CASE REPORT

Intra Uterine Fetal Death

Supervisor
dr. Mutawakil J Paransa, Sp.OG Creator
Rashif Yali Anbia
(120001115039)
Introduction
Perinatal death estimated 7.6 million
each year

57% of them are IUFD

98% in developing
countries
What is IUFD ?

Mortality of the fetus with a birth weight of 500

grams or more. (WHO)
Risk Factor

- Age  over 35 years have risk 40-50% higher risk

than women aged 20-29 years.

- Frequency  Primipara > multipara

- low socioeconomi and low education

Classifications
- Group I: Mortality before the pregnancy reaches 20
weeks of full (Early fetal death)
- Group II : Mortality after the pregnancy 20-28 weeks
(Intermediate fetal death)
- Group III: Mortality after the pregnancy over 28 weeks
(Late fetal death)
- Group IV: Mortality can not be classified in three
categories above.
Diagnosis

Anamnesis
- Patients admitted to no longer feel fetal movement
- Abdomen doesn’t getting bigger, maybe even shrinking
- Abdomen often become hard and feel the pain as if to give birth
- Weight loss
Physical Examination
- Inspection: High fundus reduced or lower than the age of the
pregnancy. Look no fetal movement can usually be seen
in women who are thin.
- Palpation: Uterus tone decreases, uterus palpable flaccid. No
palpable fetal movement
- Auscultation: Not hearing the fetal heart rate after 10-12 weeks
gestation in ultrasonic Doppler examination is strong
evidence of fetal death.
Examination Suggest

USG : No fetal heartrate

No Fetal movement
Management
Active Wait SC
Till 2
weeks
Induction if doesn’t spontaneous,
decreased platelets,
w/ oxy cervix immature, taking
misoprostol.
Patient Identify
Name : Ny. YP
Age : 21 years
Marital Status : Married
Religion : Islam
Graduate from : Senior High
Occupation : Housewife
Address : Tegallaya RT 003/004
Kel. Cipanengah Kec. Lembusitu Kota Sukabumi (43168)
Date of admission : 19 October 2015
Husband identify
Name : Mr. RA
Age : 22 years
Marital Status : Married
Religion : Islam
Graduate from : Senior High
Occupation : Chef asistent
Address : Tegallaya RT 003/004
Kel. Cipanengah Kec. Lembusitu Kota Sukabumi (43168)
Chief Complaint
Woman G1P0A0 complaint post USG with no
fetal heart rate
History of Present Illness

Woman G1P0A0 came to the hospital emergency room

Syamsudin. From the clinic one day ago because the USG
showed was the absence of movement and the baby's
heartbeat.
History of Present Illness

Gestation who recognized her now approximately 8

months. The last patient control to the clinic at 7
months gestation and admitted that the fetus is still
good.
Another Complaint

Abdominal pain at lower regio

History of Past Illness

- No history of Diabetics
- No history of hypertension
- No history of asthma
- no history of allergy
Menstrual History

- Menarche : at 14 years old

- Duration : 6-7 days
Physical Examination

General condition : Looks moderate ill

Level of consciousness : Compos mentis
Vital signs
Blood pressure : 120/ 80 mmHg
Heart rate : 84x/minute
Respiration rate : 20 x/minute
Temperature : 36,4° C
Eyes : Cn +/+ ; Sl +/+
Obstetric Examination
Inspection : Striae gravidarum, abdomen concave.
Palpation :
Leopold 1 : Soft and not fully-rounded part was palpated (buttock)
Leopold 2 : Right : Wide and flat part was palpated (back)
Left : Small part (extrimitas)
Leopold 3 : Round and harder part was palpated (head)
Leopold 4 : lowest part has not enter the pelvic inlet (convergent)
Uterine Contraction : (-)
Fetal Heart Rate : (-)
Examination Suggestion

◦USG
Diagnosis
Woman G1P0A0 gravida 24-25 weeks with IUFD
Prognosis
Mother : Dubia ad Bonam
Fetal : ad malam
Observation
Date S O A P
19/10/2015 KU/K: CM G1P0A0 -Observation VS
19.00 St.Geeneralis: Gravida 24-25 -Infus with RL
T: 120/70 mmhg weeks with IUFD
N : 84 x/mnt
R : 20 x/mnt
S : 36,2 °C
Stat.Obstet :
-Abdomen concaf, FU 23
cm, head presentation
DJJ : (-) HIS (-)
Observation
Date S O A P
19/10/2015 KU/K: CM G1P0A0 -Observation VS
21.30 St.Geeneralis: Gravida 24-25 -Infus with RL
T: 110/70 mmhg weeks with IUFD
N : 82 x/mnt
R : 18 x/mnt
S : 37,2 °C
Stat.Obstet :
-abdomen concave, FU 23
cm, head presentation
DJJ : (-) HIS (-)
Observation
Date S O A P
20/10/2015 KU/K: CM G1P0A0 -Observation VS
08.00 St.Geeneralis: Gravida 24-25 -Infus with RL
T: 100/60 mmhg weeks with IUFD
N : 82 x/mnt
R : 20 x/mnt
S : 37,2 °C
Stat.Obstet :
-abdomen concaf, FU 23
cm, head presentation
DJJ : (-) HIS (-)
Observation
Date S O A P
20/10/2015 KU/K: CM G1P0A0 -Observation VS
09.30 St.Geeneralis: Gravida 24-25 -Infus with RL
T: 110/70 mmhg weeks with IUFD -Taking Cytostol
N : 84 x/mnt 100mg
R : 18 x/mnt -Taking
S : 37,2 °C Misoprostol
Stat.Obstet : 100mg, ½ Tab
-abdomen concave, FU 23 -Opened 2cm
cm, Head presentation -Planning birth
DJJ : (-) HIS (-) with pervaginam.
Observation

Boy babies born vaginally at 21 October 2015, 13:40

it doesn’t live.
Whereas the placenta was born at 13:44 in full, with
Weight 550 grams, and Lenght: 39cm.
CASE ANALYSIS

How to diagnosis Intra uterine fetal death (IUFD) ?

What the management was right in this case ?
Diagnosis

Theory Case
Anamnesis Anamnesis
- Patients admitted to no longer feel - Abdominal pain at lower regio
fetal movement
- Abdomen doesn’t getting bigger,
maybe even shrinking
- Abdomen often become hard and
feel the pain as if to give birth
- Weight loss
Diagnosis

Theory Case
USG : No fetal heartrate One day ago because the USG showed
No Fetal movement was the absence of movement and the
baby's heartbeat.
Management
Theory Case

- Active with Inducton - Active by taking Misoprostol 100mg, ½ Tab

- Wait until 2 weeks, if doesn’t spontaneous, - Pervaginam
decreased platelets, cervix immature, taking
misoprostol.
- SC
Thank You…