Nursing management intense maternal monitoring mgso4 administration antihypertensive medications depending on the condition of mother and fetus, delivery might be indicated electronic fetal monitoring 1. Number 116 management of intrapartum fetal heart rate tracings. Who guidelines for the management of postpartum haemorrhage and retained placenta 1 background one of the millennium development goals set by the united nations in 2000 is to reduce maternal mortality by threequarters by 2015. Fialac a ipas and school of public health, unc at chapel hill, chapel hill, nc, usa b division of maternalfetal medicine, department of obstetrics and gynecology, university of california, irvine, usa c gynmed clinic, vienna, austria abstract the frequency of intrauterine fetal death iufd.
The information is designed to aid practitioners in making deci. Management and prognosis u eclampsia u expectant management of preeclampsia with severe features u management of hypertension in pregnant and postpartum women u uzanj, carbonnelm, piconneo, asmarr, ayoubijm. However, as 50% of pregnancies are unplanned, some may receive. For consistency of data collection and reporting, the reproductive care. Expectant management leading to successful vaginal. The rate of iufd was similar when sex of the baby was analyzed. Sadly, the death of a fetus may occur at any stage of a pregnancy, including during the labour process. Obstetricians should be familiar with the management of intrauterine fetal death as prompt and appropriate counselling will aid the couples grief process. Hazem almandeel intrauterine fetal demise definition. Clinical management of the induction of labor in intrauterine. If the mother goes home the possibility of passive movements. Here, we report a case of successful vaginal delivery after iufd by expectant management in a woman with an incarcerated uterus. Management of antepartum fetal death fetus miscarriage.
Mode of delivery vaginally vs caesarean section all potential complications may occur. This protocol is designed to assist the primary care provider in the clinical management of a variety of problems that occur during pregnancy. Who guidelines for the management of postpartum haemorrhage. There is variation in the thresholds for reporting stillbirth, both internationally and across canadian provinces. Many states use a fetal weight of 350 g or more to define a fetal demise. There is conflicting data regarding expectant management patients. Low dose vaginal misoprostol in the management of women. Management of gynecologic issues in women with breast cancer march 2012 2010. Care of the childbearing family with intrauterine fetal. Medical management is considered a safe and effectivetreat ment optionfor iufd.
The purpose of this guideline is to identify evidencebased options for women and their relatives who have a late intrauterine fetal death iufd. The loss of a fetus at any stage is a fetal demise. These include differences in either gestational age or fetal birth weight fretts 2005. Pdf impact of management protocols of intrauterine fetal death on. The diagnosis of sab can be emotionally overwhelming for patients. Options for management should be discussed which could include induction or expectant management. The content on the uptodate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Women consented for medical management with the combined protocol. The key factor in the pathophysiology is hemorrhage at the decidualplacental interface. The decision of method is influenced by service availability and obstetric history. Management of abnormal uterine bleeding associated with ovulatory dysfunction july 20 number 5 secondtrimester abortion june 20 2012.
The management of induction of labour in women with late iufd and a favourable cervix is often uncomplicated. Successful treatment was defined as delivery within 72 hours of the first misoprostol dose. Intrauterine fetal death secondary to rh isoimmunization can be prevented with correct administration of antid ig. When an intrauterine fetal death iufd is suspected this must be confirmed by two. If the first dose does not lead to effective contractions the subsequent dose could be doubled to 200.
Medical management of later intrauterine fetal death sa health. Metaanalysis showed expectant management and medical management have similar success and complication rates. M, rh isoimmunization, fetal congenital anomalies, umbilical cord accidents, prenatal infections, antepartum. Intrauterine fetal demise iufd is fetal death that occurs after 20 weeks gestation but before birth. If this is to be achieved, maternal deaths related to postpartum haemorrhage pph must be significantly reduced. The recent food and drug administrations approval of prostaglandin e2 pge2 vaginal suppositories provides the clinician with a technique for the immediate management of missed abortion and intrauterine fetal death iufd. Low dose vaginal misoprostol in the management of women with. This is a clinical guideline only, intended for use by perinatal health professionals all policies and procedures must be approved by the appropriate processes within each facility. Proportion of cesarean sections was near 6% 9163 corresponding to the incidence rate of 3. If the diagnosis is suspected in the community setting then the mother should be referred to hospital for confirmation.
Intrauterine fetal death in the 2nd trimester misoprostol. Review article misoprostol for intrauterine fetal death r. Medical management of abortion generally involves either a combination regimen of mifepristone and misoprostol or a misoprostolonly regimen. To standardise management of iufd and stillbirth based on an evidence based best practice approach.
We also describe a therapeutic strategy for the management of such cases. Management of intrauterine fetal death with prostaglandin. Intrauterine fetal death in the 2nd trimester also known as 2nd trimester missed abortion the full guidance on missed abortion has been published in the international journal of gynecology and obstetrics 2007. Management of late intrauterine fetal death and stillbirth guideline guideline number. These were compared with surgical management, expectant management, placebo, or different types of medical interventions were compared with each other. According to the centers for disease control and prevention cdc. Intervention and alternatives induction of labour in late.
