Definition
Intrauterine fetal demise (IUFD) or stillbirth refers to fetal demise before delivery.
Incidence
In developing countries, the stillbirth rate has decreased from 15–16 per 1,000 total births in the 1960s to 7–8 per 1,000 births in the 1990s.
Risk factors
These include extremes of maternal age, multifetal pregnancy, post-term pregnancy, male fetus, and fetal macrosomia (defined as estimated fetal weight ≥4,500 g).
Diagnosis
- Symptoms. If fetal demise occurs early in pregnancy, there may be no symptoms aside from cessation of the usual symptoms of pregnancy (nausea, frequency, breast tenderness). Later in pregnancy, fetal demise should be suspected if there is a prolonged period without fetal movement.
- Signs. The inability to identify fetal heart tones at a prenatal visit beyond 12 weeks’ gestation and/or the absence of uterine growth may suggest the diagnosis.
- Laboratory tests. Declining levels of human chorionic gonadotropin (hCG) may aid in the diagnosis early in pregnancy.
- Radiological studies. Historically, an abdominal radiograph was used to confirm IUFD. The three radiologic findings suggestive of fetal death include overlapping of the fetal skull bones (Spalding sign), an exaggerated curvature of the fetal spine, and gas within the fetus. However, radiographs are no longer used. Ultrasound is now the gold standard to confirm IUFD by documenting the absence of fetal cardiac activity beyond 6 weeks’ gestation. Other sonographic findings include scalp edema and fetal maceration.
