Fetal Death

7/17/2019 Fetal Death

http://slidepdf.com/reader/full/fetal-death-568efc177dfff 1/22

FETAL DEATH

NUSWIL BERNOLIAN

FETOMATERNAL DIVISION

DEPARTMENT OF OBSTETRIC ANDGYNAECOLOGY

DR MOH. HOESIN GENERAL HOSPITAL

PALEMBANG



DEFINITION

WHO: a death bef!e"#$%ete e&$'%()* !

e&t!a"t)* f!# the #the! fthe $!d'"t f "*"e$t)*+)!!e($e"t),e f d'!at)* f

$!e-*a*".

M)"hae% /. Pa)da(+ Na0%) H((a)*.

E#b!*)" a*d feta% de#)(e. C!ea( a*dRe(*)12( #ate!*a% a*d feta% #ed)")*e.



Ce*te!( f! D)(ea(e C*t!%a*d P!e,e*t)* a*d the

V)ta% Stat)(t)"( Re$!t(O*% th(e dead fet'( a*d*e*ate( b!* at afte! 76

8ee1(+ ! )f -e(tat)*a% a-e )(*t a,a)%ab%e+ 8e)-h)*- 95 -! #!e ;Ma"D!#a* a*d

<)!#ee!+ 4556=The ab(e*"e f ()-*( f %)fe at! afte! b)!th



EPIDEMIOLOGY

USA : Rate f (t)%%b)!th( h)-he!tha* *e*ata% #!ta%)t

76> : ?.>@.. 4559: 3.4 $e! 7555

%),e b)!th(

O*e ha%f ""'!!ed %e(( tha* 4>8ee1(+ a*d 45 *ea! te!#

49 & h)-he! )* b%a"1 fet'(e(

RR 7+7? )* )*te!!a")a% "'$%e(

ACOG: I*"!ea(e & )* #'%t)feta%



S)#'%)a* et a%: I* %8 !)(1-!'$( : 7.3 $e! 7555 b)!th(

I* ab!'$t)* : 37.

SGA : 6.3

Ge(tat)*a% h$e!te*(),e

d)(!de!( : 9.Ch!*)" h$e!te*()* : ?.3

D)abete( : 9.6



ETIOLOGY

FETAL : 4 5 PERCENT

PLACENTAL : 4 9PERCENT

MATERNAL 75 PERCENT

UNEPLAINED 7 9PERCENT



FETAL 4 5

CHROMOSOMALABNORMALITIES

NONCHROMOSOMAL BIRTHDEFECTS

NONIMMUNE HYDROPS

INFECTIONS : VIRUSES+

BACTERIA+ PROTOOA



PLACENTAL 49

PREMATURLEY RUPTURED MEMBRANES

ABRUPTION

FETOMATERNAL HAEMORRHAGE

CORD ACCIDENT

PLACENTAL INSUFFICIENCY

INTRAPARTUM ASPHYIA

PREVIA

TWINTWIN TRNASFUSION

CHORIOAMNIONITIS



MATERNAL 75

DIABETES

HYPERTENSIVEDISORDERS

OBESITY

AGE 9 YEARS

THYROID DISEASE

RENAL DISEASE

ANTIPHOSPOLIPID

THROMBOPHILIAS

SMO<ING

ILLICIT DRUGS ANDALCOHOL

INFECTIONS ANDSEPSIE

PRETERM LABOUR

ABNORMAL LABOUR

UTERINE RUPTURE

POSTTERMPREGNANCY



PROTOCOL FOREAMINATIONS

INFANTDESCRIPTION

MALFORMATIONS

S<IN STAINING

DEGREE OFMACERATION

COLOR: PALE+PLETHORIC

UMBILICAL CORDPROLAPSE

ENTANGLEMENT:

NEC<+ ARMS+ LEGS

HEMATOMAS ORSTRICTURES

NUMBER OF VESSELS

LENGTH

WHARTON /ELLY:NORMAL+ ABSENT



AMNIOTIC FLUID

COLOR: MECONIUM+BLOOD

CONSISTENCY

VOLUME

MEMBRANES

STAINED: MECONIUM+CLOUDY

THIC<ENING

PLACENTA

WEIGHT

STAININGMECONIUM

ADHERENT CLOTS

STRUCTURALABNORMALITIES:CIRCUMVALLATE ORACCESSORY LOBES+

VELAMENTOUSINSERTION

EDEMA: HYDROPHICCHANGES



EVALUATION FORRECURRENT TM 7 LOSS

<ARYOTYPE OFMISCARRIEDTISSUE

PARENTAL<ARYOTYPE

LUTEALPHASEASSESSMENT

GTT

THYROID

UTERINE CAVITYASSESSMENT BYSONOHYSTEROGRAPH Y ;PREFFERED=+ HSG+

OR HYSTEROSCOPY

APS ANTIBODYSCREEN

INHERITEDTHROMBOPHILIAS+ IFLOSSES BETWEEN 7579 WEE<S

RECOMMENDED



RECOMMENDEDEVALUATION FOR TM

49 LOSSFETAL WOR< UP

FETAL AUTOPSY

PLACENTHALPATHOLOGY

RADIOGRAPH OFFETAL S<ELETON

MATERNAL WOR<UP

CBC+ <LEIHAUERBET<ETEST

PARVOVIRUS B 76 I-M+I-G

SYPHILLIS

LUPUS ANTICOAGULANT

ANTICARDIOLIPIN AB

FTHYROINE+ TSH

INHERITEDTHROMBOPHILIAS



LABORATORYEVALUATION

If a't$( a*d "h!#(#a% (t'd)e($e!f!#ed: 9 d)(",e!ed ha,e#a! (t!'"t'!a% a*#a%)e(.

