Fetal death

There is talk of fetal death when a fetus dies inside the uterus weighing more than 500 grams and / or with a gestational development greater than 22 weeks; That is to say, when it has reached such a development that, under optimum conditions, life outside the womb might have been possible. Most of fetal deaths occur in the third trimester of pregnancy , and talk of early fetal death when it occurs in the second quarter , or more accurately, when the weight is less than 1000 grams and / or development is under 28 Weeks. There is talk of abortion when the weight of the embryo or fetus is less than 500 grams and / or the development of the pregnancy is less than 22 weeks. Most abortions occur in the first trimester, and there is talk of late miscarriage when it occurs in the second trimester. 1 2

Symptoms

It is usually the lack of movement of the fetus.

Diagnosis

The dead fetus, when born is renamed stillbirth (born dead). Until the end of the twentieth century, the diagnosis of fetal death was only certain after birth, proving that, after complete separation of the mother, she did not breathe or show other evidence of life, such as heartbeat, pulsation Of the umbilical cord or movement of voluntary muscles. Today ultrasound allows the diagnosis of fetal death within the uterus (confirming the absence of heart activity) and also allows estimation of fetal size. 1

Causes

In a large majority of cases the causes remain unknown, even if multiple tests are performed on the mother and autopsy on stillbirth. The following have been identified as possible causes:

  • Bacterial pathogenicity .
  • Congenital disease , such as pulmonary hypoplasia.
  • Chromosomal Aberrations .
  • Intrauterine growth restriction .
  • Cholestasis .
  • Diabetes mellitus .
  • Pre-eclampsia .
  • Psychotropics (such as alcohol , nicotine , etc.).
  • Medications for which there is evidence of teratogenesis or toxicity.
  • Chronologically prolonged pregnancy.
  • Placenta abruptio .
  • Injury .
  • Radiation .
  • Rh incompatibility .
  • Celiac disease , which usually presents without digestive symptoms so that most cases are not recognized or diagnosed. 3 4
  • Accidents of the umbilical cord . 5
  • Uncontrolled or poorly controlled pregnancy.
  • Thrombophilia .
  • Illicit drugs.
  • Some voluntary abortions are counted in statistics such as fetal deaths. 6

Treatment

Intrauterine fetal death does not usually present an immediate risk for the woman. Therefore , since delivery usually begins spontaneously in two weeks, the woman may choose to wait, unless the woman finds the idea of ​​carrying a dead fetus traumatizing. Case, you can choose induction of labor . If more than two weeks pass , then there may be a risk of developing coagulation disorders , which is why induction of labor is recommended after this time . The delivery should be vaginal , leaving the cesarean section for complications .

Emotional approach

Most women who lose the product of your pregnancy feel misunderstood to the trivialization with which people in your environment social refer to what happened in phrases such as “have another”. For the mother who has lost a future child, that being was important and had an entity in itself that is not substitutable by another. Accompaniment is more advisable from the recognition of pain in the direction of acceptance as a process of loss and as a process of maturation and growth. In fact, as with the death of any loved one. For example, it is advisable for professionals to offer the couple the possibility of seeing the stillbirth so that a farewell can take place as a ritual that, by marking a before and after, allow the psychological grieving process to take place . 7

References

  1. ↑ Jump to:a b «Protocol: Antepartum Fetal Death» . Spanish Society of Obstetrics and Gynecology. June, 2008.
  2. Return to top↑ Intrauterine mortality , UN
  3. Volver arriba↑ Tersigni C, Castellani R, de Waure C, Fattorossi A, De Spirito M, Gasbarrini A, Scambia G, Di Simone N (2014). «Celiac disease and reproductive disorders: meta-analysis of epidemiologic associations and potential pathogenic mechanisms». Human Reproduction Update 20 (4): 582-593. doi:10.1093/humupd/dmu007. ISSN 1355-4786. PMID 24619876.
  4. Back to top↑ Saccone G, Berghella V, Sarno L, Maruotti GM, Cetin I, Greco L, Khashan AS, McCarthy F, Martinelli D, Fortunato F, Martinelli P (Oct 9, 2015). ‘Celiac disease and obstetric complications: a systematic review and metaanalysis’ . Am J Obstet Gynecol . Pii: S0002-9378 (15): 01194-1. doi : 10.1016 / j.ajog.2015.09.080 . PMID  26432464 .
  5. Back to top↑ Collins JH (MD). “Silent Risk: Issues About the Human Umbilical Cord” Retrieved on 2009-3-17
  6. Back to top↑ Bythell M, et al. (2008) The contribution of late termination of pregnancy to stillbirth rates in Northern England, 1994-2005. The British Journal of Obstetrics and Gynecology, 115 (5): 664-666
  7. Back to top↑ Santos Leal, Emilio ; Claramunt Armengau, M. Àngels ; Álvarez, Mónica ; Jové, Rosa (2009). The Empty Crib, The Painful Process of Losing a Pregnancy . The Sphere of Books. ISBN  9788497348508 .