Intrauterine Fetal Death (IUFD)

Clinical Description

Death of the fetus > 28 weeks gestation or > 1kg weight

Signs and Symptoms

• Patient complains of absence of fetal movement, no increase in the size of the pregnancy, SFH smaller than gestational age, absence of fetal heart sounds on fetoscope or doppler If IUD is few days old breast size may diminish and colostrum secretion may start in some cases.

Investigations

• USS with no fetal cardiac activity (Verify by 2 health care providers),
• FBC, fasting blood sugar, VDRL, blood group and rhesus, urine dipstick, MRDT, Placental histology and fetal autopsy are advisable if cause of foetal death is uncertain.

Treatment

At Health Center refer to hospital

• Give woman option of immediate induction of labour (refer to Reproductive

Health protocols) versus waiting for spontaneous labour

• If augmentation of labour, then manage like live birth
• Ensure adequate analgesia in labour (Pethidine 100mg im 6 hourly until delivery occurs)
• Ensure privacy to the extent possible
• Provide bereavement counseling
• Prescribe Bromocriptine 2.5mg 12 hourly for 5 days for lactation suppression
• Evaluate for completeness of placenta and membranes to decide the need for evacuation of retained products of conception.
• Comment on abnormal features. (e.g., fetal congenital anomalies, retroplacental clot, umbilical cord knotting or nuchal cord)
• If the patient is rhesus negative, give Anti D immunoglobulin (RhoGAM) 300 μg (1500 IU) within 72 hours of delivery