Intrauterine Fetal Demise - Symptoms, Diagnosis, and Treatment

What Is Intrauterine Fetal Demise?

Intrauterine fetal demise (IUFD) is the clinical term used for the death of the fetus at or after the 20th week or during the second trimester of gestation. The difference between the IUFD and a miscarriage is that a miscarriage occurs before the 20th week of pregnancy, while IDFD happens after the 20th week. Intrauterine fetal demise is classified into three types depending on how far along the pregnancy death has occured.

The three types of IUFD include:

• Early Stillbirth - When a fetal death occurs between 20 and 27 weeks of pregnancy.

• Late Stillbirth - When a fetal death occurs between 28 and 36 weeks of pregnancy.

• Term Stillbirth - When a fetal death occurs during or after 37 weeks of pregnancy.

What Are the Causes of Intrauterine Fetal Demise?

In most cases of intrauterine fetal demise, the cause is unexplained. However, some of the possible causes of intrauterine fetal demise are as follows:

• Post-term pregnancy (pregnancy occurring after 42 weeks of gestation).

• Serious maternal infections (such as malaria, cytomegalovirus, listeriosis, toxoplasmosis, syphilis, or HIV).

• Feto-maternal hemorrhage (blood transfer from baby to mother).

• Chronic maternal disorders (such as diabetes, high blood pressure, or obesity).

• Fetal growth restriction (the baby cannot grow normally during pregnancy).

• Complications during childbirth.

• Genetic abnormalities.

• Congenital abnormalities.

• Rh diseases.

• Uterine rupture.

• Placental problems (such as placental abruption, vasa previa, or underdeveloped placenta).

• Umbilical cord problems.

Some of these problems are not preventable. However, the doctor may be able to predict the possible dangerous conditions and take the required precautions to ensure safe delivery. If a doctor fails to provide the necessary treatment, it may be considered medical negligence.

What Are the Symptoms of Intrauterine Fetal Demise?

The signs and symptoms will not always be present for everyone and are not the same for all, and this is why doctors recommend paying close attention to any changes during pregnancy. If the mother feels something might be wrong, they should immediately inform their healthcare provider. The most frequently noted fetal demise symptoms include:

• Bleeding or spotting during pregnancy.

• Lack of baby movement or kicking.

• Abdominal pain and cramping.

• Fetal heartbeat is not detectable with a doppler or stethoscope.

• Fetal movements are not detectable with an ultrasound.

• High fever or infection in the mother.

What Are the Risk Factors for Intrauterine Fetal Demise?

Intrauterine fetal demise can occur mainly due to one of three categories - maternal pathology, fetal pathology, or placental pathology.

Fetal pathology occurs when there is a problem with the fetus and its inability to develop, which results in fetal death. Some common types of fetal problems that can cause difficulties in the development of the fetus include the following:

• Genetic abnormalities.

• More than one fetus shares the uterus.

• Contacting some types of infection from the mother.

• Growth retardation.

Any problem with the mother's health can also cause intrauterine fetal demise. However, fetal death in the uterus is less frequently caused by maternal pathology when compared with fetal pathology. A few causes of intrauterine fetal demise occurring due to the mother's health include the following:

• Uncontrolled diabetes.

• Advanced maternal age.

• Preeclampsia or hypertension.

• Rh incompatibility (when the blood type is different between the fetus and the mother)

• Ruptured uterus.

• Over-term pregnancy (pregnancy that lasts more than 42 weeks).

• Smoking.

• Overweight.

Placental pathology is considered the leading cause of intrauterine fetal demise. Approximately 65 % of intrauterine fetal demise is known to happen due to placental problems. A few of the placental problems that can cause intrauterine fetal demise may include the following:

• Placental abruption.

• Hemorrhage.

• Placental insufficiency.

• Umbilical cord detachment.

• Premature membrane rupture.

What Test Is Performed to Check Intrauterine Fetal Demise?

The doctor makes the diagnosis of intrauterine fetal demise by examining the symptoms and performing tests to check for signs of life in the uterus.

Diagnostic tests used to diagnose intrauterine fetal demise include:

• Biophysical Profile - A combination of non-stress tests and ultrasound to check for fetal vital signs.

• Non-Stress Test - This test helps to check the heartbeat of the fetus.

• Ultrasound - This imaging technique helps to look for the signs of fetal movement and heartbeat in the mother's uterus.

• Umbilical Artery Doppler Velocimetry - This test monitor if the umbilical cord blood is flowing properly.

After a stillbirth, healthcare professionals try to determine its cause. Determining the possible cause will help provide information about what to watch for in future pregnancies. Doctors will check if the cause is placental, maternal, or fetal, so the mother must undergo several tests to check for any underlying conditions that can be treatable. The placenta will also be examined. Finally, with the parent's consent, an autopsy of the fetus can also be performed.

What Is the Treatment for Intrauterine Fetal Demise?

After diagnosing the intrauterine fetal demise, the parents are informed, and pregnancy termination and labor induction options are discussed. During this period, parents have some options to consider. They can take time to decide and process their child's loss, and they can choose to induce labor later. If other healthy babies are in the uterus, the mother may wait to remove the baby until another baby is fully developed.

The following steps are involved in the intrauterine fetal demise:

• Dilation and evacuation procedure (this involves dilating the cervix to remove the fetus).

• Foley bulb induction (a catheter is inserted to start contractions).

• Medicines are administered to induce labor and deliver naturally.

A doctor will inform the mother about the available treatment for delivering a stillborn child and the potential risk factors that come with these treatments. The common complications involved in the procedure include infection, heavy bleeding, and uterine damage. If the unborn fetus is not removed from the uterus, it can lead to many complications. The mother may experience blood clots, fever, vomiting, severe pain, infection, diarrhea, and heavy bleeding.

After the delivery of a stillbirth baby, the parents need support and counseling, as losing a baby can be devastating. Many women who experience intrauterine fetal demise experience guilt, sadness, anger, and helplessness. So proper counseling and therapy are required to tackle these emotions.

Conclusion

Intrauterine fetal demise can happen at any stage of pregnancy. It is not completely preventable but can be prevented to a certain extent by regular prenatal visits and tests. Fetal demise can put the parents in grief, so proper counseling is needed, and discovering the cause of the demise is also important to prevent such incidents in future pregnancies.