Intrauterine Death

INTRODUCTION:
  • It is the term used when the death of a fetus occurs after the 20th week of pregnancy.
  • Prior to this, it is considered a miscarriage.
CLINICAL FEATURES:
  • The mother may notice less movement in the fetus for several days, and her breasts may diminish in size.
  • In cases of hypertension the blood pressure sometimes falls.
  • The uterus may be found to be smaller than the duration of pregnancy
ETIOPATHOLOGY:
  • Maternal
  1. gestational hypertension
  2. blood group incompatibility
  3. metabolic disorders
  4. intrauterine infections
  • Fetal
  1. major anomalies
  2. umbilical cord complications ( looping, knotting, twisting)
  3. Placental
  4. chronic placental insufficiency
  5. placental abruption
  6. chorioamnionitis
DIAGNOSIS:
  1. Ultrasound
  2. absent fetal heart beat
  3. Absent fetal movements
  4. Overlapping of skull bones (Spalding sign)
  5. Gross distortion of fetal anatomy (maceration)
  6. Soft tissue oedema: skin >5 mm
  7. Echogenic amniotic fluid (fetal demise fragments)
  8. Thrombus in fetal heart
  9. Gas shadow in fetal heart (Robert sign)
  10. Intra-aortic gas is the earliest conclusive evidence of intrauterine death
  • Alpha fetoprotein levels are increased 
  • DIC can be seen
CONTRAINDICATIONS:
  • Amniotomy or artificial rupture of membrane is done by fracturing the membranes with a sterile plastic instrument guided between the two gloved fingers. Amniotomy is usually avoided in intrauterine fetal death because of the increased risk of fetal sepsis within the necrotic intrauterine tissues.
TREATMENT:
  • Wait for spontaneous expulsion
Exam Question of:
  • Alpha fetoprotein levels are increased in Intrauterine Death 
  • Artificial rupture of membrane (ARM) is contraindicated in Intrauterine death
  • Robert’s sign is associated with intra uterine death of the fetus
  • Intra-aortic gas is the earliest conclusive evidence of intrauterine death
  • Intrauterine death at 36 weeks is left untreated waiting for spontaneous expulsion
  • DIC can be seen in Intrauterine death
  • Spalding sign is seen in Intrauterine death

Don't Forget to Solve all the previous Year Question asked on Intrauterine Death