Makindo Medical Notes

Intrauterine death (IUD) refers to the death of the fetus after 20 weeks of gestation but before birth. Causes are often multifactorial, involving maternal, fetal, or placental factors. In the UK, it is synonymous with “stillbirth” after 24 weeks.

Maternal Causes 👩

• Hypertensive Disorders: Preeclampsia, eclampsia, chronic hypertension → placental insufficiency.
• Diabetes Mellitus: Poor control → congenital malformations, macrosomia, placental insufficiency.
• Thrombophilias: Antiphospholipid syndrome, Factor V Leiden → placental infarction & clots.
• Infections: CMV, syphilis, listeria, toxoplasmosis, parvovirus B19.
• Substance Use: Smoking, alcohol, cocaine, opioids → abruption, IUGR, fetal death.
• Autoimmune Disorders: SLE, vasculopathies → placental insufficiency.
• Trauma: MVAs, falls, assault → abruption, fetal hypoxia.

Fetal Causes 👶

• Congenital anomalies: Anencephaly, severe cardiac defects, renal agenesis.
• Chromosomal abnormalities: Trisomy 13, 18, Turner syndrome.
• Infections: CMV, rubella, syphilis → direct fetal compromise.
• Growth restriction: Severe IUGR from chronic hypoxia/placental insufficiency.

Placental & Cord Causes 🧬

• Placental abruption: Premature separation → haemorrhage, hypoxia.
• Placental insufficiency: Seen in preeclampsia, chronic HTN.
• Placenta praevia: May cause catastrophic bleeding.
• Umbilical cord accidents: Knots, entanglement, cord prolapse → acute hypoxia.

Diagnosis 🔍

Diagnosis is usually prompted by reduced or absent fetal movements and confirmed by imaging.

• Ultrasound: Absent fetal heartbeat, absent movements, assess growth/AFI.
• Doppler: For suspected cord or placental insufficiency.
• Maternal blood tests:
  • Thrombophilia screen
  • Infection serology (CMV, parvovirus, syphilis, toxoplasmosis)
  • Blood glucose (diabetes control)
  • Kleihauer–Betke for fetomaternal haemorrhage
• Post-delivery investigations:
  • Placental histology
  • Fetal autopsy (with consent)
  • Amniocentesis (if anomalies suspected)

Management 🏥

Once IUD is confirmed, management aims at safe delivery and parental support.

• Stabilise mother: ABCs, screen for coagulopathy (esp. DIC if fetus retained >4 weeks).
• Delivery options:
  • Expectant: Some will labour spontaneously (risk DIC if prolonged).
  • Induction: Prostaglandins (misoprostol, dinoprostone) ± oxytocin.
  • Surgical ev