UW intrauterine fetal demise 02-20 (1)

Question 1

IUFD. table. Definition?

Answer 1

absent fetal cardiac activity or >=20 weeks

Question 2

IUFD. table. risk factors?

Answer 2

Aneuploidy
Fetal or placental anomalies
Fetal growth restriction
Congenital infection
Substance use (tobacco, cocaine)
Maternal conditions (eg HTN, DM)

Question 3

IUFD. table. Evaluation. FETAL? 3

Answer 3

Autopsy
Gross and microscopic examination of placenta and umbilical cord
Karyotype/genetic studies

Question 4

IUFD. table. Evaluation. MATERNAL? 3

Answer 4

Kleinhauer-Betke test
Antiphospholipid antibodies
Coagulation studies - for Hx of recurrent pregnancy loss, family or personal history of venous thrombosis, of fetal growth restriction.

Question 5

IUFD. table. Management. 20-23 weeks ?

Answer 5

Dilation and evacuation OR vaginal delivery (cesarean delivery by maternal choice if Hx of prior classical cesarean/myomectomy)

Question 6

IUFD. table. Management. >= 24 weeks?

Answer 6

Vaginal delivery
same: (cesarean delivery by maternal choice if Hx of prior classical cesarean/myomectomy)

Question 7

IUFD. table. complications?

Answer 7

Coagulopathy after several weeks of fetal retention

Question 8

IUFD. Most stillbirths are associated with uncomplicated pregnancies, but risk factors include aneuploidy, fetal growth restriction, and maternal tobacco use.

Answer 8

.

Question 9

IUFD. how to make Dx?

Answer 9

ultrasound

Question 10

IUFD. once Dx is confirmed - next step?

Answer 10

The parents should be informed as empathically as possible (eg, “I am sorry for your loss”). Because the diagnosis can be overwhelming, the next steps in management should be presented as gently and clearly as possible.

Question 11

IUFD. Patients with stillbirth require delivery.
safest mode?

Answer 11

Induction of labor for vaginal delivery

Question 12

IUFD. Medically stable patients, such as this one with normal vital signs and laboratory results, can undergo …………. what? and when 2?

Answer 12

induction of labor immediately OR within a week if the parents require additional time to process the diagnosis.

Question 13

IUFD. why delivery is required immediately OR within week? why this time frame?

Answer 13

This time frame is recommended because prolonged fetal retention increases the risk for maternal coagulopathy; therefore, waiting for spontaneous labor is not recommended.

Question 14

IUFD. Can we wait spontaneous delivery?

Answer 14

NO
prolonged fetal retention increases the risk for maternal coagulopathy

Question 15

IUFD. dilation and evacuation (D&E) is not recommended at what weeks?

Answer 15

≥24 weeks gestation due to increased fetal size, which increases the risk for maternal complications

Question 16

IUFD. dilation and evacuation (D&E) when is recommended at what weeks?

Answer 16

indicated at <24 weeks gestation in patients whose condition is medically unstable and who require expedited delivery.

Question 17

IUFD. as in case - eg no fetal moves 3 days, patient stable. tai nereikia skubaus delivery nes stable condition.

Answer 17

.

Question 18

Patients with a previous stillbirth are 2-10 times more likely to have another.

Answer 18

.

Question 19

The pathophysiology of stillbirth can be…. 3?

Answer 19

fetal, placental, or maternal in origin.

Question 20

Two of the highest-yield tests for identifying the cause of stillbirth?

Answer 20

are placental evaluation and fetal autopsy

Question 21

Gross and microscopic placental evaluation can reveal evidence of placental thrombosis, abruption, infection, and other placental disease. Fetal autopsy can estimate the time of death, identify anatomic anomalies, and facilitate additional genetic studies.

Answer 21

.

Question 22

If patient declines autopsy? what offer?

Answer 22

Patients who decline fetal autopsy are still recommended to undergo noninvasive fetal evaluation (eg, external examination for dysmorphic features, MRI) and evaluation of the placenta, fetal membranes, and umbilical cord. In addition, maternal testing for other causes of stillbirth (eg, antiphospholipid antibody syndrome, fetomaternal hemorrhage) should be performed. However, even after thorough evaluation, up to half of stillbirths have no identifiable cause.

Question 23

However, even after thorough evaluation, up to half of stillbirths have no identifiable cause.!!!!!!!!!!!!!!!!!!

up to half of cases have no identifiable cause.

Answer 23

Therefore, patients should be counseled in advance that testing may be negative.

Question 24

Chromosomal abnormalities are common causes of …..??? when???

Answer 24

Chromosomal abnormalities are common causes of first-trimester spontaneous abortions.

Question 25

Chromosomal abnormalities at ≥20 weeks cause what???

Answer 25

Genetic abnormalities typically cause anomalies (eg, cardiac defect) that are visible during ultrasonography. This patient’s ultrasounds were normal, making a genetic defect less likely.