Intrauterine Fetal Demise (IUFD) refers to the death of a baby in the womb after 20 weeks of gestation. This term is distinct from a miscarriage, which describes a pregnancy loss before the 20th week. IUFD, also known as stillbirth, involves the delivery of a fetus that shows no signs of life.
Understanding Intrauterine Fetal Demise
The causes of IUFD are varied, and in 25-50% of cases, no clear cause is identified. Placental issues are a common factor, accounting for 10-20% of cases. These include placental abruption, where the placenta prematurely separates from the uterine wall, or placental insufficiency, which restricts the flow of oxygen and nutrients to the fetus. Umbilical cord complications, such as compression, knots, or twisting, can also disrupt blood flow and lead to IUFD.
Maternal health conditions contribute to IUFD risk. Preeclampsia, a pregnancy complication characterized by high blood pressure, and uncontrolled diabetes can both reduce blood flow to the placenta. Infections, such as cytomegalovirus (CMV), urinary tract infections, genital infections, and toxoplasmosis, can cross the placenta and harm the fetus. Chronic hypertension, autoimmune diseases, or thrombophilias, which increase the risk of blood clots, also elevate the risk.
Fetal factors, including genetic conditions and structural abnormalities, account for approximately 25% of stillbirths. These can range from chromosomal abnormalities to birth defects that are incompatible with life. Other risk factors include advanced maternal age, obesity, and carrying multiple fetuses.
Diagnosing and Confirming IUFD
Recognizing potential signs of IUFD often begins with changes noticed by the pregnant person. A primary indicator is the absence of fetal movement, which prompts immediate medical evaluation. Other symptoms might include a sudden loss of pregnancy symptoms, vaginal bleeding, spotting, or abdominal cramping.
Upon presentation with these concerns, healthcare professionals conduct a medical evaluation. The definitive diagnostic tool for confirming IUFD is an ultrasound. During an ultrasound, the absence of fetal cardiac activity confirms the demise.
Beyond the lack of a heartbeat, an ultrasound may reveal other findings that support the diagnosis. These can include the overlapping of skull bones, known as Spalding sign, or gross distortion of fetal anatomy, indicating maceration. Soft tissue edema and echogenic amniotic fluid due to fetal demise fragments can also be observed. A second ultrasound scan or opinion may be obtained to confirm these findings.
Management and Delivery Options
Following an IUFD diagnosis, healthcare providers discuss various management and delivery options with the parents. One approach is expectant management, where the pregnant person waits for labor to begin naturally. This can take up to three weeks after the fetal death. Medical monitoring is still necessary to watch for potential complications such as coagulopathy, a blood clotting disorder.
Another common option is the induction of labor, achieved using medications. Misoprostol, a prostaglandin medication, is frequently used to induce labor, as it is effective in achieving vaginal birth within 24 hours. It can be administered vaginally or orally, with vaginal administration often preferred. Mifepristone may also be used in combination with misoprostol to shorten the induction-to-delivery interval.
Cesarean section is not the preferred method for delivery following IUFD unless specific medical reasons pose a risk to maternal health, such as severe preeclampsia, placental abruption, or uterine rupture. The choice of delivery method is a personal decision, and healthcare providers work with families to consider both medical safety and emotional well-being. The discussion includes potential risks associated with each option, such as infection or hemorrhage, to ensure informed decision-making.
Coping and Support
Experiencing IUFD is a significant loss, and parents and families often navigate a grief process. This grief can manifest in various ways, and there is no single or correct way to cope with the loss of a baby. The emotional impact can be significant, extending to feelings of sadness, anger, guilt, and isolation.
Seeking support can be an important part of the healing journey. Professional counseling, either individual or couples therapy, can provide a safe space to process emotions and develop coping strategies. Support groups, both in-person and online, offer a community where parents can connect with others who have experienced similar losses, reducing feelings of isolation and fostering mutual understanding.
Resources are available to help navigate the complexities of grief. Organizations dedicated to stillbirth and infant loss provide information, peer support, and guidance on memorializing the baby. Grieving is a process that takes time, and allowing oneself to feel and express emotions, while also seeking professional help when needed, supports long-term emotional well-being.