puntland medical association pma نقابة أطباء بونتلاند hq: garowe tell:+ 252 5...
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Puntland Medical AssociationPMA
بونتالند أطباء نقابةwww.puntmedass.org
HQ: Garowe tell:+252 5 845533
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Cotinuous Medical EducationTopic: IUFD (Inter-Uterine Fetal Death)
Date: 17, Oct 2014 Presenter: Dr. Habibo Noh.
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Definition
Is a fetal death from 24 weeks GA and more but before onset of labour
Incidence ; Complicates 1% of pregnancies 33
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Etiology
• Unknown in 25-60% of cases
• Identifiable causes can be attributed to:
oMaternal conditions
o Fetal conditions
o Placental conditions
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Fetal conditions (25-40%)
• Chromosomal anomalies
• Prematurity/immaturity : Preterm prelabor rupture of membranes(PPROM)
• Preterm labor where uterus contractions
• Cervical dysfunction initiates preterm delivery
• Infections TORCH :
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Placental and Cord conditions 25-35%
o Placental bed pathology: inadequate spiral artery remodeling and/or spiral artery pathology leading to utero-placental vascular insufficiency such as placental infarction.
o Placental pathology: originated during development of the placenta itself, abnormalities in the parenchyma or localization of the placenta.
o Umbilical cord complication : tight knot in the cord and abnormal umbilical cord coiling and Prolapse
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Maternal conditions 5-10%
• Trauma
• Abnormal labour
• Sepsis
• Post term
• Uterine rupture
• Drugs
• Sever anemia
• Epilepsy
• Thrombophilia
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UNKNOWN CONDITIONS
• Mom with no perinatal care delivery and diagnosed (discordant twins).
• Toxoplasmosis , Rubella, CMV.88
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Diagnosis
• Real time ultrasound is the definite method for diagnosing intrauterine fetal death by demonstrating the absence of fetal cardiac activity and movements.
• When the fetus has been dead for more than2 days;
fetal scalp edema
overlap of cranial bones (Spalding’s sign)
Air bubbles in heart and great arteries( Robert’s sign)
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PREVENTION
• Regular ANC
• To screen out the risk patients to monitor carefully for the assessment of fetal well being and to terminate the pregnancy a the earliest evidence of fetal compromise
• Better education can directly influence the implementation of RH
• Several causes like chromo sol abnormality are not preventable even with modern medical knowledge
• Post-maturity can preventable
• IUFD secondary to RH is immunization can be preventable with correct admiration anti D
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Complications
• Problem associated with retained dead fetus
Infection
Maternal distress psychological manifestation, depression
Coagulopathy
Rhesus iso immunization in rhesus mother negative
DIC
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Management
Initial counseling• Conformation of diagnosis
• Breaking bad news
Maternal investigationBasic investigation Urine full report
Urine culture
Full blood count
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Conti
• Random blood sugar
• Coagulation screen
• Bleeding time
• Clotting time
• Serum fibrinogen level
• Prothrombin time
• Ultrasound
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Conti
Special investigation:
• Diabetic mellitus detection( fasting blood sugar)
• Syphilis screening ( VDRL) and conformation taste (TPHT)
• Thyroid function test ( TSH,T3,T4)
• Blood culture and anti bacterial sensitivity test
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Accomplishing the delivery of fetus
• Vaginal delivery should aimed unless there are specific indications for abdominal delivery
• Spontaneous labour could be awaited for up to two to four weeks or labour could be induced
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General discussion and future perspectives
• Example for Maternity ward • From April to September Number of attended was 598
• 410 was delivery ( NSVD & C/S)
• 77 was IUFD
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0 to 451%5 to 9
36%
above913%
GRAVIDA
0 to 4 5 to 9 above9
PARITY
0 to 4 5 to 9 above9
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24-2816%
29-3229%
33-369%
37-4023%
above 4023%
GA
24-28 29-32 33-3637-40 above 40
17-2448%25-32
39%
above 32
13%
AGE GROUP
17-24 25-32above 32
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THANK YOU
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