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Iud
- 1. INTRA UTERINE FETAL DEMISE DR SHABNAM NAZ ASSISTANT PROFESSOR CMC,SMBBMU LARKANA
- 2. IUFDIUFD Definition – IUFD denotes death of fetus in utero or weighing >500gm or >24 weeks, before the onset of labour. Incidence: 4.5/1000
- 3. Etiology • Unknown in 25 – 60% of cases • Identifiable causes can be attributed to •Maternal conditions •Fetal conditions •Placental conditions
- 4. Fetal causes --25-40% •Chromosomal anomalies •Birth defects •Non immune hydrops •Infections • TORCH
- 9. Placental --25-35% •Abruption •Cord accidents •Placental insufficiency •Intrapartum asphyxia •P Praevia •Twin-twin transfusion Synd: •Chorio-amnionitis
- 10. Cord prolapse
- 11. Calcification and haemorrhage in placenta
- 12. Vasa Previa
- 13. Maternal 5-10% •Antiphospho-lipid antibody •DM •HTN •Trauma •Abnormal labor •Sepsis •Uterine rupture •Post-term pregnancy •Drugs
- 14. Ruptured uterus
- 15. • Mom with no prenatal care delivers undiagnosed twins at EGA 34 weeks
- 19. Diagnosis to confirm iud history &examination -Absence of fetal movements -Retrogression of the positive breast changes. - Gradual retrogression of the height of the uterus - Uterine tone is diminished - Fetal movement are not felt during palpation. - Fetal heart sound are not audible
- 20. Diagnosis (contd…) -Straight- X-ray abdomen - Spalding sign: it usually appears 7 days after I.U.F.D. - Hyperflexion of the spine - Crowding of the ribs shadow - (Robert’s sign) Appearance of gas shadow in great vessels : 12 hours
- 21. cont Sonography : (a)absent fetal movements (b) Oligohydramnios and collapsed cranial bones Spalding sign
- 22. Evaluation of iufd to detect the cause • I-Maternal medical conditions • VTE/ PE • DM • HPT • Thrombophilia • SLE • Autoimmune disease • Severe Anemia • Epilepsy • Heart disease II-Past OB Hx •Gestational HTN with adverse sequele •Placental abruption •IUFD •Recurrent abortions •Baby with congenital anomaly / hereditary condition •IUGR
- 23. Current Pregnancy Hx • Maternal age • Gestational age at fetal death • HPT • DM/ Gestational D • Smoking , alcohol, or drug abuse • Abdominal trauma • Choliestasis • Placental abruption • PROM or prelabour ROM
- 24. FAIMLY HISTORY •Recurrent abortions •VTE/ PE •Congenital anomalies •Abnormal karyotype •Hereditary conditions •Developmental delay
- 25. 2-Evaluation of still born infants • Infant desciption • Malformation • Skin staining • Degree of maceration • Color-pale ,plethoric • Umbilical cord • Prolapse • Entanglement-neck, arms, ,legs • Hematoma or stricture • Number of vessels • Length • Amniotic fluid • Color-meconium, blood • Volume
- 26. Knots in cord
- 29. EXAMINATION OF PLACENTA Placenta •Weight •Staining •Adherent clots •Structural abnormality •Velamentous insertion •Edema/ hydropic changes Membranes •Stained •Thickening
- 31. Vasa Previa
- 32. 3. INVESTIGATIONS • Maternal investigations: • CBC • Blood Group & antibody screen • HB A1 C • Kleihauer Baket test • Serological screening for Rubella CMV, Toxoplasmosis, Syphilis, Herpes & Parvovirus • Karyotyping of both parents • Hb electrophoresis' • Antiplatelet antibodies • Thrombophilia screening (ant thrombin iii, Protein C & S deficiency , factor IV leiden,Factor II mutation, lupus anticoagulant, anticardolipin antibodies) • DIC
- 33. cont • Fetal investigations • Fetal autopsy • Karyotype • (specimen taken from cord blood, intracardiac blood, body fluids, skin, spleen, Placental wedge, or amniotic Fluid) • Fetography • Radiography
- 34. cont • Placental investigations • Chorionicity of placenta in twins • Cord thrombosis or knots • Infarcts, thrombosis, abruption, • Vascular malformations • Signs of infection • Bacterial culture for E coli, • Listeria, group B strept.
- 35. Pregnancy Management • Single or multiple gestation • Gestational age at death • The parents wish
- 36. Management • Explain the problem to the woman and her family. Discuss with them the options of expectant or active management. • If expectant management is planned: • Await spontaneous onset of labour during the next four weeks • Reassure the woman that in 90% of cases the fetus is spontaneously expelled during the waiting period with no complicatons. • If platelets are decreasing, four weeks have passed without spontaneous labour, fibrinogen levels are low or the woman request it,consider active management (induction of labour)
- 37. Management (contd…) If induction of labour is planned, assess the cervix • If the cervix is favourable (soft, thin, partly dilated) labour using oxytocin. • If the cervix is unfavourable(firm, thick, closed) ripen the cervix. Note: Do not rupture the membranes. • If spontaneous labor does not occur within four weeks, platelets are decreasing and the cervix is unfavourable, ripen the cervix.
- 38. Complications 1. Psychological upset 2. Infection: Once the membranes rupture, infection, especially by gas forming organism like CI. Welchi. 3. Blood coagulation disorders 4. During labour : Uterine inertia and PPH
- 39. Prevention of IUFD: • Regular antenatal care • To screen out the at-risk patients to monitor carefully for the assessment of fetal well being and to terminate the pregnancy at the earliest evidences of fetal compromise.
- 40. Morbid pathology of IUFD • A dead fetus undergoes an aseptic destructive process called maceration. The epiderm is the first structure to undergo the process, whereby blistering and peeling off of the skin occur. It appears between 12-24 hours after death. The foetus becomes swollen and looks dusky red. Gradually aseptic autolysis of the ligamentous structure and liquefaction of the brain matter and other viscera take place.
- 41. Moen Jo Daro Larkana Sindh