Intrauterine Fetal Death

Question 1

Stillbirth

Answer 1

Child delivering after 24 weeks of pregnancy that doesn’t breathe or show any other signs of life

Question 2

Types of IUD

Answer 2

1 - antepartum fetal death

2 - intrapartum fetal death

Question 3

Causes of antepartum fetal death

Answer 3

Maternal(DM, HTN)
Fetal (fetal immune hemolytic disease and cord accidents)
Placental (twin twin transfusion, abruption, infarction, fetal to maternal haemorrhage)

Question 4

Spalding sign

Answer 4

Overlapping of fetal skull bones on X-ray . Diagnostic of IUD

Question 5

Robert sign

Answer 5

Gas shadow in fetal circulatory system on x ray. Diagnostic of IUD

Question 6

Ultrasound signs of IUD

Answer 6

Absent fetal heart activity 
Collapsed skull 
Non filled aorta 
Retraction of brain tissue 
Poorly visualised mildline falx echo 
Empty fetal bladder

Question 7

Management of IUD baby

Answer 7

Either induction of labour or conservative management

Question 8

Pros for induction of labour after iud diagnosis

Answer 8

Coagulopathy starts within 48 hours of fetal demise
Post mortem is more effective on a fresh dead baby
Psychologically daunting to carry a dead fetus

Question 9

Pros for conservative management after IUD

Answer 9

Spontaneous labour starts in a few weeks. Induction can lead to induction failure and c section. Coagulopathy evident only after 4 weeks

Question 10

What is contraindicated for induction in IUD baby

Answer 10

ARM as it can lead to infection if there is intrauterine death

Question 11

Conservative management in IUD

Answer 11

Coagulation profile is checked every week. If it develops then it has to be reversed before induction of labour. Low dose heparin is used. PTT kept at 2.5 times normal. When fibrinogen is above 200 mg/dl heparin is stopped and labour induced after 6 hours.

If patient of coagulopathy goes into spontaneous labour , fresh blood, FFP and cryoprecipitate is given. Heparin is contraindicated

Question 12

Indications for c section in dead fetus (absolute)

Answer 12

1- placenta Previa of major degree 
2 - severe CPD 
3 - previous classical c section 
4 - 2 or more previous c sections 
5 - obstructed labour 
6 - uterine rupture

Question 13

Relative indications for c section of dead baby

Answer 13

1- previous 1 c section
2 - transverse lie or shoulder presentation
3 - fetal tumor or abdominal distension

Question 14

Intrapartum death

Answer 14

Death of baby weighing 1.5 kg or more. After onset of labour. Within 28 days. Related to intrapartum events

Question 15

Causes of intrapartum death

Answer 15

1- long trial of labour in already compromised baby
2- Missed CPD
3- missed malpresentation
4 - mishandling of breech

Question 16

Evaluation of still born baby

Answer 16

1- photography
2- radiology
3- karyotyping
4- autopsy examination

Question 17

Indications of karyotyping

Answer 17

1- obvious fetal anomaly 
2- potter syndrome 
3- IUGR without any other cause 
4- family history of abnormal children 
5- obstetrical history of recurrent pregnancy loss 
6- non immune hydrous fetalis

Question 18

Postnatal suppression of lactation in IUD mother

Answer 18

Bromocriptine 2.5 mg twice daily for 14 days. Postnatal visit at 6 weeks.