INDEX

SR TOPIC NAME PAGE

NO. NO.
1 INTRODUCTION 1
2 ETIOLOGY(AYURVEDA) 2
3 DIAGNOSIS(AYURVEDA) 3
4 ETIOLOGY(MODERN) 3
5 DIAGNOSIS(MODERN) 5
6 INVESTIGATION 5
7 COMPLICATION 6
8 MANAGEMENT 6
9 REFERENCE 9
 INTRAUTERINE FETAL DEATH

(IUD)

Introduction:

 Literally, intrauterine fetal death (IUFD) embraces all fetal deaths weighing 500 g
or more occurring both during pregnancy (antepartum death) and during labor
(intrapartum).
 Thus for practical purpose, antepartum death occurring beyond the period of
viability is termed as intrauterine death.
 In Ayurveda IUD is related with the मृतगर्भ .

Intrauterine Fetal death with macerated

1
 According to Ayurveda

 ETIOLOGY

यस्याः पुनरतिमयत्रदोषोपचययद्वय िीक्ष्णोष्णयतिमयत्रसेवनयद्वय वयिमूत्रपुरीषवेगतवधयरणैवया

तवषमयश(स)नशयनस्थयनसम्पीडनयतिघयिैवया क्रोधशोकेर्ष्या ियत्रयसयतदतिवया सयहसैवया ऽपरै ाः
कमातिरन्ताःकुक्षेगािो तियिे ॥ च.स. शय.८/३०

मयनसयगन्तुतिमया िुरुपियपैाः प्रपीतडिाः ।

गिो व्ययपद्यिे कुक्षौ व्ययतधतिश्च प्रपीतडिाः|| सु. सं. तन ८/१३

गिेडतिदोषोपचययदपथ्येदैविोडतप वय ॥

मृिेडन्तरुदर्ं शीिं स्तब्धं ध्मयिं िृशव्यथम्। अ. ह्र. शय. २/२२

Considering all above causes together following factors may be held responsible for
intra-uterine death of fetus:

1) Accumulation of doshas or physical disorders- various maternal physical

disorders.
2) Abnormalities of diet- Nutritional factors.
3) Abnormalities of mode of life and trauma- Trauma causing partial placental
detachment resulting into revealed or concealed antepartum hemorrhage and
fetal death.
4) Psychological disorders.
5) Daiva or deeds of previous life- idiopathic.
6) Disorders of fetus- Congenital or acquired abnormalities or disorders of fetus.
7) Abnormal postures
8) Absence of diet.

2
 DIAGNOSIS

गिया स्पन्दनमयवीनयं प्रणयशाः श्ययवपयण्डु िय |

िवत्युच्छ्वयसपूतित्वं शूलं चयन्तमृािे तशशौ || सु .तन.८/१२

Sushruta has mentioned that besides cessation of fetal movements and labour pains.
There occurs blackish or whitish discolouration of skin, foul smell in expiration and pain.

According to modern
 ETIOLOGY
• Unknown in 25-35% of cases

• Known causes

S/No Causes %

1. Maternal 5-10

2. Foetal 25-40

3. Placental 20-35

4. Unexplained 15-35

MATERNAL CAUSES(RISK FACTORS)

• Obesity (>30kg/m 2 ): proven, modifiable, highest ranking

• Maternal (>35yrs)/paternal age

• Smoking/Alcohol/Drug abuse

• Infections (malaria, hepatitis, influenza, syphilis, Toxoplasma, sepsis)

3
• Medical ds –DM,HT,Thyroid Diseases

• Pre-existing diseases (HD, Anemia, Epilepsy)

• Autoimmune Disorders (APS, SLE)

• RH incompatibility

• Hyperpyrexia

• Thrombophilias

• Trauma

• Cholestasis of pregnancy

• Labour related (preterm, dystocia, uterine rupture)

FETAL CAUSES

• Multiple gestation

• IUGR

• Congenital anomalies

• Infections

• Hydrops (immune & non-immune)

• Birth Defects

PLACENTAL CAUSES

• Abruption

• Cord accidents

• Placental insufficiency

• Placenta previa

• TTTS

4
 • Chorioamnionitis

• Feto-maternal hemorrhage Iatrogenic- ECV, Drug overdoses

 DIAGNOSIS

Symptoms: Absence of foetal movements

Signs: Retrogression of the positive breast changes per abdomen

• Gradual retrogression of the height of the uterus

• Uterine tone is diminished

• Foetal movement are not felt during palpation

• Foetal heart sound is not audible

 INVESTIGATIONS

Sonography—Earliest diagnosis is possible with sonography. The evidences are:

 (a) Lack of all fetal motions (including cardiac) during a 10-minute period of
careful observation with a real-time sonar is a strong presumptive evidence of
fetal death and
 (b) Oligohydramnios and collapsed cranial bones are evident

Straight- X-ray abdomen (obsolete)

 Robert’s sign : Appearance of gas shadow (in 12 hours)

 Spalding sign: Collapse skull bones (usually appears 7 days after )
 Ball sign : Hyperflexion of the spine
 Helix sign : Gas in umbilical arteries
 Crowding of the ribs shadow

5
 Sonographic plate showing collapsed cranial bones—a late feature of IUD

 COMPLICATIONS
 Infection
 PPH
 Retained placenta
 Abruption
 DIC
 Shock, renal failure
 Sepsis
 Maternal death

 MANAGEMENT

• Depends on:

 Single or multiple gestation

 Gestation age at death
 Parents wish (varied response)

6
INDUCTION OF LABOUR:

Fetal death <28weeks

– Mifepristone 200 mg followed by Misoprostol 400 µg 4 - 6 hourly most effective
with shortest I-D interval

Fetal death >28weeks

– Cervical ripening (mechanical or chemical) followed by Oxytocin induction

EXPECTANT ATTITUDE (NON-INTERFERENCE):

The patient and her relatives are likely to be upset

psychologically but they should be assured of safety of non-interference. In about 80%
cases spontaneous expulsion occurs within 2 weeks of death. The patient may remain
at home with the advice to come to the hospital for delivery.

7
8
 REFERENCE BOOKS

 Sushrut Samhita – First Volume, Prof. Priyavat sharma

 Ashtanghridaya Sharirsthanam – Tr Srikantha Murthy Vol 1

 Textbook of Obstetrics (edition 9th) – Dr. D.C. Dutta

 Charak Samhita Vol 1 – Dayal Parmar

 https://www.slideshare.net/RajeshGajbhiye/iud-final