (t)%%b)!th( h)-he!tha* *e*ata% #!ta%)t
76> : ?.>@.. 4559: 3.4 $e! 7555
%),e b)!th(
O*e ha%f ""'!!ed %e(( tha* 4>8ee1(+ a*d 45 *ea! te!#
49 & h)-he! )* b%a"1 fet'(e(
RR 7+7? )* )*te!!a")a% "'$%e(
ACOG: I*"!ea(e & )* #'%t)feta%
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S)#'%)a* et a%: I* %8 !)(1-!'$( : 7.3 $e! 7555 b)!th(
I* ab!'$t)* : 37.
SGA : 6.3
Ge(tat)*a% h$e!te*(),e
d)(!de!( : 9.Ch!*)" h$e!te*()* : ?.3
D)abete( : 9.6
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ETIOLOGY
FETAL : 4 5 PERCENT
PLACENTAL : 4 9PERCENT
MATERNAL 75 PERCENT
UNEPLAINED 7 9PERCENT
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FETAL 4 5
CHROMOSOMALABNORMALITIES
NONCHROMOSOMAL BIRTHDEFECTS
NONIMMUNE HYDROPS
INFECTIONS : VIRUSES+
BACTERIA+ PROTOOA
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PLACENTAL 49
PREMATURLEY RUPTURED MEMBRANES
ABRUPTION
FETOMATERNAL HAEMORRHAGE
CORD ACCIDENT
PLACENTAL INSUFFICIENCY
INTRAPARTUM ASPHYIA
PREVIA
TWINTWIN TRNASFUSION
CHORIOAMNIONITIS
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MATERNAL 75
DIABETES
HYPERTENSIVEDISORDERS
OBESITY
AGE 9 YEARS
THYROID DISEASE
RENAL DISEASE
ANTIPHOSPOLIPID
THROMBOPHILIAS
SMO<ING
ILLICIT DRUGS ANDALCOHOL
INFECTIONS ANDSEPSIE
PRETERM LABOUR
ABNORMAL LABOUR
UTERINE RUPTURE
POSTTERMPREGNANCY
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PROTOCOL FOREAMINATIONS
INFANTDESCRIPTION
MALFORMATIONS
S<IN STAINING
DEGREE OFMACERATION
COLOR: PALE+PLETHORIC
UMBILICAL CORDPROLAPSE
ENTANGLEMENT:
NEC<+ ARMS+ LEGS
HEMATOMAS ORSTRICTURES
NUMBER OF VESSELS
LENGTH
WHARTON /ELLY:NORMAL+ ABSENT
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AMNIOTIC FLUID
COLOR: MECONIUM+BLOOD
CONSISTENCY
VOLUME
MEMBRANES
STAINED: MECONIUM+CLOUDY
THIC<ENING
PLACENTA
WEIGHT
STAININGMECONIUM
ADHERENT CLOTS
STRUCTURALABNORMALITIES:CIRCUMVALLATE ORACCESSORY LOBES+
VELAMENTOUSINSERTION
EDEMA: HYDROPHICCHANGES
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EVALUATION FORRECURRENT TM 7 LOSS
<ARYOTYPE OFMISCARRIEDTISSUE
PARENTAL<ARYOTYPE
LUTEALPHASEASSESSMENT
GTT
THYROID
UTERINE CAVITYASSESSMENT BYSONOHYSTEROGRAPH Y ;PREFFERED=+ HSG+
OR HYSTEROSCOPY
APS ANTIBODYSCREEN
INHERITEDTHROMBOPHILIAS+ IFLOSSES BETWEEN 7579 WEE<S
RECOMMENDED
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RECOMMENDEDEVALUATION FOR TM
49 LOSSFETAL WOR< UP
FETAL AUTOPSY
PLACENTHALPATHOLOGY
RADIOGRAPH OFFETAL S<ELETON
MATERNAL WOR<UP
CBC+ <LEIHAUERBET<ETEST
PARVOVIRUS B 76 I-M+I-G
SYPHILLIS
LUPUS ANTICOAGULANT
ANTICARDIOLIPIN AB
FTHYROINE+ TSH
INHERITEDTHROMBOPHILIAS
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LABORATORYEVALUATION
If a't$( a*d "h!#(#a% (t'd)e($e!f!#ed: 9 d)(",e!ed ha,e#a! (t!'"t'!a% a*#a%)e(.
