IUFD Flashcards
What are the causes of IUFD?
- unexplained 35-40%
- infections
- maternal risk factors
- fetal risk factors: chromosomal anomalies, cord accidents, feto-maternal hemorrhage, IUGR
- paternal risk factors: father > 40 years
What is the clinical picture of IUFD?
Symptoms
- regression of pregnancy symptoms
- absent fetal movements
- abdominal/pelvic pains
- vaginal bleeding
- vaginal discharges
Signs
- abdominal examination -> signs of trauma, change contour, rigidity & tenderness, uterine contractions, symphysis-fundal height, absent fetal tone & movements, no FHS
- vaginal examination -> bleeding, discharges, cervical state
What investigations are done for confirmation of diagnosis of IUFD?
1- confirm IUFD: ultrasonography
2- diagnosis of etiology
3- detection of possible complications: coagulation profile & INR (DIC), Kleihauer test (Rh isoimmunization)
What are the ultrasound findings in IUFD?
1- absent fetal heart beats
2- Spalding sign (+ve 7 days after death)
3- fetal scalp & skin edema
4- Ball sign: hyperflexion & angulation of fetal spine
5- oligohydramnios
6- Robert’s sign (gas shadow within heart or greater vessels)
How should detection of etiology be done?
Maternal tests
- CRP, urine, & bile salts
- Kleihauer test or flow cytometry
- serology & culture for antibodies & infection
- RBS & HbA1c for occult maternal DM
- thyroid function tests
Fetal tests
- blood sample & placental swab for culture
- fetal & placental tissue for karyotyping
- post-mortem examination
Paternal Test
- blood sample for karyotype if CFMF is detected
How is IUFD managed?
- if < 22 weeks (missed abortion)
1- medical TOP: misoprostol or PGE2 vaginal tab
2- if medical failed: hysterotomy - if > 22 weeks (IUFD)
1- expectant management for maximum of 2 weeks if woman is well
2- C section if medical TOP failed
Why shouldn’t labour be delayed more than 2 weeks?
- value of post-mortem may be reduced
- appearance of baby may deteriorate
- she will need testing or DIC twice weekly & CRP
Who should be treated with intra-partum antimicrobial therapy?
women with sepsis -> treat with IV broad spectrum antibiotics
What is fetal maceration?
- blistering & peeling of fetal skin (12-24hrs after death)
- ligaments are softened
- vertebral column in liable to sag
- skull bones overlap each other at the sutures (7 days after death)
What should be given to mother during purperium?
- thrombo-prophylaxis -> heparin
- dopamine agonists to suppress lactation -> cabergoline, bromocriptine
- counseling for future pregnancy
What are the contraindications for dopamine agonists?
women with pregnancy induced hypertension -> increases BP -> intracranial hemorrhage