(Fetal death)
A stillbirth is the birth of a dead fetus in a gestational age> 20 weeks. To determine the cause, maternal and fetal tests are performed. The treatment is the same as the routine care after a live birth.
A stillbirth is the birth of a dead fetus in a gestational age> 20 weeks. To determine the cause, maternal and fetal tests are performed. The treatment is the same as the routine care after a live birth. Etiology The fetal death during late pregnancy may maternal, placental or fetal anatomic or genetic causes (see Table: Common causes of stillbirths). In general, the most common reason Premature separation of placenta Common causes of stillbirths type examples Maternal diabetes mellitus, if not set Hereditary thrombotic disorders pre-eclampsia or eclampsia sepsis substance abuse trauma Placental Premature separation of placenta chorioamnionitis fetomaternal circulation Fetofetale transfusion umbilical cord accidents (eg prolapse, nodes) Insufficient uteroplacental perfusion Vasa previa Fetal chromosomal abnormalities alloimmunothrombocytopenia Fetal alloimmune or hereditary anemia infection Severe congenital malformation (eg. As the heart or the brain) non immunogenic fetal hydrops single gene disorders complications when a fetus dies in late pregnancy or in forward-close and remain for weeks in the uterus, can develop disseminated intravascular coagulation (DIC). Diagnostics include studies on the causal explanation: Fetal karyotyping and autopsy Maternal blood directly (for the detection of anemia and leukocytosis) Kleihauer-Betke test screening for hereditary and acquired thrombotic diseases, including tests for prothrombin G20210A mutation, protein C and – S levels, Activated protein C resistance (if positive test for factor V Leiden), antithrombin, fasting homocysteine ??levels and antiphospholipid antibodies (lupus anticoagulant, anticardiolipin [IgG and IgM] anti-?2- glycoprotein I [IgG and IgM]) TORCH test (toxoplasmosis [with IgG and IgM], other pathogens [eg. as human parvovirus B19, varicella zoster viruses], rubella, cytomegalovirus, herpes simplex) Rapid plasma protein test (rapid plasma reagin, RPR) TSH (and if Patholog ica free T4) diabetes test (HbA1C) Examination of placenta Often, however, can not be found the cause. Treatment emptying the uterus as needed routine care after childbirth Psychological support an evacuation of the uterus may be spontaneously occurred. If this is not the case, an emptying of medicinal products (eg. B. oxytocin) or by surgical intervention (e.g., should. dilatation and extraction [D & E], before the abortion an osmotic dilator for cervical ripening, with or without misoprostol applied should be ). The postpartum procedure corresponds to that of a live birth. developed a disseminated intravascular coagulation (DIC), the coagulopathy should be treated immediately and aggressively by exchange of blood or blood products as required. If the pregnancy product is discharged, curettage may be required to remove any remaining placenta residues. Residues remain more when it comes in very early pregnancy to a stillbirth. Usually the parents react with deep sadness and need emotional support, sometimes even a psychotherapeutic treatment. Risks of future pregnancies, which are related to the assumed cause, should be discussed with the patients. Summary A placental abruption is the most common cause of stillbirth, but there are numerous other causes (maternal, fetal or placental). Disseminated intravascular coagulation may develop secondary. Tests to determine the cause should be carried out; however, the cause often can not be determined. The uterus should be emptied using drugs or by dilation and extraction and psychological support are provided to parents.