Fetal Death

Question 1

What is the most common aneuploidy in abortuses?

Answer 1

Trisomy 16

Triploidy: 15%
Tetraploidy: 5%
Monosomy X (45X, 0): 15-25%

Question 2

What is most accurate feature for dating unviable fetus?

Answer 2

Femur length - more reliable due to postmortem soft tissue changes (HC, AC)
Ultrasound may also help determine time

Question 3

What are later features of fetal demise?

Answer 3

Overlapping cranial sutures
Postmortem skin edema

Question 4

What OB complications does Factor V lead to?

Answer 4

Stillbirth, preeclampsia, placental abruption, IUGR

Question 5

How would congenital parvovirus infection associated with fetal demise appear?

Answer 5

Fetal hydrops

Question 6

What risk does uncontrolled maternal hypothyroidism cause?

Answer 6

Miscarriage

Question 7

What features are shared between severe hypertension and active anti-phospholipid antibody syndrome?

Answer 7

Oligohydramnios
Intrauterine growth restriction

Question 8

How does viral infection in utero affect fetus?

Answer 8

Placentomegaly
Polyhydramnios
Normal or decreased growth depending on timing

Question 9

What are the Kubler-Ross stages?

Answer 9

Denial, Anger, Bargaining, Depression, Acceptance

Question 10

What are ultrasound criteria for a missed abortion?

Answer 10

CRL of 7mm with no cardiac activity

Question 11

How should IUFD be handled at 20-23 wks vs >=24 wks?

Answer 11

20-23 wks: Dilation and evacuation or vaginal delivery
>=24 wks: Vaginal delivery

Question 12

What is suggested by areas of necrosis around umbilical vessels and abnormally pale and enlarged placenta, in stillbirth?

Answer 12

Infectious cause, likely transplacental - fetal inflammatory cells then mobilize along umbilical vein, causing cord inflammation and perivascular foci of necrosis

Parvovirus, CMV, Listeria, Syphilis, Toxoplasma