Intrauterine Fetal Demise

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The sudden demise of fetus in the womb is the worst trauma to the mother and her entire family. It affects physically, mentally, emotionally and financially. The mothers carry the tragic memories throughout their life with a sense of guilt, that they could not do anything to save their child. It also does shake the confidence of the Doctor who was involved in the antenatal care. In spite of knowing the limitations of medical science, they do suffer from distress and anxiety.

Whenever the fetal demise occurs in first half of pregnancy i.e. less than 20 weeks of gestation, it is classified as abortion or miscarriage. However, the demise after 20 weeks gestation or more than 500 grams is classified as Intra Uterine Fetal Demise.

In this moment of great grief, rather than blame game & fault finding, it is advisable to direct the energy and resources in investigating the cause so that the recurrence can be prevented.

What would be the symptoms in Mother with IUFD?

  • Absent fetal movements.
  • Lax uterus.
  • Foul smelling dirty brown discharge per vaginum.

How to diagnose IUFD ?

  • Non localization of fetal heart sounds by Fetal Doppler.
  • In remote places where facility of ultrasound is not available, X-ray can be useful.

IUD

Causes of IUFD in Pregnancy?

  1. Reduced blood supply to fetus:

A. Immediate Causes:

  • Cord compression.
  • Cord prolapsed after rupture of fetal membranes.
  • Abruptio placenta (Separation of placenta from its bed),
  • Vasa Previa (Location of vessels in the lower uterine segment below the level of fetus).
  • Pregnancy induced hypertension, Preeclampsia, Eclampsia.
  • Prolonged and difficult labor.

B. Chronic Causes:

  • Pregnancy induced hypertension, Preeclampsia, Eclampsia.
  • Post maturity.
  • Gestational diabetes.
  • Chronic illnesses like Asthma, cardiovascular diseases, chronic kidney disease etc.

2. Lethal Chromosomal or Genetic Abnormalities.

3. Blood abnormalities and hemolytic disorders.

4. Maternal or Fetal Infections.

5. Pregnancy in extreme of age.

6. Unknown causes.

How to deal with IUFD?

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Induction of artificial labor pains with the help of medicines to facilitate the normal vaginal delivery should be attempted. In rare cases, there may be a need for cesarean delivery.

Occasionally due to fear of poisoning, there may be tendency to take impulsive decision of cesarean delivery, but the unnecessary scar may prone the mother to increased risk of uterine rupture in next pregnancy. Hence, vaginal delivery is best.

Does IUFD leads to poisoning in mother?

The poisoning does not happen so easily. The demised fetus decomposes by two methods –

  1. Swell by accumulation of fluids.
  2. Shrinks by autolysis and decomposition.

In majority, the labor will begin spontaneously to expel the fetus without causing any harm to the mother. However, in some mothers the infection or inflammatory process may lead to life threatening condition called as Disseminated Intravascular Coagulation, and may require intensive management.

Tips to support Mother and Family.

  • The mother and family should be counseled that, whatever the cause, IUFD cannot be always prevented.
  • Survival of the fittest is the basic law of nature. The fetus affected with chromosomal or structural abnormality would not produce enough hormones to sustain itself.

How to secure next pregnancy ?

  • Treat the preexisting illnesses like diabetes, chronic hypertension, blood dyscrasias etc. before conception.
  • Advise regular Antenatal care as soon as she conceives.
  • Intensive management and timely delivery of Immuno-sensitized fetus suffering from “Rh” or “ABO”i incompatibility.
  • The diseases that cause insufficiency of blood to fetus by either causing hypercoagulability or by constriction of blood vessels, should be treated by appropriate medicines.
  • Antiphospholipid antibody syndrome is a type of autoimmune disorder that can be fatal to both mother and fetus and hence needs appropriate treatment to safeguard both.
  • Appropriately treat hormonal diseases like PCOS to ensure prevention of teratogenecity, reduce the risk of developing gestational diabetes and pregnancy induced hypertension and increasing the chances of live pregnancy.

Disclaimer:

The information is shared to create awareness towards Pregnancy and Childcare to reduce maternal and child deaths. Atmost care has been taken by the author to include the verified information from authentic sources. However, kindly discuss the same with your health care provider before implementation.