Review article misoprostol for intrauterine fetal death r. Intrauterine fetal death 25 mic gm pv 6 hrly or 25 mic gm 2 hrly inducing pregnancy termination, miscarriage and intrauterine fetal death may or may not need mifepristone 200 mg 36. Fetal death refers to the spontaneous intrauterine death of a fetus at any time during pregnancy. Other acceptable tissue samples include 1 cm 2 of fetal skin, achilles tendon, or retropatellar cartilage. The loss of a fetus at any stage is a fetal demise. Causes of intrauterine fetal death are changing in recent years article pdf available in journal of perinatal medicine 461 january 2017 with 3,339 reads how we measure reads.
Management of intrauterine fetal death with prostaglandin e2 vaginal suppositories. Fetal deaths later in pregnancy at 20 weeks of gestation or more, or 28 weeks or more, for example are also sometimes referred to as stillbirths. According to the 2003 revision of the procedures for coding cause of fetal death under icd10, the national center for health statistics defines fetal death as death prior to the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy and which is not an induced termination. The fetal death itself does not constitute an indication for cesarean section 1, therefore the surgery should be reserved for specific conditions, since it increases maternal morbidity without any fetal advantage 2. To assess the incidence and conditions associated with cesarean section in a cohort of pregnant women with intrauterine fetal death. Apply clinical judgment when it is not known whether intrauterine fetal death occurred before or after 20 weeks gestation. A stillbirth is a death that occurs after 20 weeks of gestation. Australian aboriginal culture is the oldest living culture i. Consequently, medical induction to expel the dead fetus is recommended, provided it can be. When fetal death occurs after 24 weeks of gestation, spontaneous expulsion may take several weeks. Discussions aim to support maternalparental choice. According to the centers for disease control and prevention cdc and national. When fetal death is suspected, an ultrasound us examination should be undertaken to confirm the diagnosis and to determine gestation and estimate fetal size.
The use of mifepristone and misoprostol in the management. Intrauterine fetal demise iufd, or stillbirth, is defined as a fetal death after 20 weeks gestation robinson, 2011 x robinson, 2011 robinson, g. Obstetricians should be familiar with the management of intrauterine fetal death as prompt and appropriate counselling will aid. Intrauterine fetal demise iufd, or stillbirth, is defi ned as a fetal death aft er 20 weeks gestation robinson, 2011. Intrauterine fetal death iufd is defined by the full nice guideline on the induction of labour and the rcog guideline on late intrauterine fetal death and stillbirth as fetal death at 24 weeks gestation or later. Fetal maceration takes place upon intrauterine fetal death iufd and is a process characterized by enzymatic autolysis of cells and degeneration of connective tissue leading to skin discoloration, desquamation with formation of bullae and eventually skin peeling, as well as edema of the outer and inner organs with turbid effusions inside the. International colloquy on the management of intrauterine. Among nulliparous women, the odds ratios for late fetal death increased threefold among women with bmi values 25 to 29. Purpose and scope to identify evidencebased options for women and their relatives who have a late intrauterine fetal death iufd. The recent food and drug administrations approval of prostaglandin e2 pge2 vaginal suppositories provides the clinician with a technique for the immediate management of missed abortion and intrauterine fetal death iufd.
Background the scale of the problem in the developed world, one in 200 infants is stillborn. The cumulative risk of fetal death is approximately 1. Review article misoprostol for intrauterine fetal death. It describes medical management for different clinical scenarios based on a womans obstetric history, medical history and her personal preferences.
Although fetal death complicated by placenta previa has been reported in several studies 1 3, no largescale study on the management of fetal death with placenta. Pdf causes of intrauterine fetal death are changing in. Realtime ultrasonography is essential for the accurate diagnosis of intrauterine fetal. Fetal death in utero fdiu, also known as intrauterine death iud, is the term used when the death of a fetus occurs after the 20th week of pregnancy.
Guidelines management of intrauterine death documentation mandator y additional tests o antibody screening o kleihauerbetake test o lupus anticoagulant and anticardiolipin antibody testing. Care of the childbearing family with intrauterine fetal demise. Fetal growth restriction fetal growth restriction is associated with a significant increase in the risk of stillbirth with the most severely affected fetuses weight less than the 2. An infant delivered without signs of life after 20 weeks of gestation or weighing 500 gms when gestation age is not known march 9, 2015 3. Fox r, pillai m, porter h, gill g 1997 the management of late fetal death. Misoprostol for induction of labour to terminate pregnancy in the second or third trimester for women with a fetal anomaly or after intrauterine fetal death. Rates of intrauterine fetal demise and respiratory morbidity at term. The use of mifepristone and misoprostol in the management of late intrauterine fetal death chuks nzewi mrcog,a, george araklitis mbbs,b nitish narvekar md mrcogc aconsultant in obstetrics and gynaecology and lead clinician for infertility, medical specialist group and princess elizabeth hospital, alexandra house, les frieteaux, st martins, gy1 3ex, guernsey. Medical management of later intrauterine fetal death. Sadly, the death of a fetus may occur at any stage of a pregnancy, including during the labour process. Late intrauterine fetal death and stillbirth this is the first edition of this guideline.
