FETAL DEMISE

A   28-year-old multigravida    at  33  weeks’  gestation   comes   to  the office

stating she has not felt    her baby    move    for 24  hours.  A   previous    18-week

sonogram    showed  a   single  fetus   with    grossly normal  anatomy.    You are

unable  to  find    fetal   heart   tones   by  auscultation    with    a   Doppler stethoscope.

From a medical viewpoint, fetal demise applies to any death after the embryo
period (≥10 menstrual weeks). From a perinatal statistics viewpoint, the term
applies to in utero death of a fetus after 20 weeks’ gestation before birth.

Antenatal demise occurs before labor. Intrapartum demise defines death that
occurs after the onset of labor.

Significance

Fetal demise is most commonly idiopathic. When a cause is identified, risk
factors include antiphospholipid syndrome, overt maternal diabetes, maternal
trauma, severe maternal isoimmunization, fetal aneuploidy, and fetal infection.

Disseminated    intravascular   coagulation (DIC)   is  the most    serious

consequence,    with    prolonged   fetal   demise  (>2 weeks)  resulting   from    release

of  tissue  thromboplastin  from    deteriorating   fetal   organs.

Grief   resolution  may be  prolonged   if  psychosocial    issues  are not appropriately

addressed.