Review Note

Last Update: 03/27/2025 09:42 PM

Current Deck: ACG Part 2::Obstetrics

New Card (Unpublished)

Currently Published Content

Front

Back

No published tags.

Pending Suggestions

Field Change Suggestions:

Front

Commit #309769

SS_OB 1.34 Discuss the anaesthetic management of problems that may arise with labour and delivery, including the following situations:
- fetal death in utero

Back

Commit #309769

Fetal Death in Utero (IUFD)

Incidence: 5-7/1000 pregnancies.

Approx. 50% occur prior to 28 weeks, 20% at or near term.

Causes of Late IUFD

Antepartum: congenital malformation, infection, APH, PET, maternal diabetes.

Intrapartum: placental abruption, severe maternal or fetal infection, cord prolapse, uterine rupture, idiopathic hypoxia-acidosis.

Obstetric Management

Care should occur in a quiet room isolated from normal labor ward activity, with 1:1 midwifery care.

Expectant management: spontaneous labor occurs normally within 3 weeks of death; however, this puts the mother at risk of developing sepsis and coagulopathy.

Induction of labor (IOL): preferred due to the possibility of developing coagulopathies.

LSCS: may occasionally occur depending on circumstances.

Anaesthetic Management

Anaesthetic assessment and evaluation should be conducted.

Investigations:
- Coagulation studies (investigate for coagulopathy).
- Full blood examination (FBE), urea and electrolytes (UEC), C-reactive protein (CRP).

Discuss analgesia options:
- This is a very distressing event for the woman and her family; provision of good pain relief is crucial.
- Entonox.
- IM or IV opioids (via PCA).
- Epidural: if no evidence of sepsis or coagulopathy.

Reference

Basildon and Thurrock IUFD Guidelines.

Oxford Handbook of Anaesthesia.

4o mini