PATHOPHYSIOLOGY OF INTRAUTERINE FETAL DEMISE

Fertilization
(Union of sperm and ovum)

Zygote - Unicellular
(Intermingling of haploid paternal 23 X or Y and maternal 23 X chromosomes)

Series of Mitotic Cell division - Cleavage

(In 24 hours become two cell organism)

In 72 hours become 16 cell organism called Morula

Morula enters the uterus on the 3rd day through peristaltic movement

Separate into two parts by fluid from the uterus on the 4th day

The outer layer gave rise to the placenta The inner layer gave rise to the embryo
( trophoblast ) ( embryoblast )

blastocytes attaches to endometrium on the 6th day

Implantation

Embryonic development begins during

the second week and continues through
the eighth week

3 Stages
• 1st stage – increase in cell number and with Fetal Development is from ninth week to birth
elaboration of cell products
• 2ndstage – morphogenesis / includes mass cell
• 3rdstage – differentiation or maturation of
physiologic processes

Predisposing Factors Precipitating Factors

Age: 31 y/o Ineffective role performance
AOG: 31 wks. Anxiety/stress in work
Congenital anomalies

Abnormal Pattern of Fetal Development Normal Pattern of Fetal Development

 arising from

Congenital Anomalies

resulting to

Abnormal Fetal Heart Rate pattern

Ominous Patterns

Late Decelerations Variable Decelerations

due to due to

uteroplacental insufficiency Cord Compression

decreased blood flow and Oxygen

supply to fetus

increased peripheral resistance

Fetal Hypertension

stimulates

baroreceptors in aortic arc and carotid arteries

decreased heart rate

(bradycardia)

If untreated If treated

Extreme vagal inhibition Maternal inhalation of oxygen

Scalp stimulation test
Fetal scalp blood sampling
Total cardiac arrest medications as ordered

Intrauterine Fetal Demise

Stabilization of Fetal heart rate

Immediate/ Forced Normal

Vaginal delivery

Continuous FHR monitoring until delivery