Fetal Demise: Causes, Symptoms, Risks, Treatment & Diagnosis

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Intrauterine Fetus demise is the medical term used for stillbirth to describe the death of the baby in the uterus at or after the 20th week of gestation. It is not a proper definition of fetus demise because it differs worldwide according to the gestational age and weight of the fetus. There are lots of maternal causes and paternal causes that may cause fetal demise.

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It results in a baby born without signs of life. It is in contrast to miscarriage which is an early spontaneous pregnancy loss before the 20 weeks of pregnancy. Pregnancy loss is very common

What Are The Causes Of Intrauterine Fetal Demise?

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There are lots of factors that can cause early fetal death at or after the 20th week of pregnancy. This is very important to find out the cause of fetal death to save the next pregnancies.

The most common causes of early fetal deaths can include:

  • Congenital birth defects
  • Placental abnormalities
  • Genetic abnormalities
  • Diabetes mellitus
  • Placental abruption and other placental disorders (such as vasa previa)
  • Hypertension
  • Placental dysfunction leading to fetal growth restriction
  • Infections
  • Obesity
  • Age (after the 40 years)
  • Umbilical cord complications
  • Uterine rupture
  • Prolonged pregnancy beyond 40 weeks

How Pregnant Woman May Present After The Fetal Demise?

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As the heart of the fetus stops to pump the blood and the movements of the baby stopped in amniotic fluid, the fetus is declared dead fetus. Most women do not experience any signs and symptoms of fetal death before 20 weeks but some women may have. Therefore, to check the fetal demise, an ultrasound has to perform to see the cardiac activity of the fetus. Fetal death is diagnosed only when an ultrasound shows no cardiac activity of the fetus.

The common symptoms of intrauterine fetal death are

  • No fetal movements or kicks
  • Cramping
  • No fetal heartbeat with a stethoscope
  • Bleeding or spotting
  • No fetal movements on ultrasound

Therefore, mothers should be conscious about their baby’s growth and development. If you feel little or no movements of the fetus, consult your doctor as soon as possible. Mild bleeding or spotting is allowed. If you feel massive bleeding or spotting, discuss it with your health care provider. Do not miss your visiting scans.

Risk Factors Associated With Fetal Demise

There are some associated factors that can make a woman at high risk for fetal demise. Some of them you can manage, while some can’t. These associated risk factors include:

  • Hypertension
  • Diabetes mellitus
  • Advanced maternal Age
  • Race
  • Obesity
  • SLE
  • Thyroid diseases
  • Kidney disease
  • Smoking
  • Alcohol consumption
  • Multiple pregnancies
  • Drug abuse
  • Environmental violence

How Can Be Diagnosed?

Mostly mothers present with the complaint of bleeding, stopping of fetal movements or kicks, and cramping. Therefore, detailed history and thorough clinical examination by stethoscope or ultrasound are very important to diagnose fetal death. The important steps of fetal death diagnosis are:

  • Detail History ( ask about bleeding, cramping, feeling of fetal movements or kicks)
  • Clinical examination
  • Check the heartbeat of the fetus by stethoscope or Doppler
  • Ultrasound is extremely important to diagnose fetal death. On ultrasound, no cardiac activity and no fetal movements show the death of the fetus in the uterus.

Management

Traditionally, Intrauterine fetal demise has been managed by surgical uterine evacuation (dilatation and curettage (D&C) up to 14 weeks. This procedure is done under General anesthesia. After that, Labour is induced using some agents like oxytocin and prostaglandins. Thus, by dilating the cervix and the uterus, pregnancy tissue is removed and the uterus is evacuated. It is successful in 95 to 100 percent of cases some risks are always there.

It has recently been researched that medication especially the orally active prostaglandin misoprostol, are effective in emptying the uterus at all gestational ages and proved an effective alternative to surgical evacuation.

Complications

The death fetus in the uterus for 4 weeks can disturb the clotting system of the mother. Once it diagnosed, removed promptly to get rid of complications.

If the dead pregnancy tissues stay for more than 4 weeks, it can cause

  • Disseminated intravascular coagulation DIC
  • Bleeding
  • Infections
  • Anemia
  • Accidental hemorrhage
  • GIT disturbance

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