Fialac a ipas and school of public health, unc at chapel hill, chapel hill, nc, usa b division of maternalfetal medicine, department of obstetrics and gynecology, university of california, irvine, usa c gynmed clinic, vienna, austria abstract the frequency of intrauterine fetal death iufd. In the united states, for example, intrauterine fetal death refers to fetal death after 20 weeks gestation2. Approximately 84% to 90% of women will go into spontaneous labor within 2 weeks of fetal death. This is described as late when it happens in a woman who is 24 weeks pregnant or more, and is estimated to occur in 1% of all pregnancies. When you have completed this tutorial you will be able to. Intrauterine fetal death iufd fetal death before onset of labour or fetus with no signs of life in utero after 20 weeks of gestation definition varies.
Brian levine, md, ms, is boardcertified in obstetrics and gynecology as well as in reproductive endocrinology and infertility. Pdf management of fetal death complicated by placenta. Any disease that causes high fever in pregnancy and toxic illness can cause fetal death. The term is usually used for pregnancy losses that. Medical management of later intrauterine fetal death sa health. This definition excludes management of prolonged retention of products of conception following fetal death. Diagnosis and management of late fetal demise, pathological evaluation of stillborns, and parental support and counseling are discussed separately. In the absence of urgent attention for the immediate labor, management should be carried out according to the pregnant woman and her relatives wish, taking into. This guideline does not include the management of multiple pregnancies with a surviving fetus, stillbirth. Unexplained causes account for 2560% of all fetal demise. Krissi danielsson, md is a doctor of family medicine and an advocate for those who have experienced miscarriage. Introduction the management of intrauterine fetal death iufd is a common and serious problem on obstetric services throughout the world. Clinical management of the induction of labor in intrauterine fetal death. Care of the childbearing family with intrauterine fetal.
Fetal maceration takes place upon intrauterine fetal death iufd and is a process characterized by enzymatic autolysis of cells and degeneration of connective tissue leading to. Such retention of the fetus can be associated with emotional distress, intrauterine infection if the membranes are ruptured, and a time. With severe malformation intrauterine death sometimes occurs. Stillbirth is typically defined as fetal death at or after 20 to 28 weeks of pregnancy depending on the source. According to the centers for disease control and prevention cdc and national center for health statistics nchs, approximately 26,000 fetal deaths over 20 weeks gestation occur in. Low dose vaginal misoprostol in the management of women. Management of late intrauterine fetal death and stillbirth. Welcome to the rcog elearning core knowledge tutorial on intrauterine fetal death. Additional us assessment may be difficult, based on. Medical management of late intrauterine death using a. For the purposes of this evidence summary this is referred to as late iufd. A pregnancy loss will be devastating for the expectant parents. Investigation and management of late fetal intrauterine death.
A randomized controlled trial comparing isosorbide dinitrateoxytocin versus misoprostoloxytocin at management of foetal intrauterine death. Consequently, medical induction to expel the dead fetus is recommended, provided it can be undertaken. Fox r and pillai m 2000 the management of intrauterine death in saunders w, edited by kean l h, baker p n and edelstone d i. Management of intrauterine fetal death with prostaglandin. Fetal monitoring tests can give some guidance in deciding when to advise delivery.
Medical treatment for early fetal death less than 24. Delivery of delivery of acardiac twin or of a fetus papyraceous when the timing of intrauterine demise is uncertain extraction of a dead fetus at maternal or. Fetuses with structural abnormalities face a higher risk of intrauterine death than normal fetuses. Induction of labour in late intrauterine fetal death. In england and wales, on the other hand, intrauterine fetal death or stillbirth refers to fetal death after 24 weeks gestation. Intrauterine fetal death nursing powerpoint presentations.
A stillbirth can result in the feeling of guilt or grief in the mother. Risk factors for iufd include extremes of maternal age, multiple pregnancy, post. Clinical management of the induction of labor in intrauterine fetal. Fetal tissue should be sent, refrigerated, in isotonic saline to the cytogenetic laboratory. Intrauterine fetal demise is the clinical term for stillbirth used to describe the death of a baby in the. Fialac a ipas and school of public health, unc at chapel hill, chapel hill, nc, usa b division of maternal fetal medicine, department of obstetrics and gynecology, university of california, irvine, usa c gynmed clinic, vienna, austria abstract the frequency of intrauterine fetal death iufd. The risks of a patient developing consumptive coagulopathy and other serious complications force the clinician to attempt to terminate pregnancy as soon as possible after making a diagnosis. Management o royal college of obstetricians and gynaecologists. In the united states, state laws require the reporting of fetal deaths, and federal law mandates. Intrauterine fetal demise obstetric clinical algorithms. Pdf clinical management of the induction of labor in intrauterine.
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