What Is Intrauterine Fetal Demise?
Intrauterine fetal demise (IUFD) is the medical term for a child who dies in utero after the 20th week of pregnancy in the second trimester.
Although there is no agreed-upon time, most doctors deem the death to be an IUFD if it occurred after 20 weeks of gestation. This is as opposed to a miscarriage, which happens before the 20th week.
While the causes of IUFDs are not always apparent, there are certain known risk factors that doctors can screen for, diagnose, and monitor throughout the pregnancy.
If the IUFD was caused by insufficient diagnosing, screening, and monitoring, then it could be a possible case of medical negligence on the part of the doctor.
Quick Facts About Intrauterine Fetal Demise
- According to the National Vital Statistics Report from 2006, the rate of IUFDs is 6.05 per 1000 births, or less than 1%.
- The number of intrauterine fetal demise cases is about the same as the number of infant deaths, according to the United States Department of Health and Human Services.
- Intrauterine fetal demise rates for non-Hispanic Black women are almost double than those of non-Hispanic White women.
- Careful monitoring by doctors may help prevent intrauterine fetal demise.
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Intrauterine Fetal Demise Causes
In many cases, it’s difficult to know the exact cause of an IUFD, but doctors should thoroughly screen, test, and monitor the mother and the baby to address any potential signs that could indicate the risk of an IUFD.
Diagnosed causes of stillbirth may include:
- Inability for the fetus to properly develop due to problems with the placenta
- Irregularity in genetics
- Complications with umbilical cord
- Suffocation from severe bleeding due to a ruptured uterus
Intrauterine fetal demise can not always be prevented. However, it is linked with certain factors that may increase the chances of it occurring.
Intrauterine Fetal Demise Risk Factors
In cases where doctors can determine the cause of intrauterine fetal death, the underlying cause falls into three categories: fetal, maternal, or placental pathology.
Fetal pathology means there was something wrong with the fetus and its development, which caused its demise.
Some potential problems with the fetus may include:
- Multiple fetuses in the womb at one time
- Hereditary or genetic abnormalities
- Slow growth in the womb
- Contracting an infection, such as fifth disease or listeria, from the mother while in the womb
While problems with the fetus are a common reason for stillbirth, they are not the only cause.
Sometimes, an IUFD is caused by an issue with the mother’s health. However, issues with the mother account for the least amount of IUFD incidents.
Some of the causes of IUFD related to the mother include:
- A pregnancy lasting longer than 42 weeks
- Her diabetes being poorly controlled
- Advanced maternal age
- Experiencing preeclampsia or eclampsia
- Having a different blood type from her child
- Rupturing her uterus
- Weight issues
- The mother being a smoker
Women with high-risk medical conditions should be monitored carefully by their doctors to lessen the chance of stillbirth.
Problems with the placenta account for almost 65% of IUFD cases when the cause of death is known.
Possible problems involving the placenta that cause an IUFD include:
- Umbilical cord accident
- Abruption (separation of placenta from the uterus wall)
- Premature rupture of membranes
- Fetomaternal hemorrhage
- Placental insufficiency
The listed risk factors are not the direct cause of intrauterine death. However, they are issues that lead to IUFDs, which is why it is vital for them to be monitored throughout the pregnancy.
Intrauterine Fetal Demise Symptoms
Intrauterine fetal demise can happen in any family. It is not always possible to know why it happens to some women and not to others.
Researchers continue to work on getting a better understanding of IUFD, however, all pregnant women should be aware of some common symptoms.
Symptoms that may indicate IUFD include:
- Not feeling the fetus moving or kicking
- Pain in the abdomen
- Infection or high fever
- Bleeding from the vagina
One sign that something is amiss that mothers can watch for is how much their child moves.
Ideally, you should be able to feel ten kicks in a two-hour window. If you are concerned that your child isn’t moving as often as they usually do, tell your doctor.
Diagnosing Intrauterine Fetal Demise
Your medical caregiver will be able to determine if there has been an IUFD.
Doctors may use the following tests to diagnose a case of IUFD:
- Ultrasound: Checking for signs of movement and life within the womb
- Non-Stress Testing: The fetus is connected to a fetal heart monitor for 20 minutes to ensure proper heart rate
- Biophysical Profile: An ultrasound and a non-stress test together check for vital signs in the fetus
- Umbilical Artery Doppler Velocimetry: Checking for proper blood flow in the umbilical cord
Even though it may be an extremely difficult experience, it is essential for mothers to be involved in the diagnosis process so that they can understand what, if anything, went wrong. It may also help the mother to see for herself through ultrasound that there is no heartbeat.
After an IUFD, doctors do their best to determine the cause. Although it is uncommon for a woman to experience multiple stillbirths in a row, these tests can let her and her medical team know if there is anything they need to watch more closely next time.
Because the cause of the IUFD may be maternal, placental, or fetal, doctors test all three aspects. This means the mother will likely undergo a series of tests to determine if there are any underlying conditions that can be treated. The placenta will also be examined, and, with the parents’ consent, the fetus will be autopsied.
The information gathered from these postmortem tests can then be used to help doctors and the mother prevent the same issue from occurring again.
Intrauterine Fetal Demise Treatment Options
Once doctors are confident that an IUFD has occurred and the mother is told, doctors will suggest that the pregnancy is terminated.
This doesn’t have to happen right away. Parents can choose to wait for the mother’s labor to be induced until they are emotionally ready for it. If the mother is carrying multiple children, she can wait until the other child is fully developed.
When the mother is ready, there are several options available to remove the fetus.
Treatment options include:
- Using medicine to start labor and deliver the fetus naturally
- Having a catheter inserted with medicine to start contractions
- Dilating the cervix to remove the fetus through the birth canal
The decision on how to remove the fetus is a very personal one. It also comes with different risks.
Keeping a stillborn fetus inside the body can cause the following obstetric complications:
- Blood clotting
- Medication side effects:
- Heavy bleeding
The risks of labor induction include:
- Damage to the uterus
- Heavy bleeding that leads to a blood transfusion
Coping After Intrauterine Fetal Demise
The period following an IUFD is highly emotional. It’s crucial for the parents to have support and counseling to help them through this time, as they may experience overwhelming feelings.
It is not uncommon for mothers affected by stillbirth to experience:
To cope with these feelings, some parents keep a folder that contains photos, a copy of the child’s footprint or handprint, and a lock of hair so the family can preserve the memory of their baby.
Other ways to process the pregnancy loss may include talking about the experience with obstetricians, family members and friends, and support groups.
Compensation for Intrauterine Fetal Demise Related to Medical Negligence
Mistakes by doctors can lead to an intrauterine fetal demise birth injury. For example, if the doctor failed to identify or address an IUFD risk factor, it may be considered medical negligence.
If you believe your doctor did not meet the standard of health care — or that their treatment, or lack thereof, was negligent — financial compensation may be available to you for your loss.
Contact the Birth Injury Justice Center today at (800) 914-1562 to work with an attorney experienced in medical negligence and malpractice.
Get a free case review to learn more about your next steps.