1. { INTRAUTERINE DEATH (STILL BIRHT)

2. Baby delivery at 24wk complete with no sign of life

3. CAUSES

4. 1. FETAL Cord accident Fetofetal transfusion Feto maternal haemorrhage Chromosomal and genetic diseases Structural abnormalities Infection Anemia of fetal origin

5. 2. DIRECT MATERNAL EFFECTS Obstetric. Cholestasis Metabolic disturbances(DM Ketoacidosis) Reduced oxygen saturation: Cystic fibrosis, Sleep apnea Uterine abnormalities, Ascherman syndrome Antibodies production: Rh, Platelet, Alloimmunization, Congenital heart block

6. DIAGNOSIS

7. ↓ FM Routine U/S Abruption or ruptured membrane Color Flow Mapping is definitive

8. U/S FINDINGS Spalding sign(overlapping of fetal skull bone) Oligohydromnia Fetal hydrops Negative fetal heart

9. INVESTIGATIONS

10. Kleihauer test→ feto maternal he Full blood count with platelet→ Basic line in case of bleeding abnormality may suggestive Blood gr, Antibody screen→ Iso immunization Anticardiolipin antibodies IgG IgM, Lupus anticoagulant Antiphospholipid syndrome HbA1C→ DM Urea & Creatinin→Renal dis. PE LFT, Uric acid→ PE, Obstetric cholestasis, Acute fatty liver Bile acid→ Obstetric cholestasis Syphilis, Parvavirus CMV Toxop serology→ Trans placental transfusion of infection

11. HOW TO DELIVER?

12. The risk of coagulation problem secondary to retained dead fetus is small Estimated risk is 25% if the fetus has been retained for wks. Therefore, given that over 90% of women will deliver spontaneously within 3 wks, conservative management is an option that can be offered Vaginal delivery is the best option unless there is obstetric indications

13. INDUCTION OF LABOR

14. A standard protocol for mifepristol induction is shown below.  Mifepristone: 200 mg 24 – 48 hr before induction Mifepristol: 200 mg p.v. then 200 mg orally/3 - hr( maximum of 4 oral doses in 2 hr) In gestation of 3 wk or more 100 mg of misopristol is effective

15. Prevention of Rh iso immunization Contraception Psychological support Follow up