Obstetrics Book

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Late Pregnancy LossAka: Second Trimester Pregnancy Loss, Stillborn, Intrauterine Fetal Demise, IUFD

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  1. Epidemiology: Incidence
    1. Pregnancy loss at 13 to 19 weeks gestation: 1-5%
    2. Pregnancy loss after 20 weeks gestation: 0.3%
  2. Definitions
    1. Miscarriage
      1. Fetal loss before 20 weeks gestational age
    2. Stillborn
      1. Fetal loss after 20 weeks gestational age
  3. Causes: Late Pregnancy Loss
    1. Fetal chromosomal and congenital anomalies (12-24% of cases)
      1. Trisomy 13, 18, 21
      2. Neural Tube Defects
    2. Uterine anomalies (e.g. incompetent cervix, Uterine Fibroids, amniotic band syndrome)
    3. Maternal infection (10-25% of cases)
      1. Bacterial Vaginosis
        1. Hay (2004) Curr Opin Infect Dis 17:41
      2. Assorted systemic and genitourinary infections have been linked to pregnancy loss
        1. Goldenberg (2003) Am J Obstet Gynecol 189:861
    4. Placental disorders (e.g. Placenta Previa or Abruptio Placentae)
    5. Severe acute or chronic condition in the mother (e.g. Diabetes Mellitus, PIH)
    6. Hypercoagulable state
      1. Antiphospholipid Antibody Syndrome
        1. Lupus Anticoagulant
        2. Anticardiolipin Antibody
      2. Systemic Lupus Erythematosus
      3. Factor V Leiden
      4. Protein S Deficiency
      5. Prothrombin G20210A
    7. Preterm Premature Rupture of Membranes
    8. Toxin exposure (Teratogen Exposure, Drug Abuse, Tobacco abuse)
  4. Examination
    1. Placental pathology
    2. Autopsy of stillborn baby
      1. Fetal Foot Measurement
        1. Most accurate method for dating gestational age
      2. Evaluate for fetal dysmorphology
  5. Imaging: Fetal Ultrasound
    1. Two examiners should independently confirm IUFD
  6. Labs: Modify based on Events leading up to Pregnancy Loss
    1. Maternal
      1. Endocrine testing
        1. Serum Glucose or Hemoglobin A1C
        2. Thyroid Function Tests (e.g. TSH)
        3. Liver Function Tests
      2. Hypercoagulable state evaluation
        1. Antinuclear Antibody (ANA)
        2. Partial Thromboplastin Time (PTT)
        3. Anticardiolipin Antibody and Lupus Anticoagulant
        4. Factor V Leiden
        5. Activated Protein C resistance and Protein S Deficiency
        6. Prothrombin G20210A Mutation
      3. Other labs to consider
        1. Maternal Urine Tox Screen
        2. Kleihauer-Betke
        3. Syphilis Serology (RPR, VDRL)
    2. Fetus
      1. Fetal Chromosomal analysis (karyotype analysis)
      2. Obtain cord blood or cardiac puncture
        1. Use Green top tube (Heparinized)
      3. Obtain skin biopsy
        1. Store in normal saline
    3. References
      1. Incerpi (1998) Am J Obstet Gynecol 178:1121
  7. Management
    1. Induction for delivery of fetus
    2. Grief counseling for family
  8. Resources
    1. Healing Hearts
      1. http://www.babylosskit.com/resource.html
    2. Miscarriage Association
      1. http://www.miscarriageassociation.org.uk/ma2006/index.htm
  9. References
    1. Michels (2007) Am Fam Physician 76:1341
    2. Goldenberg (2004) J Matern Fetal Neonatal Med 16:79

Stillborn (C0749019)

ConceptsPathologic Function (T046)
EnglishStillborn
SourcesOMIM
Derived from the NIH UMLS (Unified Medical Language System)



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