Intrauterine fetal demise (IUFD) refers to fetal dead at ≥ 20 weeks gestation (before the onset of labor).
WHAT MAKES US SUSPECT IT?
Fetal growth restriction, abnormal fetal karyotype, tobacco use during pregnancy
- Decreased/absent fetal movement
Doppler sonography will be unable to detect fetal heart tones
Ultrasound will confirm the absence of fetal cardiac activity
WHEN DO WE MAKE THE DIAGNOSIS?
The absence of fetal cardiac activity on ultrasound is the point in which we will make the diagnosis of IUFD.
HOW DO WE MANAGE THIS CONDITION?
Management will depend on the gestational age:
20-23 weeks: one of the following two options are possible
- Dilation and evacuation
- Vaginal delivery (C-section can be done if there is a history of prior cesarean/myomectomy)
≥ 24 weeks: vaginal delivery is the preferred route in this group (C-section can be done if there is a history of prior cesarean/myomectomy)
WHAT ELSE ARE WE WORRIED ABOUT?
Coagulopathy can occur if the fetus is retained for several weeks after demise (patients should NOT wait for spontaneous delivery of the fetus).
Page Updated: 10.18.2016