Kurdistan Region University of Duhok Faculty of Medical Science School of Nursing

1. University of Duhok
Faculty of Medical Science
School of Nursing
Intrauterine Fetal Death
(IUFD)
prepared by:
Znar A. Tamar
Ali Ahmad Ali
Faris Ismail Ali
15/Dec/2013

2. Objective
• Introduction
• Definition of intrauterine death
• Epidemiology of IUFD
• Etiology or causes of IUFD
• Risk factors and clinical features
• Diagnosis of IUFD
• Treatment & management
• Nursing care of IUFD
• Reference

3. introduction
• In addition to cases in which a fetus dies during
delivery as a result of asphyxia (oxygen
deprivation if the umbilical cord becomes
twisted) or difficult labor,,, others can die in utero
before labor starts. followed by expulsion of the
fetus from the uterus within a few days. However,
in rare instances the dead fetus is not expelled
from the uterus at once, but is retained for
several weeks.
• Fetal death refers to the spontaneous death of a
fetus at any time during pregnancy, although the
term is often used interchangeably with
‘stillbirth’. A stillbirth is a death that occurs after
20 weeks of gestation.

4. Definition of IUFD
Intrauterine fetal death: 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.

5. Epidemiology
In the present investigation the epidemiological
factors responsible for intrauterine fetal deaths after
20 week of gestation were studied. A
retrospective study of 16882 pregnancies registered
and managed in the Department of Obstetrics and
Gynecology, in united state

6. Continue…..
One hundred and three cases of intrauterine fetal
deaths were registered and treated expectantly
out of 16882 total pregnancies registered
during the four year study period. The stillbirth
rate was 6.1 per 1000 total births.

7. Etiology
Pregnancy complications:
- Pre-eclamptic toxemia
- Antepartum haemorrhage : placenta previa,
abruptio placentae
Pre- existing medical disease and acute illness:
- Chronic hypertension
- Chronic nephritis
- Diabetes
- Severe anemia
- Hyperpyrexia
Hyperpyrexia
- Syphilis, Hepatitis, toxoplasmosis etc.

8. Continue…
• Fetal
- Congenital malformation
- Rh-incompatibility
- Post maturity
• External version
• Idiopathic 20 –30%

9. Maternal Complications
• Decreased platelets
• Decreased fibrinogen
• Increased PT/PTT (Clotting times)
• Clinical bleeding / oozing from all sites
RX involves DELIVERY, pRBC’s, FFP, PLATELETS,
Supportive Management

10. Continue….
• Depression, Anxiety, Psychosocial
• Anxiety with future pregnancies
• May have repeat losses (depending on causes)
• Bleeding ---> can lead to DIC but may only
require blood product replacement
• Pain, Infection (similar to any other delivery)

11. Risk factors
Multiple pregnancy
Advanced maternal age
History of fetal demise (IUFD)
Maternal infertility
Maternal haemoconcentration
Maternal colonization with certain
pathogens
Small for gestational age infant
Obesity
Paternal age
African American race

12. Clinical features
• Absence of fetal movement
• Vaginal bleeding
• abdominal pain

13. Diagnosis of IUFD
• In most patients, the only symptom is decreased fetal
movement. An inability to obtain fetal heart tones
upon examination suggests fetal demise; however, this
is not diagnostic and death must be confirmed by
diagnostic tests .
• Labor should be induced as soon as possible after
diagnosis. Patient responses vary in regard to this
recommendation; some wish to begin induction
immediately, while others wish to delay induction for a
period of hours or days until they are emotionally
prepared.

14. Diagnostic tests
• Ultrasound: Caregivers can see if there is a heartbeat and
movement of the fetus.
• Non-stress testing: This test is also called NST. Two belts
placed across abdomen record changes in the heart rate of the
fetus when uterus contracts.
• Biophysical profile: This test uses ultrasound to check the
heart rate, breathing, and body movements of the fetus. It also
checks amount of amniotic fluid.
• Umbilical artery Doppler velocimetry: This test uses
ultrasound to check the blood flow inside the umbilical artery. This
artery carries blood from the fetus to the placenta.

15. Treatment & management
• Explain the problem to the woman and her
family. Discuss with them the options of
expectant or active management.
• Medical induction of labor: Medicine is used
to start labor and fetus delivered naturally.

16. Continue…..
• Extra-amniotic Foley catheter induction of labor:
A catheter is inserted into the cervix. Medicine
goes through the catheter. The medicine prepares
the cervix for labor, or starts contractions. The
fetus is delivered through the vagina.
• Dilation and evacuation (D and E): The cervix is
dilated, or made larger. The fetus is then removed
through the vagina
• Dilation and curettage (D and C): The cervix is
dilated, and caregivers use tools to remove the
fetus through the vagina.

17. Pain management
•
Pain management in patients undergoing
induction of labor for fetal death is usually
easier to manage than in patients with live
fetuses.
• Higher doses of narcotics are available to the
patient and often a morphine is sufficient for
successful pain control. Should a patient desire
superior pain control to intravenous narcotics,
epidural anesthesia should be offered.

18. References
www.drugs.com
www.allnursing.com
www.medical.com
www.slideshare.com
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