IUFD or Intrauterine foetal death, this includes any foetal deaths that occur during labour or during pregnancy that weigh 500 gram. Fetal, placental, or maternal problems can all lead to foetal death.
1. Causes :
A. Maternal(5-10%) causes :
- Infections of mother like malaria, hepatitis, influenza, toxoplasma, and syphilis.
- High grade fever that is > 103F.
- Post dated pregnancy.
- Pregnancy induced hypertension.
- Diabetes in pregnancy.
- Antiphospholipid syndrome.
- Thrombophilias.
- Systemic lupus erythematosus.
B. Fetal(25-40%) causes :
- Infections including viral, bacterial.
- Chromosomal abnormalities.
- IUGR – Intrauterine growth retardation.
- Rh-incompatibility.
C. Placental(20-35%) causes :
- Antepartum haemorrhage.
- Twin transfusion syndrome(TTTS).
- Cord prolapse, cord around the neck.
- Placental insufficiency.
D. Iatrogenic causes :
- Drugs like quinine in over dosage.
2. Diagnosis :
A. Clinical features :
- Absence of fatal movements, which was noted by mother previously.
- After a variable amount of time has passed since the fetus’s death, the pregnancy’s positive breast changes begin to regress.
B. Per abdomen examination :
- Uterine tone gets decreased.
- Foetal movements not felt.
- Absence of foetal heart sound.
- Gradual retrogression of the fundal height and it becomes smaller than the period of gestation.
D. Investigations :
- USG.
- Straight X-Ray of abdomen.
- Blood tests – falling blood fibrinogen level and partial thromboplastin.
3. Management :
Counselling to be done with the patient party and providing them psychological supports. The main objective of management is through delivery and delivery to be done by applying various methods.
- Combination of mifepristone and a prostaglandin.
- Misoprostol(PGE1).
- Prostaglandins(PGE2).
- Oxytocin infusion.