Intrauterine Fetal Demise Definition, Reason, Symptoms, Treatment & Prevention
Understanding
Intrauterine fetal death ( IUFD ) is a condition of fetal death before birth or fetal death during labor.
IUFD is different from abortion (miscarriage). IUFD is a term generally used to describe the death of a fetus in utero after 20 weeks of gestation or more. Medically, IUFD is sometimes referred to as stillbirth. Meanwhile, the term abortion is used for fetal death at less than 20 weeks gestation.
Based on the time, IUFD is divided into three, namely:
- Early IUFD, namely fetal death occurs at 20-27 weeks of gestation.
- Late IUFD, namely fetal death occurs at 28-36 weeks of gestation.
- Term IUFD, namely fetal death occurs at 37 weeks of gestation or more.
Symptom
Most cases of intrauterine fetal death (IUFD) do not cause any symptoms. In conditions like this, IUFD is usually only discovered when pregnant women go to the doctor for antenatal care.
If there are symptoms, generally the symptoms that the mother complains about are that her fetal movements feel reduced or absent altogether. In addition, in some cases of IUFD, complaints of bleeding from the vagina and severe abdominal pain can also be found.
Reason
The cause of intrauterine fetal death (IUFD) is not always clear. But in general, several things that can cause fetal death in the womb are:
- Disturbances in the baby, such as genetic disorders and defects due to chromosomal disorders or infections.
- Disorders of the placenta or umbilical cord, such as twisting of the umbilical cord and placental abruption (placenta detaches from its attachment site).
- Health problems in the mother, such as uncontrolled diabetes, hypertension, obesity, antiphospholipid syndrome, or autoimmune disease.
IUFD events are more prone to be experienced by mothers with the following pregnancy conditions:
- Pregnant at the age of less than 20 years or over 35 years
- Smoking or exposure to secondhand smoke during pregnancy
- Pregnant twins
- Have a previous history of miscarriage or IUFD
- Unwed pregnancy
Diagnosis
In the early stages of determining the diagnosis of Intrauterine fetal death (IUFD), the doctor will conduct a complete interview, especially regarding fetal movements. The doctor will determine whether the fetal movements are reduced or absent altogether. Then a physical and obstetric examination will be carried out. The doctor will measure the height of the uterus and assess whether the size is appropriate for the mother’s gestational age.
Furthermore, to ensure the presence or absence of IUFD, an ultrasound examination (USG) needs to be performed. Fetal death can be determined if there is no heartbeat and any activity in the heart from an ultrasound examination.
Treatment
As soon as the diagnosis of Intrauterine fetal death (IUFD) is confirmed, the mother will be given a complete explanation regarding her condition. The principle of IUFD treatment is termination (termination) of pregnancy by removing the fetus.
Termination of pregnancy can be done in several ways, depending on the gestational age, the size of the fetus, and the choice of the mother. But in general, there are two ways to terminate a pregnancy that are most often done, namely:
- Induction of labor is done by placing an infusion containing oxytocin in the mother. Oxytosis is a type of hormone that stimulates the contraction and opening of the uterus.
Through this induction, it is hoped that the cervix can open completely, the uterus will contract properly, and finally the fetus will be expelled from the uterus. This action is generally performed in IUFD cases that occur at 28 weeks of gestation and above.
- Dilation of the cervix with laminaria, accompanied by the administration of drugs containing prostaglandins into the vagina. Similar to induction, inserting laminaria and administering prostaglandins also aim to open the cervix and stimulate the uterus to contract.
This action is usually more effective when performed in IUFD that occurs before 28 weeks of gestation.
Termination of pregnancy sometimes cannot be done immediately after the diagnosis of IUFD is known. Some mothers often feel unprepared or don’t believe what they experienced when they first learned of an IUFD diagnosis and needed time to agree to termination of pregnancy.
Termination of pregnancy does not have to be done as soon as possible. However, it should be done in less than three weeks, starting from the time of fetal death.
If the deceased fetus remains in the uterus for too long, the mother is at risk for disseminated intravascular coagulation ( DIC ). This is a blood clotting disorder that can cause the mother to experience bleeding and blockage of blood vessels at the same time.
Prevention
So that Intrauterine fetal death (IUFD) can be prevented, the doctor will first carry out various examinations on the mother. The goal is to find out the possible causes of her IUFD.
If IUFD is caused by maternal factors, such as the presence of diabetes or antiphospholipid syndrome, then these diseases should be treated before planning for the next pregnancy. In addition, maintaining an ideal body weight and avoiding exposure to cigarette smoke also help reduce the risk of having IUFD again in the future.