INTRODUCTION

Fetal death refers to the spontaneous death of a fetus at anytime during pregnancy,
although the term is often used interchangeably with ‘still birth’. A still birth is a
death that occurs after 20 weeks of gestation.

Ante-partum fetal death contributes to about two-third of prenatal mortality.

Incidence is still high in developing countries, in majority of cases, causes is still
unknown. But there are MATERNAL, FETAL, AND PLACENTAL causes.

In addition to cases in which a fetus dies during delivery as a result of asphyxia

(oxygen deprivation if the umbilical cord becomes twisted) or difficult labour,
others can die in-utero before labour starts. Followed by expulsion of the fetus
from the uterus within few days. However, in rare instances the dead fetus is not
expelled from the uterus at once, but is retained for several weeks.

LITERATURE REVIEW

IUFD, also known as stillbirth, is the death of a fetus after 20weeks of gestation.
According to WHO, approximately 2 million stillbirths occur annually worldwide,
with a global stillbirth rate of 18.4 per 1000 birth (Lawn et al., 2016).

Several risk factors have been identified for IUFD including Maternal age,
Multiples gestation, Chronic medical conditions, Infections e.t.c (Patterson et al.,
2017).

IUFD can result from various causes including Placental abruption, umbilical cord
accidents, Fetal growth restriction, Genetic factors e.t.c (Korteweg et al., 2017).

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Diagnosis of IUFD is typically made using ultra sound, which can detect fetal
demise by demonstrating absence of fetal movement, heart activity or breathing
(American College of Obstetricians and Gynecologist, 2019).

Management options for IUFD include Expectant management, Induction of

labour, Dilation and evacuation ( National Institute for Health and Care
Excellence, 2019).

IUFD can have a profound Psychological impact on parents. These include Grief
and bereavement, Anxiety and depression, and Post-traumatic stress disorder
(Shapiro et al., 2018

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INTRAUTERINE FETAL DEMISE (IUFD)

Intrauterine fetal demise (IUFD) is the medical term for a fetus that dies at or after
the 20th week or second trimester of gestation. IUFD differs from a miscarriage,
which occurs before the 20th week of gestation and having a birth weight of
greater than 500g.By WHO. Older definition use a gestation age of 28 weeks.

The legal definition which is used by the Confidential Enquiry into Maternal and
Child death (CEMACH) is a child that has issued forth from its mother after the
24th week of pregnancy and which did not at any time after being completely
expelled from its mother breathe or show any other signs of life.

INCIDENCE AND PREVELANCE OF IUFD

WORLDWIDE: IUFD affects approximately 26 million pregnancies annually
NIGERIA: IUFD affects approximately 1 in 100 pregnancies
NIGER STATE: IUFD affects approximately 1 in 50 pregnancies
There are three categories of intrauterine fetal demise that are characterized by
when the fetus died in-utero and how far along the stillbirth occurred in the
pregnancy.

The three types of IUFD include

 Early stillbirth occurs between 20 and 27 weeks of gestation.

 Late till birth occurs between 28 and 36 weeks of gestation.

 Term stillbirth occurs upon or after 37 weeks of gestation.

Stillbirth has many causes such as infections, Issues with the umbilical cord and/or
placenta, and overall complications with labor. It is important to note some cases
of IUFD may not have any apparent cause.
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IUFD can happen to anyone however doctors can identify risk factors of
intrauterine fetal demise and ensure the expectant mother is properly monitored,
diagnosed and treated for any complications that may increase these risks.

unfortunately, some cases of intrauterine fetal demise may be caused by lack of

prenatal care by doctors. If a medical professional failed to screen, diagnose, or
treat any risk factors leading to a stillbirth, It may be considered medical
negligence.

CAUSES

1. IDIOPATHIC

2. FETAL CAUSES

 Major anormalies

 Umbilical cord knot/loop

 Birth defect

 Genetic disorder of the fetus

3. MATERNAL CAUSES

 TORCH
T-Toxoplasmosis
O- Other infections
R-Rubella [german measles]
C- Cytomegalovirus[CMV]
H-herpes simplex virus [HSV]
- Rh incompatibility
- Metabolic disorders
- Gestational diabetics and Hypertension
PLACENTAL CAUSES
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- Placental insufficiency
- placental abruptio
- chorioamnionitis

RISK FACTORS

Advance maternal age >35 year

Multiple Gestation

Previous history of IUFD

Gestational diabetes ot hypertension

Fetal growth restriction

History of still birth or miscarriage

Trauma

Obesity

Use of alcohol or smoking during pregnancy

SIGNS AND SYMPTOMS

FETAL

 Spalding sign:

Spalding sign is the overlapping of the bones of the fetal skull. indicating
intrauterine fetal death. (usually appears 7 days after)

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 Scalp edema:

Scalp edema swelling in the fetal scalp

 Absent flow in umbilical cord:

Absent blood flow in umbilical cord indicating possible fetal distress or demise.

