Intrauterine Fetal Death in Preeclampsia

A 22-year-old Gravida 2, Para 1--with a history of one previous cesarean section--presented to the outpatient department with two months of amenorrhea for her first antenatal visit. A dating scan confirmed an intrauterine pregnancy. 

Regular antenatal visits were conducted, and an NT scan revealed a nuchal translucency of 1.3 mm. At 18 weeks of gestation, a TIFFA scan and Doppler showed a live fetus with placental clotting and positive screening for PIH (bilateral umbilical artery with an early diastolic notch and high resistance flow). 

Aspirin 75 mg daily was prescribed, with instructions for follow-up. However, the patient did not return until six weeks later.

At this visit, she reported decreased fetal movement at seven months of amenorrhea. Examination showed pallor, blood pressure of 130/100 mmHg, and an absent fetal heart sound. Investigations revealed anemia (Hb: 8.5 g%), normal coagulation profile, and reduced amniotic fluid (1-2 cm). 

An ultrasound confirmed intrauterine fetal demise with cranial bone overlapping (Spalding sign) and minimal pericardial effusion. Gestational age was estimated at 22 weeks by ultrasound, while her dating scan indicated 24 weeks +2 days.

The patient was counseled and admitted for management. After anemia correction with one unit of PRBC, labor was induced using Foley's catheter, followed by mifepristone and oxytocin. 

A macerated female fetus weighing 350 g was delivered. Antibiotics were administered.

Stillbirth causes include maternal, fetal, and obstetric factors. Proper antenatal care, screening for preeclampsia and gestational diabetes, and early intervention can reduce intrauterine fetal death (IUFD). Comprehensive workups, including history, lab evaluations, fetal autopsy, and placental examination, are essential for understanding causes and preventing recurrence.

Source: D R, Mayuri L. Intrauterine fetal demise in pre-eclampsia: A case report. Int J Clin Obstet Gynaecol. 2024;8(6):118-120.