IUFD Flashcards

1
Q

What are the causes of IUFD?

A
  • unexplained 35-40%
  • infections
  • maternal risk factors
  • fetal risk factors: chromosomal anomalies, cord accidents, feto-maternal hemorrhage, IUGR
  • paternal risk factors: father > 40 years
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2
Q

What is the clinical picture of IUFD?

A

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

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3
Q

What investigations are done for confirmation of diagnosis of IUFD?

A

1- confirm IUFD: ultrasonography
2- diagnosis of etiology
3- detection of possible complications: coagulation profile & INR (DIC), Kleihauer test (Rh isoimmunization)

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4
Q

What are the ultrasound findings in IUFD?

A

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)

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5
Q

How should detection of etiology be done?

A

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

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6
Q

How is IUFD managed?

A
  • 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
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7
Q

Why shouldn’t labour be delayed more than 2 weeks?

A
  • value of post-mortem may be reduced
  • appearance of baby may deteriorate
  • she will need testing or DIC twice weekly & CRP
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8
Q

Who should be treated with intra-partum antimicrobial therapy?

A

women with sepsis -> treat with IV broad spectrum antibiotics

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9
Q

What is fetal maceration?

A
  • 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)
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10
Q

What should be given to mother during purperium?

A
  • thrombo-prophylaxis -> heparin
  • dopamine agonists to suppress lactation -> cabergoline, bromocriptine
  • counseling for future pregnancy
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11
Q

What are the contraindications for dopamine agonists?

A

women with pregnancy induced hypertension -> increases BP -> intracranial hemorrhage

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