OUR LADY OF FATIMA UNIVERSITY

120 MacArthur Hwy, Valenzuela, 1440, Metro Manila

OUR LADY OF FATIMA UNIVERSITY

VALENZUELA CITY - MAIN CAMPUS
COLLEGE OF NURSING

A REPORT ABOUT
INTRAUTERINE FETAL DEATH (IUFD)

SUBMITTED BY:
ANGELICA D. FUENTES

COURSE & SECTION:

BSN 2-Y2-B10
Group C

SUMMITED TO:
MS. EVELYN SARACHO

MARCH 2025
 OUR LADY OF FATIMA UNIVERSITY
120 MacArthur Hwy, Valenzuela, 1440, Metro Manila

INTRAUTERINE FETAL DEATH

Intrauterine fetal demise (also called IUFD or stillbirth) occurs when a child dies in the womb at or
after the 20th week of pregnancy. It refers to situations in which the fetus is no longer alive, but the uterus
has not yet started to expel its contents and the cervical os remains closed. The mother may go into labor
on her own within a few weeks, or labor may be induced.

CAUSES

Intrauterine fetal death (IUFD) can result from a variety of causes, some of which are known, while
others may be unexplained. The most common causes of IUFD includes:

1. Placental Problems
• Placental abruption: When the placenta separates from the uterus before delivery, it can reduce
the oxygen and nutrients supplied to the fetus, leading to death.
• Placenta previa: A condition where the placenta covers the cervix, which can result in bleeding
and interfere with the fetus’s blood supply.
• Placental insufficiency: When the placenta doesn’t function properly, it may not provide enough
nutrients and oxygen to the fetus, leading to fetal death.
2. Infections
• Bacterial infections: Infections such as Group B streptococcus, listeriosis, or chorioamnionitis
(infection of the membranes around the fetus) can lead to fetal death.
• Viral infections: Infections like cytomegalovirus (CMV), rubella, or parvovirus B19 can also
result in IUFD.
3. Maternal Health Conditions
• Pre-eclampsia/eclampsia: Pregnancy-related hypertension can cause problems with the placenta,
leading to fetal distress or death.
• Diabetes: Poorly controlled maternal diabetes can increase the risk of stillbirth.
• Chronic illnesses: Conditions like kidney disease, heart disease, or autoimmune disorders (e.g.,
lupus) can increase the risk of fetal death.
• Blood clotting disorders: Conditions like antiphospholipid syndrome can increase the risk of
clotting in the placenta.
4. Fetal Abnormalities
• Chromosomal abnormalities: Genetic conditions like Down syndrome, trisomy 18, or trisomy
13 can lead to stillbirth.
• Congenital anomalies: Severe birth defects, such as heart defects or neural tube defects, can
result in fetal death.
 OUR LADY OF FATIMA UNIVERSITY
120 MacArthur Hwy, Valenzuela, 1440, Metro Manila

5. Umbilical Cord Complications

• Cord prolapses: When the umbilical cord slips through the cervix before the baby, it can be
compressed, cutting off the oxygen supply to the fetus.
• Cord accidents: Such as cord knots, cord torsion, or cord entanglement, can reduce blood flow
and lead to fetal death.
6. Trauma or Injury
• Any trauma to the mother (such as car accidents or falls) can cause harm to the fetus, leading to
death.
7. Maternal Substance Use
• Smoking: Smoking during pregnancy can increase the risk of stillbirth.
• Alcohol or drug use: These substances can interfere with fetal development and lead to death.
• Medications: Certain medications that are unsafe during pregnancy may pose a risk.
8. Multiple Pregnancy (Twins or Higher Order)
• Higher-order multiples (twins, triplets, etc.) have an increased risk of IUFD due to complications
such as growth restriction, preterm labor, or placental insufficiency.
9. Advanced Maternal Age
• Women over the age of 35 may have a higher risk of stillbirth due to factors like increased risk of
genetic abnormalities or health conditions.
10. Unknown Causes
• In some cases, no clear cause for IUFD is identified, even after thorough investigation.
It's important to note that sometimes, despite all efforts, the cause of IUFD may remain unexplained.
Proper prenatal care, early detection of complications, and managing underlying health issues can reduce
the risk of fetal death.

