1. Puntland Medical Association PMA نقابة أطباء بونتلاند www.puntmedass.org HQ: Garowe tell:+ 252 5 845533 1 1 www.puntmedass.org

2. Cotinuous Medical Education Topic : IUFD (Inter-Uterine Fetal Death) Date : 17, Oct 2014 Presenter : Dr. Habibo Noh. 2 2 www.puntmedass.org

3. Definition Is a fetal death from 24 weeks GA and more but before onset of labour Incidence ; Complicates 1% of pregnancies 3 3 www.puntmedass.org

4. Etiology Unknown in 25-60% of cases Identifiable causes can be attributed to: o Maternal conditions o Fetal conditions o Placental conditions 4 4 www.puntmedass.org

5. 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 : 5 5 www.puntmedass.org

6. 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 6 6 www.puntmedass.org

7. Maternal conditions 5-10% Trauma Abnormal labour Sepsis Post term Uterine rupture Drugs Sever anemia Epilepsy Thrombophilia 7 7 www.puntmedass.org

8. UNKNOWN CONDITIONS Mom with no perinatal care delivery and diagnosed (discordant twins). Toxoplasmosis, Rubella, CMV. 8 8 www.puntmedass.org

9. 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) 9 9 www.puntmedass.org

10. 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 10 www.puntmedass.org

11. Complications Problem associated with retained dead fetus  Infection  Maternal distress psychological manifestation, depression  Coagulopathy  Rhesus iso immunization in rhesus mother negative  DIC 11 www.puntmedass.org

12. Management Initial counseling Conformation of diagnosis Breaking bad news Maternal investigation  Basic investigation  Urine full report  Urine culture  Full blood count 12 www.puntmedass.org

13. Conti Random blood sugar Coagulation screen Bleeding time Clotting time Serum fibrinogen level Prothrombin time Ultrasound 13 www.puntmedass.org

14. 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 14 www.puntmedass.org

15. 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 15 www.puntmedass.org

16. 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 16 12 16 www.puntmedass.org

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19. THANK YOU End 19