1. INTRAUTERINE FETAL DEATH

2. DEFINITION
Antepartum death occuring beyond 28 weeks is termed as IUD

3. 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

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

5. 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

6. 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)

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

8. COMPLICATIONS Psychological upset Infection
Blood coagulation disorders
During labour

9. PREVENTION
Regular antenatal care
To screen out at risk mothers

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

11. METHODS OF TERMINATION
Oxytocin
Prostaglandin

12. MANAGEMENT
Termination
Psychological support
Lactation suppression