Snap Shot
  • A 39-year-old G3P1011 presents to labor and delivery triage in the 28th week reporting decreased fetal movement. Fetal tracings show no fetal heartbeat present.
  • Defined as demise after twenty weeks gestation
  • Complicates 1% of pregnancy
  • Symptoms
    • decreased fetal movement reported
    • often detected incidentally during prenatal visit
  • Physcian exam
    • decreased fetal movement felt
  • Maternal evaluation of fetal movement is not sensitive or specific
  • Fetal stress test 
  • Ultrasound
    • real time ultrasound shows no fetal movement
  • Labs
    • b-HCG pregnancy test remain positive for a while because it continues to be produced by the placenta
  • Dilation and currettage
    • complications with a retained dead fetus increase with gestational age
    • the most feared complication is DIC

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