MEDICAL MANAGEMENT OF FETAL DEATH IN UTERO

The loss of a fetus at any stage is a fetal demise. According to the 2003 revision of
the Procedures for Coding Cause of Fetal Death Under ICD-10, the National Center
for Health Statistics defines fetal death as "death prior to the complete expulsion or
extraction from its mother of a product of human conception, irrespective of the
duration of pregnancy and which is not an induced termination of pregnancy. The
death is indicated by the fact that after such expulsion or extraction, the fetus does
not breathe or show any other evidence of life, such as beating of the heart,
pulsation of the umbilical cord, or definite movement of voluntary muscles.
Heartbeats are to be distinguished from transient cardiac contractions

respirations are to be distinguished from fleeting respiratory efforts or gasps." It is

further classified as early (before 20 weeks' gestation), intermediate (20-27 weeks'
gestation), or late (after 28 weeks' gestation).

Management of fetal death in utero has changed dramatically from earlier

recommendations that regarded the event as a medically innocuous condition to be
managed conservatively except under life-threatening circumstances, with 75% of
women delivered within 2 weeks after fetal demise. After coagulopathy was
observed in pregnancies complicated by fetal death in utero and with newer agents
to effect cervical ripening and uterine contractions, the management of stillbirth has
become more proactive. Investigations have evaluated the significance of a
previous stillbirth,

maternal complications of pregnancy, infective agents, intrapartum events,

usefulness of autopsy examinations, and placental findings in the cause of fetal
death. The one material complication frequently evaluated after the diagnosis of a
fetal demise is the development of disseminated intravascular coagulopathy (DIC).
Numerous publications have evaluated the causes of fetal death in utero, but
except for the rarely encountered case of DIC, other maternal complications
associated with the management and delivery of a stillbirth have not been assessed
in a large investigation.
MEDICATION

>Any medicines prescribed will depend on the type of treatment received.

ACTIVITY

>Restrictions are usually not necessary unless associated with the delivery option.

>Sexual intercourse should be avoided for 4 to 6 weeks. Starting another

pregnancy should be delayed at least 6 months.

DIET

>No special diet.

NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...

>You are pregnant and fail to gain weight or your abdomen is not increasing in size.

>Your unborn child appears to have stopped moving.

>Following the death of a fetus, you or a family member need help or emotional
support in coping with the grief process.