Fetal Death In-Utero

(FDIU)

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Definition

-  Fetal death >20/40 whilst still in maternal uterus resulting in stillbirth

 

Features

-   

 

Ix

-  US to confirm fetal death

-  On Dx

-  Comprehensive history for ?cause

-  +/- Amniocentesis: cytology, MCS

-  LVS & peri-anal swab for MCS

-  FBE, Group & Antibodies

-  Serology: CMV, Toxoplasma, Parvovirus B19 +/- Rubella, Syphilus, HBV, HVC, HIV (if not already done)

-  Kleihauer

-  U&E, uric acid

-  LFT, bile salts

-  TFT

-  HbA1c +/- GCT

-  Anticardiolipin antibodies

-  Lupus anti-coagulant

-  Activated protein C (APC) resistance

-  On delivery as per Stillbirth

-  Thrombophillia screen

-  8-12/52 Post partum if IUGR, pre-eclampsia, maternal thrombosis or Hx of or where previously thrombophilia testing was positive at birth

-  Can be performed at birth if above known at time of delivery

-  Anticardiolipin antibodies

-  Repeat Lupus anticoagulant

-  +/- APC resistance (if not done already)

-  Factor V Leiden mutation (if APC resistance positive at birth)

-  Fasting Homocysteine & if positive test for MTHFR gene mutation

-  Protein C & S deficiency

-  Prothrombin gene mutation 20210A

-  Anti-thrombin III

 

Mx

-  IOL

-  Manual evacuation of placenta under epidural (preferable over GA)

-  If RPOC left in-utero risk of infection & bleeding

-  48hrs Abx

 

 

 

References

 

PSANZ: CPG for Perinatal Mortality Audit, April 2009