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Intrauterine Fetal Death: Management and Complications

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Practical Guide to Simulation in Delivery Room Emergencies

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Abstract

Intrauterine fetal death (IUFD) is one of the adverse outcomes of pregnancy that can occur at any trimester. There are annually 2.6 million late stillbirths worldwide. Race, pregnancy at an advanced age or adolescent pregnancies, parity, multiple gestations, previous adverse pregnancy outcomes and previous stillbirth, postterm pregnancy and obesity are the main risk factors for fetal loss. Potential causes for IUFDs can be divided into four groups: (1) Maternal diseases, (2) Pathologies related to the fetus, (3) Placental and Umbilical Cord abnormalities, and (4) Infections. Macroscopic and histopathological examination of the fetus, placenta, umbilical cord and membranes, genetic evaluation and fetal autopsy are the essential components of the evaluation. The most valuable step for the determination of the cause is the evaluation of the placenta. The risk of coagulopathies increases if the onset of labor lasts longer than 4 weeks after IUFD. Dilatation and evacuation (D&E) or induction of labor are the two delivery methods. The choice between them depends on the experience of the clinician, the week of pregnancy, whether the autopsy is planned, and the patient decision. Infections, postpartum hemorrhage, genital tract lacerations, uterine rupture retained placenta and disseminated intravascular coagulopathy (DIC) are the most common complications of stillbirths. Currently, the Covid-19 outbreak caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which affects the whole world, is also being evaluated for adverse outcomes in pregnancy. Analyses point out that there may be an association with Covid-19 and IUFDs. Increasingly high-quality evidence will shed light on the management of pregnancy with Covid-19.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Zeynep Kamil Women and Children’s Health Training and Research Hospital, İstanbul, Turkey

    Reyyan Gökçen İşcan

  2. Department of Biomedical and Human Oncological Science (DIMO), Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy

    Antonio Malvasi

  3. Santa Maria della Misericordia Hospital Perugia, University of Perugia, Perugia, Italy

    Antonio Malvasi

  4. International Translational Medicine and Biomodelling Research Group, Department of Applied Mathematics, Moscow Institute of Physics and Technology (State University), Moscow, Russia

    Antonio Malvasi

  5. The New European Surgical Academy (NESA), Berlin, Germany

    Antonio Malvasi

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  1. Reyyan Gökçen İşcan
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  1. Professor of Anesthesia and Intensive Care, University of Foggia, Foggia, Italy

    Gilda Cinnella

  2. Department of Anesthesia and Intensive Care, Riuniti University Hospital, University of Foggia, Foggia, Italy

    Renata Beck

  3. Department of Biomedical and Human Oncological Science (DIMO) Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy

    Antonio Malvasi

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Gökçen İşcan, R., Malvasi, A. (2023). Intrauterine Fetal Death: Management and Complications. In: Cinnella, G., Beck, R., Malvasi, A. (eds) Practical Guide to Simulation in Delivery Room Emergencies. Springer, Cham. https://doi.org/10.1007/978-3-031-10067-3_12

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