IUFD (Intrauterine Fetal Demise)

Adrian Setiawan, M.D.

IUFD (Intrauterine Fetal Demise)
IUFD is fetal death after 20 weeks gestation
but before the onset of labor.
It complicates about 1% of pregnancies.
With the development of newer diagnostic
and therapeutic modalities over the past two
decades, the management of IUFD has shifted
from watchful expectancy to ore active
intervention.
Etiology
More than 50% of cases, is not known or
cannot be determined.
Associated causes : hypertensive diseases of
pregnancy, DM, erythroblastosis fetalis,
umbilical cord accidents, congenital
anomalies, fetal or maternal infections,
fetomaternal hemorrhage, Antiphospolipid
antibodies, hereditary thrombophilias.
Diagnosis
Clinically IUFD should be suspected when the
patients reports the absence of fetal
movements, the uterus is small for date or if
the fetal heart tones are not detected using
Doppler device.
Diagnostic confirmation facilitated since the
advent of USG, real time USG confirms the
lack of fetal movement and absence of fetal
cardiac activity
Management
Fetal demise 14 28 weeks :
- Watchful Expectancy, 80% of patients
experience the spontaneous onset of labor
within 2 to 3 weeks of fetal demise.
- Induction of Labor using vaginal suppositories
of prostaglandin E2 (dinoprostol) ,
prostaglandin E1 (misoprostol)
After 28 weeks gestation :
- If the condition of the cervix is favorable for
induction and there are no contraindications,
misoprostol followed by oxytocin is the
treatment of choice.
Monitoring of Coagulopathy
- Regardless of the mode of therapy chosen,
weekly fibrinogen levels should be monitored
during the period of expectant management,
along with a hematocrit and platelet count.
- Decreasing the fibrinogen level may be an
early sign of consumptive coagulopathy in
cases of fetal demise.
Follow Up
All women with a fetal demise should be
tested :
- TORCH
- Anticardiolipin
- Hereditary thrombophilias
- Fetal chromosomal studies
- Subsequent pregnancies must be managed as
high risk cases.
Thank You.