Table of Contents
Overview – Intrauterine Foetal Death
Intrauterine foetal death refers to the death of a fetus after 20 weeks of gestation but before birth. This tragic event has a wide range of possible causes and requires careful diagnosis, compassionate communication, and sensitive management. It is distinct from earlier pregnancy loss (termed spontaneous abortion) and has both physical and psychological implications for the mother and family.
Definition
- Foetal death occurring in utero after 20 weeks gestation
- Before 20 weeks = Spontaneous abortion
Aetiology
- Idiopathic (no identifiable cause in many cases)
- Secondary causes include:
- Maternal conditions: Hypertension, diabetes mellitus
- Haemolytic disease: Erythroblastosis fetalis
- Congenital anomalies
- Placental failure or insufficiency
- Infections: Eg. TORCH infections
Epidemiology
- Occurs in approximately 1% of pregnancies
Clinical Features
- Reduced foetal movements as reported by the mother
- Maternal weight may plateau or decline
- No foetal heart rate detected on handheld Doppler
- Elevated maternal serum alpha-fetoprotein (AFP)
- Ultrasound shows absent foetal heartbeat and no signs of life
Investigations
- Ultrasound scan is the primary diagnostic tool to confirm absence of foetal cardiac activity
- Consider further tests (e.g. thrombophilia screen, karyotyping, placental pathology) depending on the clinical scenario
Management
- Diagnosis confirmed via ultrasound
- Depending on gestational age:
- <12 weeks → Dilatation and curettage (D&C)
- 13–20 weeks → Dilatation and evacuation (D&E)
- >20 weeks → Induction of labour
- Monitor for disseminated intravascular coagulation (DIC)
- Provide bereavement support and mental health referral as appropriate
- Offer investigations to determine cause (especially for recurrent cases)
Summary – Intrauterine Foetal Death
Intrauterine foetal death, defined as foetal death after 20 weeks gestation, affects approximately 1% of pregnancies. Diagnosis relies on clinical suspicion and ultrasound confirmation, with management tailored to gestational age. For a wider overview of obstetric care, see our Obstetrics Overview page.