Puntland Medical AssociationPMA

بونتالند أطباء نقابةwww.puntmedass.org

HQ: Garowe tell:+252 5 845533

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Cotinuous Medical EducationTopic: IUFD (Inter-Uterine Fetal Death)

Date: 17, Oct 2014 Presenter: Dr. Habibo Noh.

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Definition

Is a fetal death from 24 weeks GA and more but before onset of labour

Incidence ; Complicates 1% of pregnancies 33

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Etiology

• Unknown in 25-60% of cases

• Identifiable causes can be attributed to:

oMaternal conditions

o Fetal conditions

o Placental conditions

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Fetal conditions (25-40%)

• Chromosomal anomalies

• Prematurity/immaturity : Preterm prelabor rupture of membranes(PPROM)

• Preterm labor where uterus contractions

• Cervical dysfunction initiates preterm delivery

• Infections TORCH :

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Placental and Cord conditions 25-35%

o Placental bed pathology: inadequate spiral artery remodeling and/or spiral artery pathology leading to utero-placental vascular insufficiency such as placental infarction.

o Placental pathology: originated during development of the placenta itself, abnormalities in the parenchyma or localization of the placenta.

o Umbilical cord complication : tight knot in the cord and abnormal umbilical cord coiling and Prolapse

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Maternal conditions 5-10%

• Trauma

• Abnormal labour

• Sepsis

• Post term

• Uterine rupture

• Drugs

• Sever anemia

• Epilepsy

• Thrombophilia

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UNKNOWN CONDITIONS

• Mom with no perinatal care delivery and diagnosed (discordant twins).

• Toxoplasmosis , Rubella, CMV.88

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Diagnosis

• Real time ultrasound is the definite method for diagnosing intrauterine fetal death by demonstrating the absence of fetal cardiac activity and movements.

• When the fetus has been dead for more than2 days;

fetal scalp edema

overlap of cranial bones (Spalding’s sign)

Air bubbles in heart and great arteries( Robert’s sign)

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PREVENTION

• Regular ANC

• To screen out the risk patients to monitor carefully for the assessment of fetal well being and to terminate the pregnancy a the earliest evidence of fetal compromise

• Better education can directly influence the implementation of RH

• Several causes like chromo sol abnormality are not preventable even with modern medical knowledge

• Post-maturity can preventable

• IUFD secondary to RH is immunization can be preventable with correct admiration anti D

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Complications

• Problem associated with retained dead fetus

Infection

Maternal distress psychological manifestation, depression

Coagulopathy

Rhesus iso immunization in rhesus mother negative

DIC

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Management

Initial counseling• Conformation of diagnosis

• Breaking bad news

Maternal investigationBasic investigation Urine full report

Urine culture

Full blood count

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Conti

• Random blood sugar

• Coagulation screen

• Bleeding time

• Clotting time

• Serum fibrinogen level

• Prothrombin time

• Ultrasound

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Conti

Special investigation:

• Diabetic mellitus detection( fasting blood sugar)

• Syphilis screening ( VDRL) and conformation taste (TPHT)

• Thyroid function test ( TSH,T3,T4)

• Blood culture and anti bacterial sensitivity test

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Accomplishing the delivery of fetus

• Vaginal delivery should aimed unless there are specific indications for abdominal delivery

• Spontaneous labour could be awaited for up to two to four weeks or labour could be induced

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General discussion and future perspectives

• Example for Maternity ward • From April to September Number of attended was 598

• 410 was delivery ( NSVD & C/S)

• 77 was IUFD

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0 to 451%5 to 9

36%

above913%

GRAVIDA

0 to 4 5 to 9 above9

PARITY

0 to 4 5 to 9 above9

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24-2816%

29-3229%

33-369%

37-4023%

above 4023%

GA

24-28 29-32 33-3637-40 above 40

17-2448%25-32

39%

above 32

13%

AGE GROUP

17-24 25-32above 32

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THANK YOU

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