Fetal Death

By:  Dr. Umesh N Jindal On:  May 14, 2016 8:51 AM
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Definition: Death of the fetus while in the uterus of mother. Fetal death has declined significantly because of better antenatal care.

Cause:

Cause can usually be determined by proper history, examination, and tests of both mother and the fetus. An autopsy conducted on the dead fetus gives important information for the management of next pregnancy. Causes are broadly categorized as:

  • Fetal (25-40%)
  • Maternal (5-10%)
  • Placental (25-35%)
  • Unexplained (25-35%)

I. Fetal causes (25-40%)

  • Genetic defects
  • Non–genetic birth defects
  • Infection-virus, bacteria, protozoa

II. Placental causes

  • Separation of placenta or accidental hemorrhage
  • Fetal–maternal hemorrhage
  • Cord accidents
  • Placental insufficiency
  • Intrapartum asphyxia
  • Placenta previa
  • Twin to twin transfusion
  • Infection in uterus

III. Maternal Causes (5-10%)

  • Antiphospholipid antibodies
  • Diabetes
  • Hypertensive disorders
  • Trauma
  • Abnormal labour
  • Sepsis
  • Acidosis
  • Hypoxia
  • Uterine rupture
  • Post term pregnancy
  • Drugs

IV. Unexplained causes (25-35%)

Symptoms:

Symptoms are not very specific but may include one or more of the following:

  • Pain abdomen
  • Bleeding or spotting P/V
  • Loss of fetal movements is the most important symptoms.
  • Uterus ceases to enlarge
  • Regression of mammary changes
  • Occasionally bleeding tendency. Occurs only very late.

Diagnosis:

By clinical examination complimented by
– Ultrasonography
– Doppler studies
A thorough examination of infant, placenta and membranes should be performed at delivery to find out the cause.
Consent must be obtained to take skin and other tissue samples.

Treatment:

Treatment lies mainly in –

  • Prevention of causative factors
  • Diagnosis as early as possible to prevent complications in mother.
  • Identification of high risk factors in mother.
  • Once fetal death has occurred, termination of pregnancy has to be done with prostaglandins, oxytocics.
  • Counselling of the patient should also be done to prevent depression, anxiety disorders. Recurrence rate of stillbirth varies from 0 to 8 % depending on risk factors.

Prevention:

  • Preconception folic acid supplements in women at risk of having baby with neural tube defects.
  • Prophylactic low dose aspirin in patients with previous preeclampsia and eclampsia.
  • Steroid therapy for women with anti-phospholipid antibody syndrome.
  • Regular antenatal care with ultrasonographic monitoring.