TYPES

Intrauterine fetal death (IUFD) can be classified based on various factors, such as the timing of the fetal
death, the gestational age, and the cause. Here are the main types of intrauterine fetal death:

1. Early Intrauterine Fetal Death

• Definition: This occurs before 20 weeks of pregnancy (often referred to as a miscarriage or
spontaneous abortion).
• Characteristics: The fetus dies early in the pregnancy, typically resulting in bleeding, cramping,
and loss of pregnancy symptoms. The pregnancy is usually lost before the fetus has reached
viability.
• Causes: Often associated with chromosomal abnormalities, infections, or maternal health
conditions.
 OUR LADY OF FATIMA UNIVERSITY
120 MacArthur Hwy, Valenzuela, 1440, Metro Manila

2. Late Intrauterine Fetal Death

• Definition: This occurs after 20 weeks of gestation but before the onset of labor.
• Characteristics: The fetus has reached a stage of development where it could survive outside the
womb with medical support (around 24 weeks), but it dies in utero. This is often referred to as
stillbirth.
• Causes: Includes placental problems, infections, maternal health issues (like pre-eclampsia,
diabetes, or blood clotting disorders), and fetal abnormalities.
3. Term Intrauterine Fetal Death
• Definition: This occurs after 37 weeks of gestation, when the pregnancy reaches full term.
• Characteristics: The fetus has developed fully and would normally be able to survive outside the
womb. It is often stillborn, and the cause of death may be related to problems such as placental
dysfunction, cord accidents, or maternal health issues.
• Causes: Could include umbilical cord accidents, placental insufficiency, or maternal conditions
like hypertension.
4. Spontaneous Intrauterine Fetal Death
• Definition: This type occurs without any intervention and typically refers to cases where no
external factors (like trauma or medical intervention) are involved.
• Characteristics: It may happen due to natural causes such as chromosomal abnormalities,
infections, or placental issues.
• Causes: Genetic issues, infections, placental abnormalities, or maternal health complications.
5. Induced Intrauterine Fetal Death
• Definition: This type occurs when fetal death is intentionally caused for medical reasons, often
after careful consideration of the risks to the mother or fetus. This can happen in cases of severe
fetal abnormalities or if the mother's health is at serious risk.
• Characteristics: Induced through medical procedures like early induction of labor, D&E
(dilation and evacuation), or through the administration of medications.
• Causes: Major congenital defects, lethal fetal abnormalities, or complications like maternal
health risks.
6. Acute Intrauterine Fetal Death
• Definition: This refers to the sudden death of the fetus, typically occurring within a short period
(hours or days).
• Characteristics: The death is abrupt, and there may be no prior indication of problems, though
some signs like decreased fetal movement may be noticed by the mother.
• Causes: Umbilical cord accidents, severe placental abruption, or acute maternal conditions like
pre-eclampsia or trauma.
7. Chronic Intrauterine Fetal Death
• Definition: This type of fetal death develops over a longer period and may result from a gradual
decline in the fetus’s health.
 OUR LADY OF FATIMA UNIVERSITY
120 MacArthur Hwy, Valenzuela, 1440, Metro Manila

• Characteristics: The fetus may have been compromised for some time before it ultimately dies.
This can result in growth restriction, lack of movement, or abnormal fetal heart rates before death
occurs.
• Causes: Placental insufficiency, maternal chronic illnesses (e.g., diabetes, hypertension), or fetal
growth restriction.
Understanding the type of intrauterine fetal death is important for managing subsequent pregnancies and
for offering the appropriate emotional and medical support to the family. Each type may involve different
clinical management strategies for both the mother and the fetus.

SIGNS AND SYMTOMS

Intrauterine fetal death (IUFD) can present with different signs and symptoms depending on the
gestational age and the specific circumstances surrounding the death. In many cases, the death of the fetus
may not be immediately obvious, and the signs may develop gradually or suddenly. Common signs and
symptoms of IUFD include:
1. Decreased or Absent Fetal Movement
• One of the most common early signs that a fetus has died in utero is the absence or significant
reduction in fetal movement. The mother may notice that the fetus is no longer moving as
frequently or at all.
• When to be concerned: If a pregnant woman notices a significant decrease in fetal movement,
especially after the 20th week of pregnancy, she should contact her healthcare provider
immediately.
2. Loss of Pregnancy Symptoms
• The mother may notice a sudden loss of pregnancy symptoms, such as the cessation of nausea,
breast tenderness, or fatigue.
• This can be especially concerning in the early stages of pregnancy if the symptoms suddenly
disappear.
3. Vaginal Bleeding
• Vaginal bleeding can occur in cases of IUFD, especially in the early stages of pregnancy. In later
pregnancies, bleeding can be associated with placental abruption or other complications.
• When to be concerned: Any abnormal bleeding, especially heavy or persistent, should be
reported to a healthcare provider.
4. No Heartbeat on Ultrasound
• A significant sign of IUFD is the absence of a fetal heartbeat during an ultrasound examination.
• Diagnosis: The absence of a heartbeat is confirmed by ultrasound, and it is often the primary
method of diagnosing fetal death.
 OUR LADY OF FATIMA UNIVERSITY
120 MacArthur Hwy, Valenzuela, 1440, Metro Manila