In essence, you are free to copy and communicate the work in its current form for noncommercial purposes, as long as you attribute queensland clinical guidelines, queensland. Progestinonly systemic hormone therapy for menopausal hot flashes. Apr 30, 20 the management of induction of labour in women with late iufd and a favourable cervix is often uncomplicated. Stillbirth management and investigation summaryarea health services ahss are required to have a local policy for the management and investigation of stillbirth based upon the clinical practice guideline for perinatal mortality audit produced by. Medical management of late intrauterine death using a combination. The value of a work up in the setting of a stillbirth after 20 weeks is for counseling for future pregnancies, possibly to reduce the risk of subsequent stillbirths, to decrease morbidity, to facilitate emotional closure for the woman and her family, silver 2010 and. S1903, and is available as a readonly pdf file here. Iufd anaesthesia for nonobstetric surgery in pregnancy. According to the 2003 revision of the procedures for coding cause of fetal death under icd10, the national center for health statistics defines fetal death as death prior to the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy and which. How persistent is the impact of an aromatase inhibitor after 5 years of use. Clinical management of the induction of labor in intrauterine fetal. To assess the incidence and conditions associated with cesarean section in a cohort of pregnant women with intrauterine fetal.
Abruptio placentae and disseminated intravascular coagulopathy david r. A death that occurs prior to 20 weeks gestation is usually classified as a spontaneous abortion. Intrauterine fetal death iufd fetal death before onset of labour or fetus with no signs of life in utero after 20 weeks of gestation definition varies. The guidance is primarily intended as a resource for obstetricians and midwives but might also be useful for women and their partners, general practitioners and commissioners of. Stillbirth management and investigation summaryarea health services ahss are required to have a local policy for the management and investigation of stillbirth based upon the clinical practice guideline for perinatal mortality audit produced by the perinatal society of australia and new zealand. Investigation and management of late fetal intrauterine death. Medical management of abortion generally involves either a. Hall, mbchb, mmed, md abruptio placentae is an important cause of vaginal bleeding in the latter half of pregnancy. Several factors contribute to risk for iufd, although in many cases the exact etiology is unknown.
Shazly and others published iufd find, read and cite all the research you need on researchgate. Intervention and alternatives induction of labour in. Medical management of later intrauterine fetal death. To provide an investigation protocol to help health care. Purpose and scope to identify evidencebased options for women and their relatives who have a late intrauterine fetal death iufd. Iufd incidence was higher in multiparous women compared to primiparous women p value 0. M, rh isoimmunization, fetal congenital anomalies, umbilical cord accidents.
Thus, the management of iufd in women with an incarcerated uterus poses a therapeutic dilemma for obstetricians. Intrauterine fetal demise iufd, or stillbirth, is defined as a fetal death after 20 weeks gestation robinson, 2011 x robinson, 2011 robinson, g. The optimal method will be a scan performed by trained sonographers. Management of late intrauterine fetal death and stillbirth. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. Misoprostol is effectivein emptying the uterus owing to its ability to induce uterine contractionsand softenthe cervix. Impact of management protocols of intrauterine fetal death on perceived stress. Medical treatment for early fetal death less than 24. The risks of failed induction and uterine rupture increase when the cervix is unfavourable, particularly in women with previous caesarean delivery see the nice full guideline on induction of labour. Management of intrauterine fetal death with prostaglandin e2 vaginal suppositories. Pdf clinical management of the induction of labor in intrauterine. Mar, 2016 for statistical purposes, fetal losses are classified according to gestational age. When an intrauterine fetal death iufd is suspected this must be confirmed by twodimensional ultrasound at the earliest opportunity. This work is licensed under creative commons attributionnoncommercialnoderivatives 4.
In both high and lowresource settings, the use of medical methods of abortion have. Review article misoprostol for intrauterine fetal death. Aug 01, 1980 management of intrauterine fetal death with prostaglandin e2 vaginal suppositories. Late intrauterine fetal death and stillbirth greentop. Pree w severe features previously known as severe preeclampsia u preeclampsia with severe features is preeclampsia with signs of end organ damage, or if blood pressures escalate to 160110 u. Management of stillbirth guideline to be used in association with the. An infant delivered without signs of life after 20 weeks of gestation or weighing 500 gms when gestation age is not known march 9, 2015 3. Medical abortion care encompasses the management of various clinical conditions including spontaneous and induced abortion both viable and nonviable pregnancies, incomplete abortion and intrauterine fetal demise, as well as postabortion contraception. Intrauterine fetal demise iufd, or stillbirth, is the death of a fetus greater than 20 weeks gestation. The main interventions examined were vaginal, sublingual, oral and buccal misoprostol, mifepristone and vaginal gemeprost. Management of intrauterine death geneva foundation for. Clinical management guidelines for obstetriciangynecologists number 102, march 2009 replaces committee opinion number 383, october 2007 this practice bulletin was developed by the acog committee on practice bulletinsobstetrics with the assistance of ruth c.
This guideline provides details on how to identify a suspected case of lassa fever, clinical and laboratory diagnosis, clinical management of lassa fever cases including in special. Medical abortion care plays a crucial role in providing access to safe, effective and acceptable abortion care. Late intrauterine fetal death and stillbirth this is the first edition of this guideline. The risk and management of fetal death in twin pregnancies are discussed separately parvovirus b19 infection during pregnancy view in chinese that the risk of stillbirth or fetal loss was greater than 30 percent. Management of antepartum fetal death free download as powerpoint presentation.546 1346 653 806 1518 137 665 1111 583 1407 970 350 955 905 608 1190 120 997 523 267 1259 544 1409 844 471 738 681 635 1419 1142 1508 17 788 287 728 1299 1230 991 886 822 1367 703 1486