What are the causes of death of the baby inside the uterus before birth (IUFD- Intrauterine fetal death)?

It is very painful experience for the mother and family. But many a times, no definite cause can be found out. 

In each pregnancy, there is 1:200 risk of Fetal death (if 200 women are pregnant, one will lose the baby before delivery, without any Apparent cause).

The most common cause is because the baby has not been growing properly. Other causes include infection, abnormal development of the baby, diabetes, early separation of the placenta, APLA syndrome (anti phospho lipid antibody syndrome where blood clots and impairs oxygen supply to the baby) and pre-eclampsia (high blood pressure and loss of protein in urine).

What tests are done to find out the cause?

If a cause is found, this can help with planning care in a future pregnancy to avoid recurrence of the same mishap. Unfortunately, despite tests, sometimes deaths cannot be explained. Even in that case, there is good chance, that you will have healthy live birth in next pregnancy. 

1. Blood test- Tests to look for conditions of your liver or kidneys, thyroid problems or diabetes, infection, APLA syndrome etc

2. If any infection is suspected, immediately after delivery, swabs can be taken from your vagina, cervix and placenta, and from your baby, to look for any source of infection. 

3. A test of your baby’s chromosomes that will involve taking a blood sample or skin/ muscle sample from your baby, with your consent. If there is chromosomal defect in the baby,  you and your husband may also be tested. 

4.  A post-mortem examination for your baby and placenta, which can be as limited or detailed as you wish. A post-mortem examination can provide very important information on why your baby has died. You have the full right to decide whether you want this or not. 

5.  A detailed examination of your placenta even without a post-mortem examination 

When can you plan for next pregnancy?

There is no hard and fast rule. there is no difference between early and late conception. Your age should be kept in mind. You can plan for next pregnancy when you and your husband are physically and mentally fit for it. 

What precaution can be taken in next pregnancy?

If the cause is found, every attempt will be made to correct it (like controlling infection, diabetes, thyroid problem, APLA syndrome etc). If no cause is found, then close observation is advised. Apart from routine tests done in each pregnant women, it is important to check for GDM (Gestational Diabetes Mellitus) and Growth scan with Colour Doppler regularly. You should observe baby's movement. 

If you have strong determination, you will win.

In her previous pregnancy, 2 years ago, this unfortunate mother lost her baby before delivery (IUFD), at 35 weeks. She underwent Caesarean Section in the UP that time.

She presented to us at 2018 at her 3rd month of pregnancy with new expectations and hope. But as she was already pregnant, we could not do much investigations. We reviewed previous tests only. We reassured her that in majority of the cases, such mishaps do not recur.

So, we advised regular check up and close observation.

We found she was having hypothyroidism, so advised L-Thyroxine 50 mcg/day.

We screened her for GDM (Gestational Diabetes Mellitus) with blood test by 75 gram OGTT (oral glucose tolerance test) and found that she had GDM. It was controlled with dietary restrictions alone. Renal, retinal check up were done. Regular sugar check up was carried out.

Interestingly, Indian women are more prone to GDM. GDM, in fact, is one of the cause of "SUDDEN UNEXPLAINED FETAL DEATH".

We discussed with her the role of "Empirical treatment" (treatment which are of doubtful benefits, done without any definite test reports, but usually not harmful) with Low dose Aspirin tablet (75 mg/day) and Low Molecular weight heparin injection (LMWH- Enoxaparin 40 mg/day) throughout the pregnancy. These are usually prescribed when we detect APLA. APLA should be tested when a lady is not pregnant. As she came to us with pregnancy, we could not check for it. After discussion with merits and demerits, she agreed to have these treatment.

Routine pregnancy care is advised including Combined test and Anomaly scan. We advised her regular Growth scan and Colour Doppler by ultrasound (to see blood flow to the baby), as per RCOG recommendation. The results were normal.

As previous Fetal death was at 35 weeks and this time she had GDM, we discussed the merits and demerits of planned premature delivery at 35 weeks. We offered delivery at NICU set up and discussion with Neonatologist. She agreed to proceed for delivery at 35 weeks.

Steroid injection was given to promote lung maturity of the baby to reduce the risk of breathing problem associated with premature delivery. 

Finally delivery was done. Baby boy weighed 2.3 kg, cried at birth, DID NOT require NICU (kept in the ward with the mother.

Mother's condition is healthy, blood sugar is normal now.

So after a long run battle, the mother is enjoying her new life. Sleepless night for feeding the baby, listening to the cry of a new born, changing the nappy- everything gives a divine feeling.