Definition:

Intrauterine fetal demise is the clinical term for the death of a baby in the uterus, during
pregnancy and before birth. The term is usually used for pregnancy losses that happen after
the 20th week of gestation.
Also Known As: Stillbirth
Background. Risk factors for and management of intrauterine fetal demise (IUFD) have
been investigated, but the maternal morbidity has not been evaluated.
Methods. Over a 60-month interval, all cases of IUFD after 20 weeks' gestation were
reviewed for maternal trauma and maternal postpartum complications.
Results. In this retrospective analysis, 498 singleton and 24 twin pregnancies with an IUFD
were identified. A cervical or perineal laceration requiring surgical repair complicated 9.4%
of pregnancies. One uterine dehiscence and one uterine rupture occurred. Endometritis, the
most common postpartum complication, occurred in 63 of 522 patients (12%). One maternal
death occurred. Total mean hospital stay was 4.9 ± 5.7 days.
Conclusion. Maternal morbidity and rarely mortality can follow IUFD, but this morbidity is
similar to that observed without IUFD.
Introduction
Fetal death in utero (stillbirth) is defined in most states as a demise at ≥20 weeks of
gestation and/or weight of ≥500 grams.[1] The fetal death rate in the United States varies
among races, but overall it is 6.8/1,000 total births and accounts for approximately half the
perinatal mortality (fetal and neonatal deaths).[2] Management of fetal death in utero has
changed dramatically from earlier recommendations that regarded the event as a medically
innocuous condition to be managed conservatively except under life-threatening
circumstances, with 75% of women delivered within 2 weeks after fetal demise.[3] After
coagulopathy was observed in pregnancies complicated by fetal death in utero[4] and with
newer agents to effect cervical ripening and uterine contractions, the management of
stillbirth has become more proactive.
Investigations have evaluated the significance of a previous stillbirth,[5] maternal serum
biochemical markers,[6] genetic causes,[7] maternal complications of pregnancy,[8,9] infective
agents,[10] intrapartum events,[11,12] usefulness of autopsy examinations,[13,14] and placental
findings[15,16] in the cause of fetal death. The one material complication frequently evaluated
after the diagnosis of a fetal demise is the development of disseminated intravascular
coagulopathy (DIC).[17] Numerous publications have evaluated the causes of fetal death in
utero, but except for the rarely encountered case of DIC, other maternal complications
associated with the management and delivery of a stillbirth have not been assessed in a
large investigation. The purpose of this investigation was to evaluate the maternal morbidity
associated with IUFD.