Intra Uterine Death of Fetus (IUD)

Intra Uterine Death of Fetus (IUD)

Definition: This refers to the death of the fetus occurringafter 24 weeks of gestation resulting in stillbirth.

Types

There are two main categories of still birth or intra uterine death.

·              Intra uterine death resulting in a fresh stillbirth

·              Intra uterine death resulting in a macerated baby.

1. Fresh Still Birth

This is intra-uterine death occurring just before delivery and is usually caused by accidents in labour such as;

Cord prolapse, delay in second stage of labour ,prolonged labour and obstructed labour.

2. Macerated Still Birth

This is an intra -uterine death when the fetus lies for 12-24hours within the uterine cavity and it usually occur in most cases before the onset of labour.

General Causes of Intra Uterine Death

·              Severe anemia in pregnancy resulting in fetal hypoxia

·              Severe attack of malaria or any other cause of hyperpyrexia such as typhoid fever.

·              Dysenteries, example amoebic or bacillary dysentery

·              Small pox and other severe viral infections ,Syphilis

·              Placenta insufficiency resulting from severe pre-eclampsia, Eclampsia, Chronic vascular hypertension example is essential hypertension, Post maturity.

·              Diabetes mellitus

·              Congenital fetal abnormalities,

·              Rhesus incompatibility

·              True knots in the cord.

S & S Clinical Manifestation

·              Failure of pregnancy in progress as evidence by lack of increase in the size of the uterus. The breast may feel less heavy.

·              Absence of fatal movement. and fetal heart sound

·              A negative pregnancy test (usually ordered by the Doctor)

·              Spalding’s sign.

·              Collapse of vertebral column of the fetus, diagnosed radiologically about 7-10days after fetal death.

·              Gas bubbles in the body..

Management

·              All cases of intrauterine death are referred to the Doctor. Usually nothing is done until confirmatory X-ray diagnosis has been made.

·              Patient is given medical induction of labour in the form of pitocin infusion or high dose of still boesterol to sensitize the uterus, before the action of oxytocin. Surgical induction is never used in this case.

In many cases, spontaneous labour occurs 2 or 3 weeks after fetal death.

Complication

Profuse hemorrhage from hypofibrinogenaemia four or more weeks after fetal deaths has occured (very common.)