 Absent fetal cardiac pulsation:

Absent of fetal heartbeat which is definitive sign of intrauterine fetal death

-
MATERNAL

 Cramping

 fever

 Not feeling the fetus moving or kicking

 pain in the abdomen

 Vaginal bleeding.

DIAGNOSIS

Non-stress test: monitoring of infants heart rate for a minimum of 20 minutes

Ultrasound imaging: that looks for signs of life and movement in the womb itself

Umbilical artery Doppler velocimetry: checks that umbilical cord blood is

flowing properly.

Biophysical profile: a combination of ultrasound and non-stress test to monitor

fetal heart rate. It is an overall evaluation of the infant's health in the womb.
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ROLE OF A MIDWIFE IN MANAGEMENT OF INTRAUTERINE FETAL
DEATH

Emotional support: Provide emotional support and counseling to women and

their families.

Pain management: Offer pain relief options, such as analgesia or epidural

anesthesia.

Labor induction: Assist with labor induction, if necessary, to help the woman
deliver the fetus.

Post-mortem care: Provide post-mortem care, including handling and storage of

the fetus, and facilitating autopsy or examination, if desired.

Bereavement support: Offer ongoing bereavement support and counseling to

women and their families

Multidisciplinary team meetings: Participate in multidisciplinary team meetings

to discuss complex cases and develop care plans.

Communication with other healthcare providers: Communicate with other

healthcare providers, such as general practitioners or pediatricians, to ensure
continuity of care.

Referral to specialist care: Refer women to specialist care, such as obstetricians

or fetal medicine specialists, if necessary

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PREVENTION

Prenatal Care: Provide regular prenatal check-ups to monitor fetal growth and
well-being.

Risk assessment: Identify high-risk pregnancies and refer women to specialist

care if necessary

Health education: Educate women on healthy lifestyle choices, such as a balanced

diet, regular exercise, and avoiding harmful substances.

Fetal movement monitoring: Teach women how to monitor fetal movements and
report any concerns.

Early Detection of IUFD:

Fetal heart rate monitoring: Use Doppler or fetal monitoring to detect any
abnormalities in fetal heart rate.

Ultrasound scanning: Perform ultrasound scans to monitor fetal growth and

detect any signs of distress.

COMPLICATIONS

MATERNAL: infection, hemorrhage, and emotional stress.

FETAL: Macceration, mummification and fetal decay.

LONGTERM: Recurrent pregnancy loss, Emotional trauma e.t.c

INCREASED RISK: Still birth, Preterm birth, and low birth weight.

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CONCLUSION

Sadly the death of fetal may occur at any stage of pregnancy including during the
labor process which can lead to psychology and emotional trauma experienced by
the family in form of anger and anxiety. All of this emotions and feeling can
exhaust you mentally and physically, harming your overall health. Intrauterine
Fetal Death (IUFD) is a pregnancy complication where a fetus dies in the womb
after 20 weeks. Causes include chromosomal abnormalities, infections, and
maternal health conditions. Prompt detection and management are crucial.
Healthcare providers must prioritize prenatal care, emotional support, and
specialist care to improve outcomes and provide compassionate care.

Maximum possible effort should be made to establish the cause for better future
outcome.

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 REFERENCE
American College of Obstetricians and Gynecologists. (2020). Stillbirth.

American Journal of Obstetrics and Gynecology

Carnegie imaging (2021,may4). Second trimester intrauterine fetal death (IUFD) -

Retrieved July 12,2024, from death-iufd/.March of Dimes. (n.d.).

Centers for Disease Control and Prevention (CDC)

Doppler ultrasound in obstetrics and gynaecology by Dev Maulik

Fetal medicine column basic science and clinical practice by Charles H. Rodeck et
al
National Demographic and Health Survey.(2018). Niger State report American
College of Medical Genetics

National Population Commission. (2018). Nigeria Demographic and Health

Survey.

Obstetrics ultrasound: A Comprehensive guide by Alfred Abuhamad

Radiology of the fetus” By peter W.Callen

Royal College of Obstetricians and Gynaecologists. (2019). Stillbirth.

Stillbirth. Retrieved July 12, 2024, from. Intrauterine fetal demise. start
pearls(internet).Retrieved July 12,2024,from My health.Alberta.ca.(n.d).
stillbirth (before delivery): care instructions .Retrieved July 12,2024,

Williams obstetrics” [25th edition]By F.Gary Cunningham et al.

World Health Organization. (2019). Stillbirths.

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