38. Intrauterine fetal death. Postterm pregnancy

Question 1

definition of postterm pregnancy

Answer 1

pregnancy that persists beyond 42 weeks from the onset of the last menstrual period.
Incidence is approx. 6-12%
based on the clinician’s most accurate estimate of the patient’s delivery date (EDD).

Question 2

what women are at the highest risk for post-term pregnancy?

Answer 2

those with a previous postterm pregnancy

Question 3

What patterns of postterm pregnancies are there?

Answer 3

1. Fetal dysmaturity (postmaturity) syndrome (20%)
2. Fetus continues to grow in utero (80%)

Question 4

when does Fetal dysmaturity (postmaturity) syndrome occur?

Answer 4

when a growth-restricted fetus remains in utero beyond term.

The syndrome is related to the aging and infarction of the placenta, with resulting placental insufficiency

Question 5

what occurs in Fetus continues to grow in utero (80%)?

Answer 5

Macrosomia (birth weight > 4000-4500 g) often results in abnormal labor, shoulder dystocia, birth trauma, and an increased incidence of cesarean delivery.

Question 6

prolonged gestation is associated with?

Answer 6

hypoplastic adrenals (ex. anencephalic fetus), related to the lack of a fetal labor-initiating factor (CRH, ACTH)

Question 7

what is the cause of postterm pregnancy?

Answer 7

unknown in most cases

Question 8

management for pregnancies that reach 41+0 weeks gestation (with favorable fetal head position) ?

Answer 8

induction of labor
preferred over expectant management (induce labor by 42+6 weeks gestation or if theres abnormal finding during follow up)

Question 9

what is important to monitor in women at 41+0 weeks gestation who choose expectant management?

Answer 9

fetal well-being by NST, BPP, and amniotic fluid volume assessment twice weekly

Question 10

definition of intrauterine fetal demise/death (IUFD)

Answer 10

fetal death after 20 weeks gestation but before the onset of labor.
1% of pregnancies.

Question 11

the etiology of antepartum fetal death?

Answer 11

50%–> unknown/undetermined
associated factors:
- IUGR
- Hypertensive disorders of pregnancy
- Diabetes mellitus
- Erythroblastosis fetalis
- Fetal congenital anomalies
- Fetal/maternal infections
- Antiphospholipid syndrome

Question 12

when should be suspect intrauterine fetal death?

Answer 12

patient reports the absence of fetal movements
if uterus is small for date

*confirm with US

Question 13

management of intrauterine fetal demise

Answer 13

induction of labor–> shouldn’t be rushed unless maternal disease indicates
spontaneous labor begins within 1-2 weeks of fetal death in most cases, but waiting increases the risk of developing coagulation abnormalities (DIC).

Question 14

what can be done to prevent intrauterine fetal death?

Answer 14

1. adherence to prenatal care
2. lifestyle measures
3. genetic counseling when indicated
4. self-monitoring of fetal movements (daily, start at 18-20 gestational w’).