INTRAUTERINE FETAL DEATH

DEFINITION Antepartum death occuring beyond 28 weeks is termed as IUD

ETIOLOGY Pregnancy complications Pre eclampsia Antepartum haemorrhage Pre existing medical and acute illnesses Chronic hypertension Diabetes Chronic nephritis Anti phosphonlipid syndrome Syphilis Hyperpyrexia Severe anemia Others

Contd…... Fetal Congenital malformation Rh incompatability Postmaturity Iatrogenic Administration of quinine group External version

DIAGNOSIS SYMPTOMS Absence of featal movements SIGNS Retrogression of breast changes PER ABDOMEN Gradual retrogression of height Uterine tone is diminished Fetal movements are not felt during palpation Fetal heart sound absent Egg shell cracking of fetal head

INVESTIGATION Sonography Lack of fetal motions Oligohydramnios Collapsed cranial bones Straight x-ray abdomen Spalding sign – irregular overlapping of cranial bones on one another is due to liquefaction of the brain matter and softening of the ligamentous structures supporting the vault Hyperflexion of spine Crowding of rib cage Roberts sign(Appearance of gas shadow)

INVESTIGATION PROTOCOL IN IUD To confirm diagnosis by sonography To confirm blood fibrinogen level To find out the cause of death

COMPLICATIONS Psychological upset Infection Blood coagulation disorders During labour

PREVENTION Regular antenatal care To screen out at risk mothers

MANAGEMENT Expectant attitude Interference Psychological upset Manifestation of uterine infection Falling fibrinogen level Prolongation of pregnancy

METHODS OF TERMINATION Oxytocin Prostaglandin

MANAGEMENT Termination Psychological support Lactation suppression