Intrauterine fetal death

Late intrauterine fetal death (IUFD) is defined as fetal death in utero after 24 completed weeks of pregnancy of a singleton fetus

Stillbirth is defined as a baby delivered with no signs of life known to have died after 24 completed weeks of pregnancy

Causes

maternal
fetal

Complications:

maternal DIC
sepsis
emotional

Obs Mx

Urgent delivery of the fetus if there is sepsis, preeclampsia, abruption or membrane rupture.

Aim to manage in a quiet room separate from the other labour ward activities to reduce stress and anxiety as well as allowing the family access to support the mother.

Analgesia for labour

An epidural technique is the most effective form of analgesia and can also be offered to the patient in the absence of significant sepsis or coagulopathy.

The risk of coagulopathy should be assessed before performing neuraxial blocks. A normal coagulation profile within 6 h of a neuraxial block is considered acceptable

The risk is very low within 3 weeks of an IUFD (unless associated with abruption, PET or uterine rupture). Check if any thromboprophylaxis has been given (or planned) and time the insertion of the neuraxial block accordingly

References

Quick hits chapter