5. Cramping or Abdominal Pain

• In some cases, the mother may experience cramping or abdominal pain, which could indicate that
the body is starting the process of labor or expulsion of the fetus.
• This is especially common in cases of early miscarriage or stillbirth where the fetus dies and the
body begins to recognize the loss.
6. Changes in the Mother's Physical Condition
• In cases of stillbirth, the mother may notice physical signs such as changes in her uterine size or
shape. This could be because the fetus is no longer growing or the body may start to recognize the
loss and begin labor.
• Symptoms like fever could indicate infection, particularly in cases of chorioamnionitis (infection
of the membranes around the fetus).
7. Sudden Disappearance of Pregnancy-Related Symptoms (Second and Third Trimester)
• For women in their second or third trimester, signs like breast tenderness or nausea may subside
suddenly, indicating the possibility of fetal death.
8. Uterine Size Discrepancy
• In some cases, the uterus may appear smaller than expected for the gestational age, which could
indicate that the fetus has stopped growing or died.
• This could be noticed by a healthcare provider during a routine examination, especially if the
fundal height (the measurement of the size of the uterus) does not match the expected size based
on gestational age.
9. Foul-Smelling Vaginal Discharge
• In the case of infection (such as chorioamnionitis), the mother might notice a foul-smelling
vaginal discharge, which could signal an infection in the uterus.
• Infection can sometimes be a cause or result of fetal death.
10. Labor (In Some Cases)
• Sometimes, labor may begin after IUFD as the body attempts to expel the deceased fetus. This
can occur with or without prior warning signs of fetal death.

It’s important to note that in some cases, a woman may not notice any symptoms of fetal death until a
routine checkup or ultrasound reveals the absence of fetal heart tones. This is why prenatal visits and
monitoring are crucial during pregnancy to ensure the health of both the mother and the fetus.

NURSING AND MEDICAL MANAGEMENT

Intrauterine fetal death (IUFD) requires careful and compassionate management by healthcare
providers to ensure both the physical and emotional well-being of the mother. The management
typically includes medical, nursing, and psychological care. Here’s an overview of the nursing and
medical management for IUFD:
 OUR LADY OF FATIMA UNIVERSITY
120 MacArthur Hwy, Valenzuela, 1440, Metro Manila

Nursing Management of IUFD

Nurses play a crucial role in providing support and assisting with the physical care of the mother. Their
responsibilities include:
1. Providing Emotional Support
• Acknowledge the Loss: Acknowledge the emotional pain the mother is experiencing. Express
sympathy and provide a compassionate presence.
• Provide Information: Educate the mother and family about the situation, the next steps, and any
medical procedures involved. Ensure that information is clear and that the family has a chance to
ask questions.
• Support for Decision-Making: Assist the mother in making decisions regarding her care, such as
whether to opt for natural delivery or induction.
• Encourage Bonding: If possible, encourage the mother and family to bond with the deceased fetus.
This can include holding the baby, taking photographs, or creating memories (e.g., handprints or
footprints). Some families find comfort in these activities.
• Offer Support Resources: Provide referrals to counseling or grief support groups to help the
family cope with their loss.
2. Physical Care of the mother
• Vital Signs Monitoring: Monitor the mother’s vital signs, including heart rate, blood pressure,
temperature, and respiratory rate. These could provide clues about complications such as infection
or hemorrhage.
• Assess for Infection: Look for signs of infection, such as fever, foul-smelling vaginal discharge,
or uterine tenderness. This is especially important if there has been a prolonged retention of the
fetus.
• Prepare for Labor and Delivery:
o Induced Labor: In many cases, labor will need to be induced if the fetus has died,
especially after 20 weeks of gestation.
o Pain Management: Ensure that the mother’s pain is well-managed, including offering
options for analgesia (e.g., epidural, intravenous pain medications, or oral pain relief).
o Prepare for Postpartum Care: After delivery, help manage postpartum care, including
monitoring bleeding (postpartum hemorrhage), and supporting the mother’s physical
recovery.
3. Postpartum Care
• Monitoring for Complications: After the delivery of the fetus, monitor for complications such as
heavy bleeding, clotting disorders, or infection. Keep track of uterine involution and ensure the
uterus is contracting properly.
• Counseling for Future Pregnancies: Once the mother has recovered physically, offer information
and counseling regarding future pregnancies, if applicable. Help her understand the potential causes
of IUFD, and discuss any necessary investigations or interventions.
 OUR LADY OF FATIMA UNIVERSITY
120 MacArthur Hwy, Valenzuela, 1440, Metro Manila

