Fetal Death Flashcards
What is the most common abnormal karyotype encountered in spontaneous abortuses?
autosomal trisomy is most common, accounting for 40-50% of cases; the most common chromosomal aneuploidy noted in abortuses is Trisomy 16, Triploidy accounts for 15% and tetraploidy for 5%; Monosomy X (45X,0) is seen in 15-25% of cases
What would give most accurate dating for postmortem fetus?
femur length, long bone measurements are more reliable than head and abdominal measurements due to postmortem soft tissue changes
How does ultrasound help determine approximate time of the demise?
recent demise would not yet demonstrate overlapping cranial sutures or postmortem skin edema
What is Factor V Leiden?
most common inherited thrombophilic disorder, affecting 5% of caucasian women in US; it is a point mutation that alters factor V, making it resistant to inactivation by protein C; heterozygosity is associated with 5 to 10 fold increased risk of thrombosis, while homozygosity is associated with 80 fold increased risk
what obstetric complications are associated with factor V leiden mutation?
stillbirth, preeclampsia, placental abruption and IUGR
What is risk of uncontrolled diabetes?
during organogenesis is associated with high rate of birth defects with the most common sites affected are the spine and the heart of the fetus; fetuses in utero exposed to high levels of glucose transplacentally have increased growth and polyuria resulting in an increase in the amniotic fluid volume
What is the most likely cause of painless cervical dilation that leads to pelvic pressure, bulging membranes, and fetal loss?
cervical incompetence or insufficiency; cone biopsy may be associated with cervical incompetence
When does preterm labor occur?
by definition not until 24 weeks gestation
What should be checked on all women with vaginal bleeding during pregnancy?
A maternal blood type and if blood type is Rh negative, RhoGAM would be indicated to prevent Rh sensitization
What are the stages of coping response?
denial, anger, bargaining, depression, acceptance
What can help the bereavement process in delivery of dead infant?
allowing parents to decide when to deliver, keeping patient adequately anesthetized during labor and delivery, letting parents hold the baby for as long as they desire, whether to have care on the maternity floor needs to be parents decision as well, offering autopsy to determine cause of death as well as having someone take pictures and keeping mementos
What are ultrasound criteria for a missed abortion?
crown rump length of 7mm with no cardiac activity
