This document discusses intrauterine fetal demise (IUD), which refers to antepartum death occurring beyond 28 weeks of pregnancy. Potential causes of IUD include pregnancy complications like preeclampsia and antepartum hemorrhage, pre-existing medical conditions in the mother like diabetes or chronic hypertension, fetal issues like congenital malformations or Rh incompatibility, and iatrogenic factors. Diagnosis of IUD can be confirmed through sonography, which may show lack of fetal motion or oligohydramnios, or through x-ray of the abdomen, which can reveal signs like overlapping cranial bones. Management of IUD involves confirming the diagnosis, identifying the cause of death, providing psychological support,

2. Antepartum death occuring beyond 28
weeks is termed as IUD

3. Pregnancy complications
 Pre eclampsia
Antepartum haemorrhage
Pre existing medical and acute illnesses
 Chronic hypertension
Diabetes
Chronic nephritis
Anti phosphonlipid syndrome
Syphilis
Hyperpyrexia
Severe anemia
Others

4. Fetal
Congenital malformation
Rh incompatability
Postmaturity
Iatrogenic
Administration of quinine group
External version

5.  SYMPTOMS
 Absence of featal movements
 SIGNS
 Retrogression of breast changes
• PER ABDOMEN
 Gradual retrogression of height
 Uterine tone is diminished
 Fetal movements are not felt during palpation
 Fetal heart sound absent
 Egg shell cracking of fetal head

6.  Sonography
 Lack of fetal motions
 Oligohydramnios
 Collapsed cranial bones
 Straight x-ray abdomen
 Spalding sign – irregular overlapping of cranial bones on one
another is due to liquefaction of the brain matter and softening
of the ligamentous structures supporting the vault
 Hyperflexion of spine
 Crowding of rib cage
 Roberts sign(Appearance of gas shadow)

7.  To confirm diagnosis by sonography
 To confirm blood fibrinogen level
 To find out the cause of death

8. Psychological upset
Infection
Blood coagulation disorders
During labour

9.  Regular antenatal care
 To screen out at risk mothers

10. Expectant attitude
Interference
Psychological upset
Manifestation of uterine infection
Falling fibrinogen level
Prolongation of pregnancy

11.  Oxytocin
 Prostaglandin

12. Termination
Psychological support
Lactation suppression