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Fetal Death Ch 13

Fetal Death Ch 13. 2009-2010 Academic Year MSIII Ob/Gyn Clerkship Self-Directed Study. APGO Educational Topic 21. A. Describe the common causes of fetal death in each trimester. B. Describe the symptoms, physical findings and diagnostic methods to confirm the diagnosis of fetal death.

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Fetal Death Ch 13

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  1. Fetal DeathCh 13 2009-2010 Academic Year MSIII Ob/Gyn Clerkship Self-Directed Study

  2. APGO Educational Topic 21 • A. Describe the common causes of fetal death in each trimester. • B. Describe the symptoms, physical findings and diagnostic methods to confirm the diagnosis of fetal death. • C. Describe the maternal complications of fetal death, including DIC. • D. Counsel the patient experiencing death of the fetus. USUHS MSIII Ob/Gyn Clerkship Self Directed Studies

  3. Fetal Death • IUFD • Fetal death after 20 weeks EGA but before the onset of labor. • Complicates 1% of pregnancies. • Shift from expectant management to active management. USUHS MSIII Ob/Gyn Clerkship Self Directed Studies

  4. Common Causes • Unknown or indeterminate in approx 50% of cases. True Knot http://pathologyoutlines.com/images/placentatrueknot.jpg USUHS MSIII Ob/Gyn Clerkship Self Directed Studies

  5. Common Causes • Hypertensive Diseases (Pre-E, Eclampsia) • Diabetes Mellitus • Erythroblastosis Fetalis • Umbilical Cord Accidents (true knot, prolapse) • Congenital Anomalies • Infections (Fetal or Maternal) • Hemorrhage (Abruption) • Thrombophilias (antiphospholipid antibodies) USUHS MSIII Ob/Gyn Clerkship Self Directed Studies

  6. Infection - TORCH • Toxoplasmosis • Rubella • CMV • HSV • Parvo-virus • Listeria USUHS MSIII Ob/Gyn Clerkship Self Directed Studies

  7. Gestational HSV Infection http://www.nature.com/jp/journal/v22/n1/images/7210584f1.jpg USUHS MSIII Ob/Gyn Clerkship Self Directed Studies

  8. Patient Presentation • Subjective decreased fetal movements • Uterus FH is small for EGA • No fetal heart tones with doppler • Will still have pos hCG • Ultrasound • No Fetal Movement • No Fetal Cardiac Activity USUHS MSIII Ob/Gyn Clerkship Self Directed Studies

  9. Diagnostic Methods for IUFD No FCA No movement http://www.slredultrasound.com/ThermalImages/Pelvic/IUFD1.jpg USUHS MSIII Ob/Gyn Clerkship Self Directed Studies

  10. Maternal ComplicationsDisseminated Intravascular Coagulopathy • Decreased platelets • Decreased fibrinogen • Increased PT/PTT (Clotting times) • Clinical bleeding / oozing from all sites • Decreasing H/H RX involves DELIVERY, pRBC’s, FFP, PLATELETS, Supportive Management USUHS MSIII Ob/Gyn Clerkship Self Directed Studies

  11. Maternal Complications • Depression, Anxiety, Psychosocial • Anxiety with future pregnancies • May have repeat losses (depending on causes) • Bleeding ---> can lead to DIC but may only require blood product replacement • Pain, Infection (similar to any other delivery) USUHS MSIII Ob/Gyn Clerkship Self Directed Studies

  12. Management = Delivery • Attempt for SVD • Expectant vs. Active management • Active Management • Cytotec • Pitocin • Pain Management • PCA (Pt Controlled Analgesia) • Epidural USUHS MSIII Ob/Gyn Clerkship Self Directed Studies

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