Intrauterine Fetal Demise Death - Causes, Symptoms, Risks

Intrauterine foetal demise, also known as IUFD or stillbirth, occurs when a foetus dies after the 20th week of pregnancy. The intrauterine death of the foetus can happen weeks or hours before labour.

Stillbirth and miscarriage are often used interchangeably. However, they are not the same. While stillbirth occurs after the 20th week of gestation, a miscarriage happens before the 20th week.

Three types of intrauterine foetal deaths are characterised by how far along the foetal death occurred in the pregnancy. The three types of IUFD include:

1. Early stillbirth: Foetus dies between 20 and 27 weeks of pregnancy
2. Late stillbirth: Foetus dies between 28 and 36 weeks of pregnancy
3. Term stillbirth: Foetus dies in or after 37 weeks of pregnancy 

Intrauterine foetal demise can happen to any pregnant woman. Therefore, pregnant women should be aware of the common symptoms of stillbirth. One thing mothers can notice is how much the child moves. Ideally, a woman should feel ten kicks within two hours. Other symptoms of IUFD may include:

1. Cramping and pain in the abdomen
2. Infection or high fever
3. Vaginal bleeding or spotting
4. Foetal kicking and movement stop suddenly
5. Foetal heartbeat is indetectable on an ultrasound
6. Overall discomfort

In several cases, it can be difficult to pinpoint the exact cause of stillbirth. However, the most common causes of intrauterine death include the following:

Placental Causes

1. Placental abruption: the placenta is separated from the inner uterine wall.
2. Placental dysfunction: underdeveloped or damaged placenta.
3. Umbilical cord problems: compression, twisting, knotting, etc.
4. Feto-maternal haemorrhage: blood transfer from the baby to the mother.

Foetal Causes

1. Congenital abnormalities or birth defects.
2. Foetal growth restrictions: when the baby does not grow at the expected rate during pregnancy.
3. Foetal infections: such as listeria or fifth disease contracted from the mother while in the womb.
4. Premature rupture of membranes.

Maternal Causes

1. Maternal infections: such as malaria, syphilis, listeriosis, HIV, etc.
2. Chronic maternal disorders: such as diabetes, thyroid, heart disease, obesity, etc.
3. Ruptured uterus: that can cause severe bleeding and suffocation.
4. Childbirth complications.
5. Preeclampsia: high blood pressure and swelling that happens late in pregnancy.
6. Blood clotting disorders: such as haemophilia.
7. Rh disease: the Rh factors in the mother’s and child’s blood do not match.
8. Trauma: such as a car crash.

Meanwhile, as the pregnancy progresses, the chances of unexplained foetal death also increase. Intrauterine foetal demise can happen to pregnant women of any age, ethnicity, or background. However, there is an increased risk of intrauterine death for women who:

1. Are 35 years or older
2. Smoke, drink alcohol, or use recreational drugs during pregnancy
3. Have a pregnancy lasting longer than 42 weeks
4. Have poor prenatal care
5. Are malnourished or obese
6. Had previous stillbirths or miscarriages
7. Have a pre-existing health condition, such as diabetes or high blood pressure
8. Have multiple pregnancies
9. Have intrahepatic cholestasis of pregnancy: a liver disorder that occurs in pregnant women

A woman with a high-risk pregnancy should regularly attend prenatal checkups with her healthcare provider to track the baby’s development.

Intrauterine foetal demise cannot always be prevented. However, sometimes, pregnant women can take some preventive measures as an early intervention to reduce the chances of pregnancy loss. Below mentioned are some of the preventive measures.

1. Attend all prenatal visits for routine monitoring and other screenings that help ensure the safety of the mother and the unborn child. 
2. Quit smoking, drinking alcohol, and using recreational drugs. 
3. Before getting pregnant, women should achieve a healthy weight.
4. Women who have been pregnant for 28 weeks or more should always sleep on their side and not on their back. Experts suspect that sleeping on the back can disrupt blood and oxygen flow to the foetus. 
5. Women should stay active during their pregnancy without overexerting themselves. Consult the doctor about the exercise and dietary options if already pregnant.
6. Avoid certain foods, such as some types of fish and cheese. The meat and poultry should be thoroughly cooked before eating. Mothers should trade less healthy food with more nutrient-rich options. 
7. Avoid stressful situations to decrease the chances of high blood pressure and undue anxiety. 
8. Immediately report to the doctor if the patient is experiencing any itching, vaginal bleeding, or stomach pain.
9. Perform a daily “kick count” and get familiar with foetal movement around 26 to 28 weeks of pregnancy. Any changes in the foetal movement should be reported. 
10. Get routine blood pressure and urine tests to check for diseases that may affect the baby’s health.

Usually, the first sign of foetal death will be the inactivity of the foetus. The doctor may use the following tests to confirm the diagnosis. 

1. Ultrasound: An ultrasound looks for signs of movement and life in the womb. 
2. Non-stress test: The test uses an electronic foetal monitor to check the foetus’s heartbeat. 
3. Biophysical profile: A combination of an ultrasound and non-stress test, the biophysical profile checks for vital signs of the foetus. 
4. Doppler velocimetry: The test uses sound waves to determine whether blood is moving through the foetus, uterus, and placenta. 

