Medical Archive

Introduction

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Definition of fetal mortality

Fetal death at >20 weeks that occurs prior to expulsion from the mother.

Fetal heart tones are not heard by Doppler
Absence of fetal cardiac activity on ultrasound (confirm)

Causes of fetal death

Cause	Percent	Examples
Obstetrical complications	29	Abruption, multifetal gestation, ruptured membranes at 20–24 weeks
Placental abnormalities	24	Uteroplacental insuwiciency, maternal vascular disorders
Fetal malformations	14	Major structural abnormalities and/or genetic abnormalities
Infection	13	Involving the fetus or placenta
Umbilical cord abnormalities	10	Prolapse, stricture, thrombosis
Hypertensive disorders	9	Preeclampsia, chronic hypertension
Medical complications	8	Diabetes, antiphospholipid antibody syndrome
Undetermined	24	Not applicable

Risk factors

Nulliparity, obesity, hypertension, and diabetes mellitus.

Evaluation of the stillborn fetus

Clinical examination

Laboratory evaluation

• Maternal evaluation
  • Kleihauer-Betke test
    • For fetomaternal hemorrhage
  • Antiphospholipid antibodies
  • Thrombophilia evaluation can be considered

Autopsy

• Fetal karyotype +/- other genetic studies
• Gross and microscopic placental evaluation
  • Signs of abruption (eg, clotted blood) or infection
• The membranes and umbilical cord
  • eg, nuchal cords, true knots

Psychological aspects

Prior stillbirth

TABLE 35-3 Management of subsequent pregnancy after stillbirth

Changes in stillbirth rates