HOW TO DEFINE
IUD or STILL BORN
fetal death after period of viability ( 28 weeks )
24 weeks in USA
24WEEKS OR >500 Gms by WHO
ACOG refers to IUFD as the demise occurring at or later than 20weeks.
2. HOW TO DEFINE
IUD or STILL BORN
fetal death after period of viability ( 28
weeks )
24 weeks in USA
24WEEKS OR >500 Gms by WHO
ACOG refers to IUFD as the demise
occurring at or later than 20weeks.
3. Epidemiology
Prevalence of perinatal deaths in a
society is the direct indicator of the
quality of antenatal care in the country
Though the prevalence of IUFD has been
reduced to a minimum unavoidable rate
in developed countries; however it still
remains very high in underdeveloped
and developing countries.
Incidence
35/1000 in INDIA(32 in urban 39 in rural
area)
5- 7.5 /1000 in developing countries
5. SIGNS AND SYMPTOMS
Symptoms
Decreased/absent movements (50%
cases)
Bleeding per vaginum, Pain abdomen
On examination
Stationary and decrease in fundal height
Flaccid uterus/absent braxton-hicks
contraction
Absent fetal movements and absent
heart sound
Egg shell crackling feel of fetal head
6. DIAGNOSIS
USG –absent fetal heart sound
Doubly confirmed
Other features
Scalp edema
Collapsed and overlapping cranial
bones(spalding sign)
Clue to diagnosis
Oligoamnios ,abruption or fetal hydrops
X-ray is an old modality only useful in
medico legal cases.
7.
8. INVESTIGATIONS
- CBC,ABO/RH,VDRL, URIN E
BS F AND PP, HBA1C
,TFT,KFT,
COAGULATIONPROFILE,
TORCH,
,LUPUS ANTI COOAGULANT, ACL
ANTIBODIES AND OTHER
THROMBOPHILIAS
9. TO CONTINUE………
GROSS EXAM of placenta ,cord and
baby
HISTOLOGY OF PLACENTA
AUTOPSY OF BABY if allowed
CYTOGENETCS STUDIES In case
of IUGR or cong malformation.
10. Degree of maceration
Grade 1 maceration
Reddened skin 6-8 hours
Grade 2 maceration
Skin slippage and peeling 8-12 hrs
Grade 3 maceration
Extensive skin peeling
Red Serous effusion in chest and
abdomen
Aseptic autolysis of ligaments and
liquifaction of inner structures like brain
11. COMPLICATIONS
Psychological upset
Coagulopathies
Infections
During labor
Uterine inertia
Retained placenta
PPH
rupture uterus( high dose of
uterotonics)
DIC
12. MANAGEMENT
Majority of women( up to 80%) goes in
spontaneous labor within two weeks of
fetal death.
INDICATION OF INDUCTION
Psychological upset of patient and
relatives
Falling fibrinogen level
IUFD >2 weeks
Onset of infection
14. METHODS OF INDUCTION
Amniotomy is contraindicated
Prostaglandins—E2 gel vaginally or
intra cervically 6 hrly up to 3 doses
E1 –misoprost 50 mic gram vaginally
or orally 6 hrly
Mefepristone 600 /200 can also be
given followed by misoproset
15. Continue…….
• Oxytocin
• method of choice( if bishop is >6).
dose 5-10 units in RL or NS with iv
infusion followed by escalating
• Dinoprostone (PGE2)
• 10 mg reservoir Intravaginal insert is a
novel technique can be used for ripening
Administration
Removal
16. INDICATION FOR LSCS
Major degree of placenta previa
Previous caesarean(2 or more)
Transverse lie
Obstructed labor
17. Guidance for examination of still
born infant
INFANT
Gross exam -skin staining
Color –pale, plethoric
Degree of maceration
Malformations
PLACENTA
Weight
Structural abnormalities
Hydropic changes
Retroplacental clot
Meconium staining
18. -----CONTINUE
MEMBRANES
Meconium stained or cloudy
Any thickening
Foul smell
CORD
Entanglement around neck
Prolapse
Length
True or false knot
Haematoma/strictures
Wharton jelly normal or absent
20. Post delivery counselling
Counsel for full autopsy
Spend time with women and husband
and discuss the reason for IUFD
Let her spend some time with infant if
she wants so
Do not keep her with women with live
babies
At follow up visit discuss the result of
autopsy and investigation and
planning for future pregnancy
21. TAKE HOME MESSAGE
Ante-partum fetal death contributes to
about two thirds of prenatal mortality
Incidence is still high in developing country
In majority of cases cause is still unknown
Pre and post delivery counseling is integral
part of management
Induction is done with prostaglandinE 1or 2
gel or tab supplemented with oxytocin
Amniotomy is contraindicated
Maximum possible effort should be made to
establish the cause for better future outcome
22. ONE CAN NOT CHANGE
THE DESTINY BUT A
SINCERE EFFORT CAN
GIVE THIS MOTHER A
NEW FUTURE
23. ADDRESS
11 Gagan Vihar, Near
Karkari Morh Flyover,
Delhi - 51
CONTACT US
9650588339
9599044257
011-22414049
WEBSITE :
www.lifecareivf.in
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Helpline : 9599044257
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