45 ha,e d(#!$h)" feat'!e( !(1e%eta% ab*!#a%)t)e(+ >"h!#(#a% ab*!#a%)t)e(

ACOG 4556 !e"##e*d( )dea%%1a!t$)*- a%% (t)%%b!*(

If * #!$h%-)" a*#a%)e( f'*d+

ha,e "h!#(#a% ab*!#a%)t)e(.



A$$!$!)ate "*(e*t #'(t bebta)*ed t ta1e feta% t)(('e

(a#$%e(+ )*"%'d)*- ')d b$(t#!te# a($)!at)*

9 #L f feta% b%d bta)*ed f!#

'#b)%)"a% "!d ;$!efe!ab%= ! b"a!d)a" $'*"t'!e+ )( $%a"ed )*t a(te!)%e+ he$a!)*)0ed t'be f!"t-e*et)" (t'd)e(.

Mate!*a% b%d : APS+ d)abete(+L'$'(+ <%e)ha'e!Bet1e (ta)*)*-

If b%d "a**t be bta)*ed+ ACOG

;4556= !e"##e*d( *e f the



7. A $%a"e*ta% b%"1 ab't 7&7 "# ta1e*be%8 the "!d )*(e!t)* ()te )* the'*J&ed ($e")#e*

4. U#b)%)"a% "!d (e-#e*t ab't 7. "#%*-+ !

I*te!*a% feta% t)(('e ($e")#e*+ ('"h a("(t"h*d!a% '*"t)* ! $ate%%a ;(1)*)( * %*-e! !e"##e*ded=

T)(('e )( 8a(hed 8)th (te!)%e (a%)*e

$!)! t $%a"e#e*t )* %a"tated R)*-e!(%'t)* ! (te!)%e "t-e*et)" #ed)'#.

P%a"e#e*t )* f!#a%)* ! a%"h% 1)%%(!e#a)*)*- ,)ab%e "e%%( a*d $!e,e*t(

"t-e*et)" a*a%()(.



MANAGEMENT

DELIVERY BY A CARING PHYSICIAN

COUNSELING : AUTOPSY

RIS< OF DEPRESSION

COAGULOPATHY : 4 95+ CHEC<FIBRINOGEN AND PLATELET



RECURRENCE RIS< RECURRENCE RIS< : 9 IF 4? WEE<S+

GREATER IF K 4? WEE<S

SHARMA ET AL+ 4553: STILLBIRTH RATE 44.?PER 7555 IN WOMEN WITH PRIOR FETAL DEATH

SUR<AN ET AL+ 455: TERM IUGR LIVE FETUS+HAS 4 RIS< OF STILLBIRTH. IF PRETERM:

ACOG 4556: LOW RIS< WOMAN UNEPLAINED

STILLBORN: RIS< 75 .RIS< OF STILLBORN 9? WEE<S : 7.> PER7555

GOLDENBERG ET AL 7669: 6 WOMEN WITHPREGNANCY LOSS 79 4 WEE<S: NET



SUBSEUENTPREGNANCY

COUNSELING FOR RIS< FACTORS

ANTENATAL SURVEILLANCE+ PRENATAL

DIAGNOSISRIS< IS REDUCED BY 7 WITH ASPIRIN

HEPARIN FOR THROMBOPHILIA

IMMUNOGLOBULIN+ PROGETERONE



FETAL <IC< COUNTS : START AT 4>

WEE<S

INTERVAL 4 WEE<S : USG+ NST+ BPP+ AFI

ACOG RECOMMENDATIO+ 4556 :ANTEPARTUM SURVEILLANCE START AT94 WEE<S

EARLIER IN IUGR OR CHRONIC DISEASE

ELECTIVE INDUCTION AT THECOMPLETION OF 96 WEE<S GESTATIONOR 9? TO 9> AFTER LUNG MATURITY IS

DOCUMENTED BY AMNIOCENTESIS



CONCLUSION

CATASTROPHIC EVENTS IN A COUPLE2SLIVES.

POSSIBILITIES OF ETIOLOGIESINVESTIGATIONS : FETUS+ PLACENTA+UMBILICAL CORD+ MEMBRANE

COUNSELING THE COUPLESPLANNING THE SUBSEUENTPREGNANCIES



THAN< YOU

Fetal Death

Documents

Transcript of Fetal Death