Intra uterine Foetal Death -Causes & prevention

Causes of Intrauterine Foetal death : Recurrent Viral infections including CMV/ parvovirus / rarely protozoan Toxo, any possibility of STI, 3) Koch’s, 4) Viral fever, 5)  Chr. Medical illness-anaemia in particular,  6) ingestion of drugs in the said preg period  Thrombophilic diseases, SLE & other connective Tissue diseases , under nutrition,  12)  Nonimmune Hydrops of known & unknown etilogy 13 ) paternal / maternal chromosomal disorders 14) Obesity    15) BV-Bact vaginosis 15)  Rh incompatibility-in cases she had faced one abortion which she does not confess to doctor  or received blood Tr earlier 15) uterine malformations/ Tumours 16) Rec. Cord Accidents=a very uncommon cause of rec IUFD.

 

8) Loss of any other neonate in family. 9) Substance abuse,

IUFD: The common Causes: There is a long list of diseases which can culminate in IUFD finally ending at stillbirths! In this cases, as I said ,the event of IUFD limited to males foetuses may be just coincidental. Quite often it becomes a herculean task on the part of obstetrician to identify the etiologic diagnosis of IUFD as in this case. Sadly, the etiologic diagnosis rests mainly on costly Lab tests and to make the problem worse in cases of Rec IUFD the cause may be different in each pregnancy.

 

 

 Relevance of History in this case who faced 4 IUFDs??- One may have to probe:-1) Preecalpsia , 2)  any possibility of STI, 3) Koch’s, 4) Viral fever, 5)  Chr. Medical illness-anaemia in particular,  6) ingestion of drugs in the said preg period 

8) Loss of any other neonate in family. 9) Substance abuse, 10) her professional hazards-Workplace Toxicity-if any.

 Can we have previous reports  ?? May  insist on previous documents / Medical  Records .If  prescriptions in previous preg are available for audit –: Papers (if available )-may be scrutinised with all patience: for H/O of Thr abortion, APH or H/O DM/ GDM/ HTN/ other severe illness. Any obvious structural malformations of first or second foetus?

Prescriptions & Lab reports of second IUFD: - - Papers also need to be audited.

 

 

What are the common & uncommon causes that we should remember while facing a case of Rec IUFD??

The  common causes( uterine & Extrauterine Factors)  are 1) Growth Retardation of unknown aetiology 2) Recurrent Viral infections including CMV/ parvovirus / rarely protozoan Toxo,  3) unknown  placental pathologies 4) Severe uncontrolled HTN 5) Uncontrolled DM 6) Severe anaemia 7)  Coagulation disorders –cong but mostly acquired. / APLA 8) Endocrine Disorders 9) HIV   10)  Chr Renal / Resp Tract Diseases  11) Seizure disorders, Org Heart Diseases, Thrombophilic diseases, SLE & other connective Tissue diseases , under nutrition,  12)  Nonimmune Hydrops of known & unknown etilogy 13 ) paternal / maternal chromosomal disorders 14) Obesity    15) BV-Bact vaginosis 15)  Rh incompatibility-in cases she had faced one abortion which she does not confess to doctor  or received blood Tr earlier 15) uterine malformations/ Tumours 16) Rec. Cord Accidents=a very uncommon cause of rec IUFD