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.)

Comments

Post a Comment

Popular posts from this blog

Methods of placental separation

  Methods of placental separation There are two methods of separation and expulsion of the placenta.   Shultze Method: 80%:  This is the most common method. Inthis method separation starts from the centre of the placenta and with the aid of Retroplacenta clot the placenta drop into the lower uterine segment or into the vagina. During delivery the fetal surface appears first at the vulva followed by the membranes. There is minimal blood loss with this method. The 3 rd  stage is neat   Mathews Duncan Method 20%:  In this method separationstarts at the edge and slides down sideways. It comes through the vulva with the lateral border first, like a button through a button hole. The maternal surface is seen first at the vulva. There is trickling of blood throughout the third stage. The third stage .is messier.   Control of bleeding:  the Contraction and retraction of theuterine muscle fibers that bring about separation of the placenta also act as “livin...
Read more

Amniocentesis

  Amniocentesis   This is withdrawing of fluid from the amniotic sac through abdominal wall using a transabdominal needle. With the aid of ultrasound the location of the placenta can be seen. It is performed between 16 to 18 week to diagnosis fetal abnormality. It may be performed later for ;   1.             Polyhydramnios   2.             Intrauterine transfusion   Dangers 1.             Abortion in early pregnancy.   2.             Abruptio Placenta – APH.   3.             Damage to fetal vessels   4.             Trauma to the fetus.   5.             Rhesus isoi...
Read more

Measurements of the fetal skull

Image
  Measurements of the fetal skull-   1. Diameter of the fetal skull   These are the diameter the birth canal must stretch to allow the head to pass during labour. The lagest being mento vertical 13.5cm.   1.             Sub-Occipito Bregmatic (9.5cm) 2.             Sub-Occipito Frontal (10cm) 3.             Occipito Frontal (11.5m) 4.             Mento Vertical (13.5cm) 5.             Sub Mento Vertical(11.5) 6.             Sub-mento Bregmatic (9.5cm) 7.             Biparieta (9.5cm) 8.             Bitemporal (8.2cm). 2. Circumferences...
Read more