Intra-uterine Death Flashcards
What is intrauterine death (IUD)?
Death of fetus after 24/40.
What is the aetiology of IUD?
Maternal: prolonged pregnancy, DM, PREC, HTN, OBCHOL, SLE, AntiPLsyndrome, thrombophilia, infecton, Rh immunisation, Hbopathies, uterine rupture, maternal trauma, maternal death.
Fetal: congenital abnormalities, genetic abdormalities, IUGR, infections (TORCH/PB19/List) hydrops fetalis, multiple gestation.
Placenta: insufficiency, abruption, vasa pervia.
Intrapartum factors: birth asphyzia, shoulder dystocia, cord accident.
Other: idiopathic
What are the RFs of IUD?
As for aetiology; also associated with high maternal age, smoking DU, previous IUD.
What is the epidemiology of IUD?
5/1000
What is the Hx/Ex of IUD?
Reduced or absent fetal movements, symptoms of underlying abnormalities.
Abdomen: absent FH, may have low fundal height, features of underlying conditions.
What is the pathology of IUD?
Depends on cause but mainly due to interrupton of flow of blood to fetus.
What Ix do you do for IUD?
USS: confirm death, fetal heart movements (two accredited operators must be present)
Blood: FBC, UE, LFT, CRP, Hb1Ac, clottnig, thrombophilia creen, TORCH screen, previous serology, Kleinhauer (fetomaternal hemorrage)
Other: placental histology, fetal karyotype, postmortem.
What is the management of IUD?
Induction of labour
Post delivery bromocriptine or cabergoline to suppress lactation, arrange beravement counseling, discuss PM consent, F/U with results of cause.
What are the complications/ prognosis of IUD?
DIC, postnatal depression. Unlikely to recur if no cause found, but manage subsequent pregnancies as high risk.
