What are the symptoms of intrauterine fetal death?

If a pregnant woman suffers from physical problems or other injuries during pregnancy, the baby may die in the womb. This is what we call intrauterine fetal death. If a pregnant woman finds out that she is carrying an intrauterine fetal death, it is often a huge psychological blow to the pregnant woman, and it will also have a great impact on her body. So what kind of symptoms will occur in pregnant women if there is intrauterine fetal death?

What are the symptoms of stillbirth?

1. Fetal movement stops, fetal heart rate disappears, and the uterus stops expanding.

2. The fundus of the uterus and abdominal circumference shrink, and the feeling of breast distension disappears and shrinks.

3. If the fetus remains still for too long, it may cause the expectant mother to feel general fatigue, loss of appetite, abdominal distension, postpartum hemorrhage or disseminated intravascular coagulation. About 80% of fetal death are delivered naturally within 2-3 weeks. If the fetus is still not expelled 3 weeks after death, the degenerative placental tissue releases thromboplastin into the maternal blood circulation, activating coagulation factors in the blood vessels and easily causing disseminated intravascular coagulation (DIC). If the fetus dies in utero for more than 4 weeks, the chance of DIC increases, which can cause severe bleeding during delivery.

Causes of stillbirth

1. Placental and umbilical cord factors: such as placenta previa, placental abruption, vasa previa, acute chorioamnionitis, velamentous adhesion of the umbilical cord, umbilical cord knotting, umbilical cord prolapse, umbilical cord around the neck, etc., massive placental bleeding or umbilical cord abnormalities, leading to fetal hypoxia.

2. Fetal factors: such as severe fetal malformation, fetal growth restriction, twin-twin transfusion syndrome, fetal infection, serious genetic diseases, maternal-fetal blood type incompatibility, etc.

3. Factors affecting pregnant women: severe pregnancy complications, such as gestational hypertension, antiphospholipid antibody syndrome, diabetes, cardiovascular disease, shock caused by various reasons, etc. Local factors in the uterus, such as excessive uterine tension or strong contraction, uterine malformation, uterine rupture, etc., can cause local ischemia and affect the placenta and fetus.

Treatment of stillbirth

1. Complete medical history: Once fetal death is confirmed, the medical history should be completed in detail, including family history, past history, and current pregnancy situation. Induce labor as early as possible, recommend fetal autopsy and pathological examination of the placenta, umbilical cord, fetal membranes and chromosome examination, try to find the cause of stillbirth, and provide postpartum counseling. Even after a comprehensive and systematic evaluation, the cause of at least 1/4 of the pathologies remains unknown.

For low-risk pregnant women with unexplained pregnancy, the recurrence rate of stillbirth before 37 weeks is 7.8‰-10.5‰; the recurrence rate after 37 weeks is only 1.8‰. For high-risk pregnant women with comorbidities or complications, the recurrence rate of stillbirth increases significantly.

2. Coagulation function test: Expectant mothers whose fetus has not been expelled within 4 weeks of fetal death should undergo a coagulation function test. If fibrinogen is <1.5g/L and platelets are <100*109/L, heparin can be used for treatment. The dosage is 0.5mg/kg each time, once every 6 hours. Generally, after 24-48 hours of medication, fibrinogen and platelets can be restored to effective hemostatic levels, and then induced labor can be performed, and fresh blood should be prepared. Pay attention to preventing postpartum hemorrhage and infection.

3. Induction of labor: There are many methods of induction of labor, including misoprostol, injection of ethametidine and high-concentration oxytocin through the amniotic cavity. The choice should be made based on the gestational age and the presence or absence of uterine scars, combined with the wishes of the expectant mother, with informed consent. The principle is to give birth vaginally as much as possible, and cesarean section is only used in special circumstances. For women without a history of uterine surgery before 28 weeks of pregnancy, vaginal placement of misoprostol is a relatively safe and effective way to induce labor. Application method: 200-400 μg is placed vaginally every 4-12 hours. For those with a history of uterine surgery before 28 weeks of pregnancy, an individualized induction plan should be developed. Induction of labor after 28 weeks of gestation should be based on obstetric guidelines.