Saturday, February 4, 2017

Intrauterine Fetal Demise (IUFD)

Intrauterine fetal demise (IUFD) refers to fetal death prior to delivery and may occur at any time prior to delivery.

The timing of the IUFD is important for the physician to appreciate both for consoling and advising the parents and for anticipating the likelihood of successful neonatal resuscitation after delivery. The appearance of the fetus at delivery can be used to estimate whether the fetal demise occurred
antepartum or peripartum.
The process of tissue degeneration (maceration) is due to the effects of autolytic enzymes on the fetus in a sterile environment.

  • Lysis occurs at the epidermal- dermal junction with subtle changes in the gross appearance of the fetus.
  • Skin desquamation and positive Nikolsky sign can be seen as early as 6 hours.
  • Further changes involve desquamation and bullae formation of the face, back, or abdomen by 12 hours, at least 5% of the body surface at 18 hours, and generalize skin desquamation at 24 hours. 
  • Sloughing of skin from a large area indicates a prolonged interval between death and delivery. 
  • Mummification occurs after approximately 2 weeks.
Management: Anticipate and prepare for a normal delivery unless information regarding the condition of the fetus is known. Obtain obstetric consultation immediately as for any emergency

delivery. The presence of fetal heart tracings during delivery or a normal appearing infant without significant skin changes indicates peripartum demise and neonatal resuscitation should be attempted . If signs of maceration are present, no resuscitative efforts are indicated.

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