This document discusses fetal death, including common causes, symptoms, diagnosis, maternal complications, and counseling patients. Fetal death occurring between 20 weeks of gestation and delivery is termed intra-uterine fetal death. Common causes include hypertensive disorders, diabetes, infections, cord accidents, and genetic anomalies. Diagnosis is made when ultrasound shows no fetal heart tone or movement. This can lead to disseminated intravascular coagulation in the mother. Patients experiencing fetal death should be counseled and delivered to prevent complications.

1. Fetal Death

2. 2009-2010 USUHS MSIII Ob/Gyn
Clerkship Self Directed Studies
APGO Educational Topic 21
 A. Describe the common causes of fetal death
in each trimester.
 B. Describe the symptoms, physical findings
and diagnostic methods to confirm the
diagnosis of fetal death.
 C. Describe the maternal complications of
fetal death, including DIC.
 D. Counsel the patient experiencing death of
the fetus.

3. 2009-2010 USUHS MSIII Ob/Gyn
Clerkship Self Directed Studies
Fetal Death
 Intra-Uterine Fetal Death (IUFD)
 Fetal death after 20 weeks EGA but
before the onset of labor.
 Complicates 1% of pregnancies.
 Shift from expectant management to
active management.

4. 2009-2010 USUHS MSIII Ob/Gyn
Clerkship Self Directed Studies
Common Causes
 Unknown or indeterminate in approx 50% of cases.
http://pathologyoutlines.com/images/placentatrueknot.jpg
True Knot

5. 2009-2010 USUHS MSIII Ob/Gyn
Clerkship Self Directed Studies
Common Causes
 Hypertensive Diseases (Pre-E, Eclampsia)
 Diabetes Mellitus
 Erythroblastosis Fetalis
 Umbilical Cord Accidents (true knot, prolapse)
 Congenital Anomalies
 Infections (Fetal or Maternal)
 Hemorrhage (Abruption)
 Thrombophilias (antiphospholipid antibodies)

6. 2009-2010 USUHS MSIII Ob/Gyn
Clerkship Self Directed Studies
Infection - TORCH
 Toxoplasmosis
 Rubella
 CMV
 HSV
 Parvo-virus
 Listeria

7. 2009-2010 USUHS MSIII Ob/Gyn
Clerkship Self Directed Studies
Gestational HSV Infection
http://www.nature.com/jp/journal/v22/n1/images/7210584f1.jpg

8. 2009-2010 USUHS MSIII Ob/Gyn
Clerkship Self Directed Studies
Patient Presentation
 Subjective decreased fetal movements
 Uterus FH is small for EGA
 No fetal heart tones with doppler
 Will still have pos hCG
 Ultrasound
 No Fetal Movement
 No Fetal Cardiac Activity

9. 2009-2010 USUHS MSIII Ob/Gyn
Clerkship Self Directed Studies
Diagnostic Methods for IUFD
http://www.slredultrasound.com/ThermalImages/Pelvic/IUFD1.jpg
No FCA
No movement

10. 2009-2010 USUHS MSIII Ob/Gyn
Clerkship Self Directed Studies
Maternal Complications
Disseminated Intravascular
Coagulopathy
 Decreased platelets
 Decreased fibrinogen
 Increased PT/PTT (Clotting times)
 Clinical bleeding / oozing from all sites
 Decreasing H/H
RX involves DELIVERY, pRBC’s, FFP,
PLATELETS, Supportive Management

11. 2009-2010 USUHS MSIII Ob/Gyn
Clerkship Self Directed Studies
Maternal Complications
 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)

12. 2009-2010 USUHS MSIII Ob/Gyn
Clerkship Self Directed Studies
Management = Delivery
 Attempt for SVD
 Expectant vs. Active management
 Active Management
 Cytotec
 Pitocin
 Pain Management
 PCA (Pt Controlled Analgesia)
 Epidural