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.

1. INTRAUTERINE
DEATH
DR ILA
GUPTA
D.G.F.’S CME ON INDUCTION OF LABOUR ON 8TH NOVEMBER 2016

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

4. ETIOLOGY
 Fetal causes (25-40%)
 Placental causes (15-25%)
 Maternal causes (5-10%)
 Unexplained causes (25-35%)

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.

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

13. Expectant
management
Spontaneous
delivery
Induction
induction
induction
1-IUFD for>2 wks
2-psychological stress
3-infection
4-Coagulation defect
i
Cervix
unfavorableCervix
favorable
Oxytocin
infusion
delivery
Pge2gel
Pge1 misoprost
Oxytocin
supplementation

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

19. Continue------
AMNIOTIC FLUID
Color -meconium/blood
Volume
consistency

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
www.lifecarecentre.in
www.lifecareabs.in
ISO 14001:2004 (EMS)
…..Caring hearts, healing hands
ISO 9001:2008
Helpline : 9599044257
Web.www.lifecareivf.in
Helpline : 9910081484
26
Year
In
your
servic
e