Intrauterine Fetal Demise

PATHOPHYSIOLOGY

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DIAGNOSTIC TESTS

Tests and procedures used to diagnose IUFD include:

Maternal investigations

•CBC

•Bl Gp & antibody screen

•HB A1 C

•Kleihauer Batke test stain for detection of possible fetal-maternal hemorrhage.

•Serological screening for Rubella

•CMV, Toxo, Sphylis, Herpes & Parovirus

•Karyotyping of both parents (RFL,

Baby with malformation

•Hb electrophorersis

•Antiplatelet anbin tibodies

•Throbophilia screening (antithrombin Protein C & S , factor IV leiden, Factor II mutation, , lupus anticoagulant, anticardolipin antibodies)

•DIC

Fetal investigations

•Fetal autopsy

•Karyotype (spcimen taken from cord blood, intracardiac blood, body fluid, skin, spleen, Placental wedge, or amniotic Fluid)

•Fetography

•Radiography

Placental investigations

•Chorionocity of placenta in twins

•Cord thrombosis or knots

•Infarcts, thrombosis,abruption,

•Vascular malformations

•Signs of infection

•Bacterial culture for Ecoli, Listeria, gp B strpt.

SYMPTOMATOGOLY

MANAGEMENT

A. MEDICAL

 Pitocin - This is an artificial version of the body's hormone oxytocin. It is given by way of an IV lineand is used to cause contractions. The amount of Pitocin used will depend on how your body accepts it. Generally, the amount is increased every 15-30 minutes until a good contraction pattern is achieved. Sometimes this is done in combination with breaking the bag of water. It is a bit easier to control than breaking the bag of water because the drug can be stopped by closing off the IV line.

 Prostaglandin Gels or Suppositories - These are used more frequently when the cervix is not favorable, meaning that it is dilated less than 3 centimeters, hard, posterior, not effaced, or barely effaced, or any combination of the above. This can be used alone, or more frequently will be done 12 or more hours prior to the use of Pitocin. Frequently it will be given more than once over the course of an evening. A suppository or tampon like substance will be placed in or near your cervix during a vaginal exam.

 Misoprostal (Cytotek) - This is a pill that can either be ingested orally or placed near the cervix. It is used more often when the cervix is not very favorable.

ETIOLOGY

B.SURGICAL

Dilation & Curettage (D&C) - Dilation and curettage is a surgical abortion procedure performed during the first 12 to 15 weeks gestation. Dilation and curettage is similar to suction aspiration with the introduction of a curette. A curette is a long, looped shaped knife that scrapes the lining, placenta and fetus away from the uterus. A cannula may be inserted for a final suctioning. This procedure usually lasts 10 minutes with a possible stay of 5 hours.

Dilation & Evacuation (D&E) - Dilation and evacuation is a surgical abortion procedure performed between 15 to 21 weeks gestation. In most cases, 24 hours prior to the actual procedure, your abortion provider will insert laminaria or a synthetic dilator inside your cervix. When the procedure begins the next day, your abortion provider will clamp a tenaculum to the cervix to keep the uterus in place and cone-shaped rods of increasing size are used to continue the dilation process. The cannula is inserted to begin removing tissue away from the lining. Then using a curette, the lining is scraped to remove any residuals. If needed, forceps may be used to remove larger parts. The last step is usually a final suctioning to make sure the contents are completely removed. The procedure normally takes about 30 minutes. Although some clinics may perform the proceudre, it is usually performed in a hospital setting because of the greater risk for complications. The fetal remains are usually examined to ensure everything was removed and that the abortion was complete.

Dilation and Extraction - The dilation and extraction procedure is used after 21 weeks gestation. The procedure is also known as D & X, Intact D & X, Intrauterine Cranial Decompression and Partial Birth Abortion. Two days before the procedure, laminaria is inserted vaginally to dilate the cervix. Your water should break on the third day and you should return to the clinic. The fetus is rotated and forceps are used to grasp and pull the legs, shoulders and arms through the birth canal. A small incision is made at the base of the skull to allow a suction catheter inside. The catheter removes the cerebral material until the skull collapses.

Vacuum or suction aspiration - Vacuum or suction aspiration uses aspiration to remove uterine contents through the cervix. It may be used as a method of induced abortion, a therapeutic procedure used after miscarriage, or a procedure to obtain a sample for endometrial biopsy. The rate of infection is lower than any other surgical abortion procedure at 0.5%.[2] Some sources may use the terms dilation and evacuation[3] or "suction" dilation and curettage[4] to refer to vacuum aspiration, although those terms are normally used to refer to distinct procedures.

a. PREDISPOSONG FACTOR

I.What is IUFD?

An intrauterine fetal demise (IUFD), or stillbirth, is defined as a death that occurs in utero or during delivery after the completion of the 20th week of pregnancy, or the death of a fetus that weighs 500 g or more in utero or during delivery.

II.GOALS

Intrauterine Fetal Demise

ANATOMY OF

THE REPRDUCTIVE SYSTEM

GENERAL:

This case study about Intrauterine Fetal Demise aims that at the end of the case presentation, the audience and the researcher will obtain better and deeper knowledge and further understanding about the case.

SPECIFIC:

• At the end of this case presentation, the audience will be able to:
• Define what Intrauterine Fetal Demise is.
• Understand the client’s past and present history and be able to relate it to pt.’s present condition.
• Interrelate the results in the client’s physical assessment to the client’s condition.
• Define the possible causes of (predisposing and precipitating factors) Intrauterine Fetal Demise.
• Determine the symptomatology with its rationale.
• Understand the anatomy and physiology of the Female Reproductive System.
• Trace the pathophysiology of Intrauterine Fetal Demise.
• Discuss the nursing care rendered to the client.

III.COMPLETE DIAGNOSIS OF NEPHROTIC SYNDROME

• Intrauterine fetal demise is the clinical term for the death of a baby in the uterus, during pregnancy and before birth. The term is usually used for pregnancy losses that happen after the 20th week of gestation.

http://miscarriage.about.com/od/pregnancylossbasics/g/intrauterine.htm

• A stillbirth occurs when a fetus has died in the uterus. Once the fetus has died, the mother may or may not have contractions and undergo childbirth. Most stillbirths occur in full-term pregnancies.

http://en.wikipedia.org/wiki/Stillbirth

• Fetal death in utero (stillbirth) is defined in most states as a demise at ≥20 weeks of gestation and/or weight of ≥500 grams.

South Med J. 2001;94 © 2001 Lippincott Williams & Wilkins