Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
INTRAUTERINE
DEATH
DR ILA
GUPTA
D.G.F.’S CME ON INDUCTION OF LABOUR ON 8TH NOVEMBER 2016
HOW TO DEFINE
IUD or STILL BORN
 fetal death after period of viability ( 28
weeks )
 24 weeks in USA
 24WEEKS OR >500 G...
Epidemiology
Prevalence of perinatal deaths in a
society is the direct indicator of the
quality of antenatal care in the c...
ETIOLOGY
 Fetal causes (25-40%)
 Placental causes (15-25%)
 Maternal causes (5-10%)
 Unexplained causes (25-35%)
SIGNS AND SYMPTOMS
Symptoms
Decreased/absent movements (50%
cases)
 Bleeding per vaginum, Pain abdomen
On examination
 S...
DIAGNOSIS
 USG –absent fetal heart sound
 Doubly confirmed
Other features
 Scalp edema
 Collapsed and overlapping cran...
INVESTIGATIONS
 - CBC,ABO/RH,VDRL, URIN E
 BS F AND PP, HBA1C
 ,TFT,KFT,
 COAGULATIONPROFILE,
 TORCH,
 ,LUPUS ANTI C...
TO CONTINUE………
 GROSS EXAM of placenta ,cord and
baby
 HISTOLOGY OF PLACENTA
 AUTOPSY OF BABY if allowed
 CYTOGENETCS ...
Degree of maceration
Grade 1 maceration
 Reddened skin 6-8 hours
Grade 2 maceration
 Skin slippage and peeling 8-12 hrs
...
COMPLICATIONS
 Psychological upset
 Coagulopathies
 Infections
 During labor
 Uterine inertia
 Retained placenta
 P...
MANAGEMENT
Majority of women( up to 80%) goes in
spontaneous labor within two weeks of
fetal death.
INDICATION OF INDUCTIO...
Expectant
management
Spontaneous
delivery
Induction
induction
induction
1-IUFD for>2 wks
2-psychological stress
3-infectio...
METHODS OF INDUCTION
 Amniotomy is contraindicated
 Prostaglandins—E2 gel vaginally or
intra cervically 6 hrly up to 3 d...
Continue…….
• Oxytocin
• method of choice( if bishop is >6).
dose 5-10 units in RL or NS with iv
infusion followed by esca...
INDICATION FOR LSCS
 Major degree of placenta previa
 Previous caesarean(2 or more)
 Transverse lie
 Obstructed labor
Guidance for examination of still
born infant
INFANT
 Gross exam -skin staining
 Color –pale, plethoric
 Degree of mace...
-----CONTINUE
MEMBRANES
 Meconium stained or cloudy
 Any thickening
 Foul smell
CORD
 Entanglement around neck
 Prola...
Continue------
AMNIOTIC FLUID
Color -meconium/blood
Volume
consistency
Post delivery counselling
 Counsel for full autopsy
 Spend time with women and husband
and discuss the reason for IUFD
...
TAKE HOME MESSAGE
 Ante-partum fetal death contributes to
about two thirds of prenatal mortality
 Incidence is still hig...
ONE CAN NOT CHANGE
THE DESTINY BUT A
SINCERE EFFORT CAN
GIVE THIS MOTHER A
NEW FUTURE
ADDRESS
11 Gagan Vihar, Near
Karkari Morh Flyover,
Delhi - 51
CONTACT US
9650588339
9599044257
011-22414049
WEBSITE :
www....
INTRAUTERINE DEATH CME ON INDUCTION OF LABOUR ON 8TH NOVEMBER 2016, Dr sharda Jain Dr. Ila Gupta
Upcoming SlideShare
Loading in …5
×

INTRAUTERINE DEATH CME ON INDUCTION OF LABOUR ON 8TH NOVEMBER 2016, Dr sharda Jain Dr. Ila Gupta

2,706 views

Published on

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.

Published in: Health & Medicine

INTRAUTERINE DEATH CME ON INDUCTION OF LABOUR ON 8TH NOVEMBER 2016, Dr sharda Jain Dr. Ila Gupta

  1. 1. INTRAUTERINE DEATH DR ILA GUPTA D.G.F.’S CME ON INDUCTION OF LABOUR ON 8TH NOVEMBER 2016
  2. 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. 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. 4. ETIOLOGY  Fetal causes (25-40%)  Placental causes (15-25%)  Maternal causes (5-10%)  Unexplained causes (25-35%)
  5. 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. 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.
  7. 7. INVESTIGATIONS  - CBC,ABO/RH,VDRL, URIN E  BS F AND PP, HBA1C  ,TFT,KFT,  COAGULATIONPROFILE,  TORCH,  ,LUPUS ANTI COOAGULANT, ACL ANTIBODIES AND OTHER THROMBOPHILIAS
  8. 8. 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.
  9. 9. 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
  10. 10. COMPLICATIONS  Psychological upset  Coagulopathies  Infections  During labor  Uterine inertia  Retained placenta  PPH  rupture uterus( high dose of uterotonics)  DIC
  11. 11. 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
  12. 12. 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
  13. 13. 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
  14. 14. 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
  15. 15. INDICATION FOR LSCS  Major degree of placenta previa  Previous caesarean(2 or more)  Transverse lie  Obstructed labor
  16. 16. 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
  17. 17. -----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
  18. 18. Continue------ AMNIOTIC FLUID Color -meconium/blood Volume consistency
  19. 19. 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
  20. 20. 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
  21. 21. ONE CAN NOT CHANGE THE DESTINY BUT A SINCERE EFFORT CAN GIVE THIS MOTHER A NEW FUTURE
  22. 22. 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

×