Perinatal Loss

Question 1

IUFD

Answer 1

death of fetus in utero after 20wks EGA

also referred to stillbirth or fetal demise

Question 2

Perinatal Mortality Rate

Answer 2

late fetal deaths (>28wks) including first 6 days of life

Question 3

Warning Signs of IUFD

Answer 3

absence of fetal activity
no fetal heart tones heard
u/s to confirm lack of fetal cardiac activity

Question 4

Risk of Prolonged Retention of Fetal Demise

Answer 4

can lead to:
DIC
infection (endometritis, sepsis)

Question 5

Plan of Care for IUFD:

Answer 5

induction w/in a few days

mode is based on GA and cervix

spontaneous labor may occur w/in 2 wks

Question 6

Evaluation after Delivery

Answer 6

causative factor identification may provide closure, may elicit risk for recurrence

extent of evaluation depends on couple’s wishes:

• chromosomal studies
• cultures of placenta and fetus (IgM, IgG)
• visual inspections for defects/abnormalities
• cord and placenta inspected (true knots, lack of wharton’s jelly, velamentous insertion, short cord)

Question 7

Grief

Answer 7

reaction to loss (physical symptoms, spiritual, thoughts, feelings, functional impairment)

can be immediate or delayed, heightened or subdued (highly variable)

Dependent factors:

• type of death
• age of deceased
• age of griever

Question 8

Adolescents and Grief

Answer 8

the adolescent who attaches meaning to her pregnancy has the highest rate of grief reaction and life impact, the younger the teen the more of an emotional physical response

may be the first time experiencing loss

rely on peers and have mistrust of adults