Iufd (znar) 5b5w3e

University of Duhok Faculty of Medical Science School of Nursing

Intrauterine Fetal Death (IUFD) prepared by:

Znar A. Tamar Ali Ahmad Ali Faris Ismail Ali 15/Dec/2013

Objective • • • • • • • • •

Introduction Definition of intrauterine death Epidemiology of IUFD Etiology or causes of IUFD Risk factors and clinical features Diagnosis of IUFD Treatment & management Nursing care of IUFD Reference

introduction

• In addition to cases in which a fetus dies during delivery as a result of asphyxia (oxygen deprivation if the umbilical cord becomes twisted) or difficult labor,,, others can die in utero before labor starts. followed by expulsion of the fetus from the uterus within a few days. However, in rare instances the dead fetus is not expelled from the uterus at once, but is retained for several weeks. • Fetal death refers to the spontaneous death of a fetus at any time during pregnancy, although the term is often used interchangeably with ‘stillbirth’. A stillbirth is a death that occurs after 20 weeks of gestation.

Definition of IUFD

Intrauterine fetal death: is the clinical term for the death of a baby in the uterus, during pregnancy and before birth. The term is usually used for pregnancy losses that happen after the 20th week of gestation.

Epidemiology In the present investigation the epidemiological factors responsible for intrauterine fetal deaths after 20 week of gestation were studied. A retrospective study of 16882 pregnancies ed and managed in the Department of Obstetrics and Gynecology, in united state

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One hundred and three cases of intrauterine feta deaths were ed and treated expectantly out of 16882 total pregnancies ed during the four year study period. The stillbirth rate was 6.1 per 1000 total births.

Etiology Pregnancy complications: - Pre-eclamptic toxemia - Antepartum haemorrhage : placenta previa, abruptio placentae

Pre- existing medical disease and acute illness: -

Chronic hypertension Chronic nephritis Diabetes Severe anemia Hyperpyrexia Hyperpyrexia Syphilis, Hepatitis, toxoplasmosis etc.

Continue… • Fetal

- Congenital malformation - Rh-incompatibility

- Post maturity • External version

• Idiopathic 20 –30%

Maternal Complications • Decreased platelets • Decreased fibrinogen • Increased PT/PTT (Clotting times) • Clinical bleeding / oozing from all sites RX involves DELIVERY, pRBC’s, FFP, PLATELETS, ive Management

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Depression, Anxiety, Psychosocial Anxiety with future pregnancies May have repeat losses (depending on causes) Bleeding ---> can lead to DIC but may only require blood product replacement • Pain, Infection (similar to any other delivery)

Risk factors Multiple pregnancy Advanced maternal age History of fetal demise (IUFD) Maternal infertility Maternal haemoconcentration Maternal colonization with certain pathogens Small for gestational age infant Obesity Paternal age African American race

Clinical features • Absence of fetal movement • Vaginal bleeding • abdominal pain

Diagnosis of IUFD • In most patients, the only symptom is decreased fetal movement. An inability to obtain fetal heart tones upon examination suggests fetal demise; however, this is not diagnostic and death must be confirmed by diagnostic tests . • Labor should be induced as soon as possible after diagnosis. Patient responses vary in regard to this recommendation; some wish to begin induction immediately, while others wish to delay induction for a period of hours or days until they are emotionally prepared.

Diagnostic tests • Ultrasound: Caregivers can see if there is a heartbeat and movement of the fetus.

• Non-stress testing: This test is also called NST. Two belts

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placed across abdomen record changes in the heart rate of the fetus when uterus contracts. Biophysical profile: This test uses ultrasound to check the heart rate, breathing, and body movements of the fetus. It also checks amount of amniotic fluid.

• Umbilical artery Doppler velocimetry: This test uses

ultrasound to check the blood flow inside the umbilical artery. This artery carries blood from the fetus to the placenta.

Treatment & management • Explain the problem to the woman and her family. Discuss with them the options of expectant or active management. • Medical induction of labor: Medicine is used to start labor and fetus delivered naturally.

Continue….. • Extra-amniotic Foley catheter induction of labor: A catheter is inserted into the cervix. Medicine goes through the catheter. The medicine prepares the cervix for labor, or starts contractions. The fetus is delivered through the vagina. • Dilation and evacuation (D and E): The cervix is dilated, or made larger. The fetus is then removed through the vagina • Dilation and curettage (D and C): The cervix is dilated, and caregivers use tools to remove the fetus through the vagina.

Pain management •

Pain management in patients undergoing induction of labor for fetal death is usually easier to manage than in patients with live fetuses. • Higher doses of narcotics are available to the patient and often a morphine is sufficient for successful pain control. Should a patient desire superior pain control to intravenous narcotics, epidural anesthesia should be offered.

References www.drugs.com www.allnursing.com www.medical.com www.slideshare.com

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