1. DEATH INTRAUTERINE FETAL DR EKHLASS JABBAR

2. Intrauterine fetal death: is defined as delivery of a baby with no signs of life after 24 wks of gnancy.  ‘;’;

3. Intrauterine fetal death: is defined as delivery of a baby with no sign of life after 24 wks of pregnancy. Still birth rate is 5.5/1000 birth. It is recognized that IUFD is more common amongst certain groups such as advanced maternal age,obesity,advanced gestation,social deprivation are all associated with increased risk. The possible cause of IUFD are:

4. Cause of IUFD Fetal :cord accident,feto-fetal transfusion,fetomaternal haemorrhage,chromosomal and genetic causes,stuctural abnormality,infection,anaemia of fetal orgion. Direct maternal effect:obstetric cholestasis,metabolic disturbances e.g diabetic ketoacidosis.

5. Reduced O2 states e.g cystic fibrosis,obstructive sleep apnoea. Uterine anomaly e.g ashermans syndrome. Antibody production e.g RH- disease,congenital heart block. Maternal placental effects:pre- eclampsia,renal disease,antiphospholipid syndromes,thrombophilia,smocking,drug abuse e.g cocaine. 30-50% of IUFD is unexplained.

6. Diagnosis:IUFD presents with decreased fetal movement in as many as 50% of cases.others present with an unexplained finding at routine U/Sor A/N visits or with signs of an acute events such as abrubtion,rupture membranes or the onset of labour.when IUFD is suspected it is important to establish the dx as soon as possible. Fetal death must be dx by U/S. CTG can be very misleading as the heart rate

7. Tracing of an anxious mother is usually identical to that of a fetus. U/S features :spalding sign (overlapping of the fetal skull bones when the fetus has been dead for some time),oligohydromnia,signs of fetal hydrops. Measurements of Bp and urine analysis should be undertaken to rule out significant pre- eclampsia.

8. When the fetal death is due to an abruption clinical signs are usually apparent.if it is felt that the fetus has been dead for some times clotting screen should be performed to role out coagulopathy. Prevention of RH isoimmunization:massive feto- maternal haemorrhage is one cause of fetal death and have occurred hours or even days before clinical presentation.if the female is RH –VE blood for kleihauer test should be taken ad soon as the dx for an estimation of the volume

9. Of feto-maternal transfusion and anti-D should be given. How to deliver:vaginal deivery is the aim unless there are absolute indication for C/S e.g placenta praevia,….. Patient should have full access to analgesia as recquired. Induction of labour :there are various strategies has been used for induction of labour.whichever method is used, it is important to remember that complications such as uterine rupture and shoulder dystochia can occur.

10. Third trimester termination achieved with standard PGE2 preparations. Other methods:combination of anti- progesterone(mifepristone)+PG analogue(misopristol).the advantage of this protocol is that the induction to delivery time is shorter. Mifepristone:200mg 24-48 hrs before induction followed by 200 microgram orally every 3-4 hrs. In gestations more than 34 wks dose of 100 microgram of misopristol appear to be effective

11. When possible membranes should be left intact for as long as possible as ascending infection can rapidly occur. PPH is not uncommon especially where there is PE,abruption,prolonged fetal death,or infection.prolonged chorioamnioitis and repeated small abrution predispose to retained placenta.when this occur it should be delt quickly and Abprophylaxis given.

12. IX: the fetus should be care fully examined after birth.the birth WT should be recorded and the placenta weighted..any dysmorphic signs should be noted. Determination of the sex of the baby. Fetal karyotyping and infection screening. Fetal skin karyotyping. Full fetal x-ray.

13. IX of the mother should include the following: Maternal blood for :infection screen,lupus anti coagulent,ACL abs,thrombophilia screen),kliehuer test,anti Ro Maternal genital swabs if inf ction is suspected,maternal urine for drug screening. Placenta:swabs for infection should be taken(from between membranes). Small sample send with saline for karyotype The whole placenta send for histopath.

14. Suppression of lactation Good supportive bra,NSAID Some female require additional pharmacological measurese.g single dose of cabergoline(long acting dopamine agonist) but should not be used in female with PET or a person with strong family history of thromboembolic disease. First follow up visit should be within 6 wks.