Finding the Cause of Intrauterine Death

Doctors encourage mothers to undergo an IUFD diagnosis as it helps understand the cause of intrauterine death. The doctor will perform one or more of the following tests to determine the cause:

1. Blood Tests: They help determine if the mother has preeclampsia, diabetes, or intrahepatic cholestasis during pregnancy. 
2. Tests for infection: The doctor takes a sample of the blood, urine, or cells from the vagina or cervix to test for infections. 
3. Examining the placenta, umbilical cord, and membranes: An abnormality in these tissues can prevent the foetus' oxygen, blood, and nutrient flow. 
4. Genetic tests: These involve taking a sample of the umbilical cord to diagnose genetic problems in the foetus, such as Down’s syndrome. 
5. Thyroid function tests: The test determines abnormalities with the mother’s thyroid gland. 
6. Autopsy: Only with the mother’s permission will an autopsy be performed by a skilled pathologist to determine the cause of foetal death. 

How to Prepare for Doctor’s Consultation?

When a woman suspects inactivity of the foetus and makes an appointment with her healthcare provider, there are some things she can do to prepare for the consultation:

1. Take a prior appointment
2. Note the symptoms
3. Enlist the medical conditions she has
4. Write down the questions for the doctor

After a stillbirth is confirmed, parents should ask the following questions to their doctors:

1. What was the cause of intrauterine death?
2. What can I do to prevent IUFD in future?
3. Do you recommend talking to a counsellor or psychiatrist?
4. How soon can I get pregnant again?
5. When should I return for the next appointment?
6. What can I expect in the next pregnancy?

Once intrauterine foetal demise is confirmed, the doctor will offer options for terminating the pregnancy and inducing labour. However, this does not need to happen right away.

Parents can take time to grieve their baby’s loss before pregnancy termination. If the mother has multiple pregnancies, she can wait until the other alive foetus has fully grown and is delivered safely. When the foetus passes away before the mother is in labour, there are four common treatment options:

1. Induced Labour: It is a medical treatment to start labour by either breaking the amniotic sac (bag of water around the foetus) or administering medication. Induced labour is considered the best option after IUFD. It should be performed immediately if the mother has:
   1. A serious infection
   2. Severe preeclampsia
   3. A broken amniotic sac
   4. A clotting disorder

The medicine to induce labour can be dispensed as a tablet or gel inserted into the vagina, a drip into a vein, a swallowed tablet, or a foley bulb (a mechanical balloon used to widen the cervix).

2. Natural Birth: Women can also decide to wait for labour to start naturally. While waiting for natural labour, mothers may require regular blood tests after 48 hours.One drawback of waiting for natural birth is that it increases the chances of the foetus deteriorating in the womb, which can affect the appearance of the foetus. The deterioration can make finding the cause of foetal death more difficult. 
3. Dilation and Evacuation (D&E): It is a surgical procedure to dilate the cervix and remove the foetal tissue from the uterus lining. Over the years, the need for surgical procedures has been reduced and replaced by medications to induce labour. 
4. Cesarean Section (C-Section): It is the surgical removal of the foetus through the mother’s belly. However, the procedure is not recommended because it is not as safe as induced labour or natural birth.  

Please Note: The mother can choose the treatment method to deliver a stillborn child. The doctor will inform the parents of the potential risk factors of each treatment method. Some common complications after the delivery can include infection, heavy bleeding, and uterine damage.

Pregnancy loss can be difficult, tempting mothers not to remove the foetus and be left alone with their emotions. However, the mother can experience several complications if the dead foetus is not removed from the uterus. These complications include:

1. Pain
2. Infection
3. Fever
4. Blood clots
5. Vomiting
6. Diarrhoea
7. Heavy bleeding
8. Damage to the cervix and uterus
9. Birthing complications in the future

When to Consult a Doctor?

Sometimes the symptoms of stillbirth can be similar to other medical conditions. Women should call their healthcare provider immediately when they experience the following:

1. The baby stops moving or moves less than usual
2. Severe pain or cramping in the back or abdomen
3. Bleeding or more than normal discharge from the vagina
4. Dizziness, changes to the vision, or long-lasting headaches
5. Painful swelling in the legs, feet, or hands
6. Fever or chills
7. Severe nausea or vomiting that affects eating and drinking
8. A feeling of something not being right

Unfortunately, no specific diet can eliminate the chances of intrauterine death. Some foods that women should generally avoid to increase the chances of a healthy pregnancy include:

1. Unpasteurised milk, cheese, and fruit juice
2. Raw or undercooked fish, meat, and eggs
3. Raw sprouts
4. Processed junk foods
5. Unpeeled or unwashed fruits and vegetables
6. Herbal teas and caffeinated drinks (limited intake)

Intrauterine death is an extremely devastating experience that can affect parents and other family members for years to come. Foetal demise after the 20th week of pregnancy can happen for several reasons, such as congenital abnormalities, maternal infections, childbirth complications, etc. However, about 1 out of 3 foetal deaths happen due to unexplained reasons.

A doctor unable to detect risk factors or monitor the foetus regularly can become responsible for intrauterine foetal death. Therefore, it is important to choose a doctor carefully after several considerations.

Remember, it is normal to experience stress and depression after a stillbirth. Get in touch with a mental health expert if you need help. The team at HexaHealth can help provide tips to prevent intrauterine death. Furthermore, we will connect you with qualified and experienced doctors who have a high success rate of delivering healthy babies. Book a consultation appointment with HexaHealth TODAY!