4. Communication
• Clear Communication with the Healthcare Team: Nurses must maintain effective
communication with the obstetrician, neonatologist, and other team members to ensure coordinated
care.
• Coordinate Postmortem Exam (if applicable): If the cause of death is not clear or if the family
requests, help facilitate a postmortem examination to understand the cause of IUFD.

Medical Management of IUFD

The medical management of IUFD depends on the gestational age, the mother’s health, and whether labor
is induced or not. The primary objectives are to ensure that the mother’s physical well-being is maintained,
and to address any complications that may arise.
1. Confirmation of Fetal Death
• Ultrasound: The first step in confirming IUFD is an ultrasound to check for the absence of fetal
heart tones and any other signs of fetal death.
• Clinical Assessment: In some cases, fetal death may be suspected based on the absence of fetal
movement or maternal symptoms, but ultrasound is necessary to confirm the diagnosis.
2. Induction of Labor
• If the fetal death occurs after 20 weeks of gestation, the mother will typically need to deliver the
deceased fetus. Labor can be induced through:
o Prostaglandins: Medications such as misoprostol (Cytotec) or dinoprostone may be used
to induce uterine contractions and cervical dilation.
o Oxytocin: If the cervix is favorable, oxytocin may be given to induce labor.
o Mechanical Methods: In some cases, a balloon catheter may be used to help dilate the
cervix.
• Pain Management: Pain management options include epidural anesthesia, intravenous analgesia,
or oral medications.
• Monitoring: Continuous monitoring of maternal vital signs and uterine contractions during the
induction process is essential.
3. Surgical Intervention (if necessary)
• In some cases, if labor does not progress or the mother is medically unstable, a Dilation and
Evacuation (D&E) procedure may be necessary, particularly if the pregnancy is early or if the
fetal tissue needs to be removed surgically.
• Cesarean Section: A cesarean section may be considered if the mother is unable to deliver
vaginally, though this is less common in cases of IUFD.
4. Postpartum Care
• After delivery, the mother will need close monitoring for postpartum hemorrhage, especially if
there has been a prolonged retention of the fetus or placental tissue.
• The healthcare team should assess for signs of infection, such as fever, foul-smelling discharge, or
uterine tenderness, and initiate appropriate treatment with antibiotics if necessary.
 OUR LADY OF FATIMA UNIVERSITY
120 MacArthur Hwy, Valenzuela, 1440, Metro Manila

5. Psychological Care
• Referral to a Counselor or Grief Support: It is crucial to provide psychological support to the
mother, offering counseling, grief support groups, or mental health services. The loss of a
pregnancy is devastating, and mental health support is vital for coping with the emotional impact
of IUFD.
• Provide Information on Grief: It is important to educate the family about the grieving process
and to validate their feelings of loss. Let the mother and family know that it is normal to experience
a wide range of emotions, and that seeking help is acceptable.

Investigations and Follow-Up Care

Following the delivery of the fetus, especially if the cause of death is unknown or there is concern about
future pregnancies, investigations may be necessary. These could include:
• Genetic testing: To identify any chromosomal abnormalities that might explain the fetal death.
• Autopsy: A postmortem examination of the fetus can help identify possible causes of IUFD, such
as infections, genetic conditions, or structural abnormalities.
• Placental examination: The placenta may be examined for signs of insufficiency, infection, or
other abnormalities.
• Maternal investigations: Tests for underlying maternal health conditions, such as blood clotting
disorders, diabetes, or infections, may be conducted.

Conclusion
The management of intrauterine fetal death involves both physical and emotional care. Nurses and
healthcare providers work together to manage labor and delivery, prevent complications, and provide
emotional support to the family. Post-delivery care focuses on recovery, investigation of the cause of fetal
death, and supporting the mother through the grieving process.
 OUR LADY OF FATIMA UNIVERSITY
120 MacArthur Hwy, Valenzuela, 1440, Metro Manila

REFERENCE