45 ha,e d(#!$h)" feat'!e( !(1e%eta% ab*!#a%)t)e(+ >"h!#(#a% ab*!#a%)t)e(
ACOG 4556 !e"##e*d( )dea%%1a!t$)*- a%% (t)%%b!*(
If * #!$h%-)" a*#a%)e( f'*d+
ha,e "h!#(#a% ab*!#a%)t)e(.
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A$$!$!)ate "*(e*t #'(t bebta)*ed t ta1e feta% t)(('e
(a#$%e(+ )*"%'d)*- ')d b$(t#!te# a($)!at)*
9 #L f feta% b%d bta)*ed f!#
'#b)%)"a% "!d ;$!efe!ab%= ! b"a!d)a" $'*"t'!e+ )( $%a"ed )*t a(te!)%e+ he$a!)*)0ed t'be f!"t-e*et)" (t'd)e(.
Mate!*a% b%d : APS+ d)abete(+L'$'(+ <%e)ha'e!Bet1e (ta)*)*-
If b%d "a**t be bta)*ed+ ACOG
;4556= !e"##e*d( *e f the
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7. A $%a"e*ta% b%"1 ab't 7&7 "# ta1e*be%8 the "!d )*(e!t)* ()te )* the'*J&ed ($e")#e*
4. U#b)%)"a% "!d (e-#e*t ab't 7. "#%*-+ !
I*te!*a% feta% t)(('e ($e")#e*+ ('"h a("(t"h*d!a% '*"t)* ! $ate%%a ;(1)*)( * %*-e! !e"##e*ded=
T)(('e )( 8a(hed 8)th (te!)%e (a%)*e
$!)! t $%a"e#e*t )* %a"tated R)*-e!(%'t)* ! (te!)%e "t-e*et)" #ed)'#.
P%a"e#e*t )* f!#a%)* ! a%"h% 1)%%(!e#a)*)*- ,)ab%e "e%%( a*d $!e,e*t(
"t-e*et)" a*a%()(.
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MANAGEMENT
DELIVERY BY A CARING PHYSICIAN
COUNSELING : AUTOPSY
RIS< OF DEPRESSION
COAGULOPATHY : 4 95+ CHEC<FIBRINOGEN AND PLATELET
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RECURRENCE RIS< RECURRENCE RIS< : 9 IF 4? WEE<S+
GREATER IF K 4? WEE<S
SHARMA ET AL+ 4553: STILLBIRTH RATE 44.?PER 7555 IN WOMEN WITH PRIOR FETAL DEATH
SUR<AN ET AL+ 455: TERM IUGR LIVE FETUS+HAS 4 RIS< OF STILLBIRTH. IF PRETERM:
ACOG 4556: LOW RIS< WOMAN UNEPLAINED
STILLBORN: RIS< 75 .RIS< OF STILLBORN 9? WEE<S : 7.> PER7555
GOLDENBERG ET AL 7669: 6 WOMEN WITHPREGNANCY LOSS 79 4 WEE<S: NET
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SUBSEUENTPREGNANCY
COUNSELING FOR RIS< FACTORS
ANTENATAL SURVEILLANCE+ PRENATAL
DIAGNOSISRIS< IS REDUCED BY 7 WITH ASPIRIN
HEPARIN FOR THROMBOPHILIA
IMMUNOGLOBULIN+ PROGETERONE
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FETAL <IC< COUNTS : START AT 4>
WEE<S
INTERVAL 4 WEE<S : USG+ NST+ BPP+ AFI
ACOG RECOMMENDATIO+ 4556 :ANTEPARTUM SURVEILLANCE START AT94 WEE<S
EARLIER IN IUGR OR CHRONIC DISEASE
ELECTIVE INDUCTION AT THECOMPLETION OF 96 WEE<S GESTATIONOR 9? TO 9> AFTER LUNG MATURITY IS
DOCUMENTED BY AMNIOCENTESIS
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CONCLUSION
CATASTROPHIC EVENTS IN A COUPLE2SLIVES.
POSSIBILITIES OF ETIOLOGIESINVESTIGATIONS : FETUS+ PLACENTA+UMBILICAL CORD+ MEMBRANE
COUNSELING THE COUPLESPLANNING THE SUBSEUENTPREGNANCIES
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THAN< YOU