Review Question - QID 109564

This patient has experienced intrauterine fetal demise. Given the risk of disseminated intravascular coagulation from the dead fetus, especially with the patient's previous history of blood clots/possible coagulopathy, and the patient's desire for an autopsy in this 25 week old fetus, induction of labor now is indicated.

Fetal demise is defined as fetal death after 20 weeks of gestation and before birth. Risk factors include fetal aneuploidy, maternal diabetes, antiphospholipid syndrome and other coagulopathies, maternal trauma, and fetal infection. The fetus itself can serve as a nidus for infection leading to sepsis and disseminated intravascular coagulation (DIC). For autopsy and karyotyping to proceed and to minimize the risk of maternal harm, induction of labor is indicated. If the patient does not wish to be induced, then spontaneous labor (which is also an option) begins in the majority of cases within one to two weeks of fetal death.

Incorrect Answers:
Answer 1: Caesarean delivery for a dead fetus is never appropriate management since it bears unnecessary harm to an already emotionally traumatized patient.

Answer 2: Induction of labor at term for an ultrasound-documented fetal demise increases the risk of maternal morbidity and mortality between the time of diagnosis and term date. Additionally, in this case, spontaneous delivery would likely occur long before term.

Answer 3-4: Dilation and curettage or evacuation would cause organ and tissue destruction decreasing the yield of autopsy. Furthermore, the fetus is more than 24 weeks old making the procedures highly risky.

Bullet Summary:
Intrauterine fetal demise increases the risk for disseminated intravascular coagulation and should be managed with induction of labor.