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IUfd

IUfd. Dr Muhabat Salih Saeid MRCOG- London-UK. Definition: dead fetuses or newborns weighing > 500gm Or > 20 wks gestation. Diagnosis. Absence of uterine growth Serial ß- hcg Loss of fetal movement Absence of fetal heart Disappearance of the signs & symptoms of pregnancy

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IUfd

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  1. IUfd Dr MuhabatSalihSaeid MRCOG- London-UK

  2. Definition: • dead fetuses or newborns weighing > 500gm • Or > 20 wks gestation

  3. Diagnosis • Absence of uterine growth • Serial ß-hcg Loss of fetal movement Absence of fetal heart Disappearance of the signs & symptoms of pregnancy X-ray Spalding sign Robert’s sign U/S 100% accurate Dx

  4. Spalding sign

  5. Causes of IUFD Fetal causes 25-40% • Chromosomal anomalies • Birth defects • Non immune hydrops • Infections

  6. Causes of IUFD Placental 25-35% • Abruption • Cord accidents • Placental insufficiency • Intrapartum asphyxia • Placenta Previa • Twin to twin transfusions • Chrioamnionitis

  7. Placental abruption

  8. Maternal 5-10% Unexplained 25-35% • Antiphospholipid antibody • DM • HPT • Trauma • Abnormal labor • Sepsis • Acidosis/ Hypoxia • Uterine rupture • Post term pregnancy • Drugs • Thrombophilia • Cyanotic heart disease • Epilepsy • Severe anemia

  9. A systematic approach to fetal death is valuable in determining the etiology A-Family history • Recurrent abortions • VTE/ PE • Congenital anomalies • Abnormal karyotype • Hereditary conditions • Developmental delay

  10. B-Maternal History I-Maternal medical conditions • VTE/ PE • DM • HPT • Thrombophilia • SLE • Autoimmune disease • Severe Anemia • Epilepsy • Consanguinity • Heart disease

  11. II-Past OB Hx • Baby with congenital anomaly / hereditary condition • IUGR • Gestational HPT with adverse sequel • Placental abruption • IUFD • Recurrent abortions

  12. Downs syndrome

  13. Current Pregnancy Hx • Maternal age • Gestational age at fetal death • HPT • DM/ Gestational D • Smoking , alcohol, or drug abuse • Abdominal trauma • Cholestasis • Placental abruption • PROM or prelabour SROM

  14. Specific fetal conditions • Nonimmunehydrops • IUGR • Infections • Congenital anomalies • Chromosomal abnormalities • Complications of multiple gestation

  15. HydropsFetalis

  16. Placental or cord complications • Large or small placenta • Hematoma • Edema • Large infarcts • Abnormalities in structure , length or insertion of the umbilical cord • Cord prolapse • Cord knots • Placental tumors

  17. 2-Evaluation of still born infants • Infant description • Malformation • Skin staining • Degree of maceration • Color-pale ,plethoric

  18. Maceration

  19. Umbilical cord • Prolapse • Entanglement-neck, arms, legs • Hematoma or stricture • Number of vessels • Length

  20. Amniotic fluid • Color-meconium, blood • Volume Membranes • Stained • Thickening

  21. Placenta • Weight • Staining • Adherent clots • Structural abnormality • Velamentous insertion • Edema/ hydropic changes

  22. Investigations Maternal investigations • CBC • BlGp & antibody screen • HB A1 C • KleihauerBatke test • Serological screening for Rubella • CMV, Toxo, Syphilis, Herpes & Parovirus • Karyotyping of both parents (Baby with malformation) • Hb electrophoresis • Antiplatelet antibodies • Thrombophilia screening (antithrombin, Protein C & S , factor V leiden, lupus anticoagulant, anticardiolipin antibodies)

  23. Fetal investigations • Fetal autopsy • Karyotype (specimen taken from cord blood, intracardiacblood, body fluid, skin, spleen, Placental wedge, or amniotic Fluid) • Fetography • Radiography

  24. Placental investigations • Chorionocity of placenta in twins • Cord thrombosis or knots • Infarcts, thrombosis, abruption, • Vascular malformations • Signs of infection • Bacterial culture for Ecoli, Listeria, gp B strpt.

  25. Management • Expectant approach: 80% goes into spontaneous labour within 2-3 weeks • Active approach: b/o emotional burden, risk of chorioamnionitis, and 10% risk of DIC (if >5wks). • Induction of labour can be initiated at any time.

  26. IUFD complications • Hypofibrinogenemia 4-5 wks after IUFD • Coagulation studies must be started 2 wks after IUFD • Delivery by 4 wks or if fibrinogen <200mg/ml

  27. Psychological aspect & counseling • A traumatic event • Post-partum depression • Anxiety • Psychotherapy • Recurrence 0-8% depending on the cause of IUFD

  28. Thanks for listening!

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