Second Trimester Intrauterine Fetal Death (IUFD)

Posted On: May 4, 2021 By Nathan D. Fox, MD

What Causes Second Trimester Intrauterine Fetal Death (IUFD)?

Intrauterine fetal death (IUFD) can be an extremely difficult experience for mothers and families. It’s important to know the risks and how a maternal fetal medicine specialist can help so you can take the best steps for your health and your baby’s. Here’s what to know about IUFD and what it means for your pregnancy. 

What is Intrauterine Fetal Death? 

Fetal death in utero, commonly known as stillbirth, is categorized based on how far along it occurs during pregnancy. Generally, 

  • Early stillbirth occurs between 20 and 27 weeks of gestation 
  • Late stillbirth occurs between 28 and 36 weeks of gestation 
  • Term stillbirth occurs after 37 weeks of gestation 

Second trimester intrauterine fetal death is typically recognized as a demise after 20 weeks of gestation or a fetal weight of more than 500 grams. It affects about 1 in 100 pregnancies each year in the United States, and the rate has declined by more than 25% in the last 15 years. This can be due to advances in prenatal care, but the rate of early stillbirth has remained at a similar level over time. 

What’s the Difference Between Stillbirth and Miscarriage? 

Generally, a pregnancy loss during the first- and early-second trimester (before 20 weeks) is classified as a miscarriage. A pregnancy loss after 20 weeks is categorized as stillbirth. However, these categories can be arbitrary and account for many other factors like fetal weight and risk factors. In many cases, the workup is similar for both categories. 

Causes of Second Trimester IUFD 

Intrauterine fetal death (IUFD) is a concern in high-risk pregnancies. Although there are some known causes and risk factors, many cases of second trimester IUFD do not present classically, and a clear cause of IUFD is not always found. in fact, in about half of all cases, the cause of stillbirth is unknown. This means it’s important to partner with a team of maternal fetal medicine specialists to get the care you need and ensure you take the right steps to prevent complications. 

Because it can be difficult to specifically classify stillbirth, more study is needed on the potential causes of IUFD. In many cases, there is no standardized method for determining the cause of pregnancy loss. Some common causes of second trimester IUFD include: 

  • Placental Insufficiency 
  • Placental Abruption 
  • Fetal Infection 
  • Genetic Abnormalities of the fetus 
  • Congenital Anomalies of the fetus 
  • Fetomaternal Hemorrhage (transfer of blood from the baby into the maternal circulation) 
  • Umbilical Cord Complications 

Placental insufficiency is likely in pregnancies that have early growth restriction, bleeding, or low amniotic fluid (oligohydramnios). A fetus with apparent abnormalities likely has a genetic or anatomic cause for IUFD. A patient with a hematoma and bleeding may also have placental abruption (separation). 

IUFD Risk Factors 

While the cause of stillbirth is not always known, there are some known risk factors that have been linked to IUFD. These include: 

  • Diabetes
  • Hypertension 
  • Obesity
  • Multiple gestations
  • Advanced maternal age
  • A history of pregnancy complications, like growth restriction and preeclampsia
  • Previous miscarriages or stillbirths
  • Exposures during pregnancy such as alcohol use, smoking, and drug use
  • Racial group (especially non-Hispanic black)Unfortunately, there are health care disparities by race when it comes to stillbirth. Although the exact mechanism is unknown,  proposed reasons include chronic environmental and societal stresseslimited access to healthcare and resources, structural racism in healthcare, as well as differences in other risk factors. 

It’s important to note that these factors do not necessarily cause IUFD – rather, stillbirths occur more frequently in the above groups because of many different factors. These risk factors can also be tied to preterm birth and other poor pregnancy outcomes. It’s also possible to have a healthy pregnancy outcome with these risk factors. 

What Happens After Stillbirth? 

A number of options are available based mostly on the mother’s preferences and gestational age. The two most common options for women with IUFD are labor induction or removal of the pregnancy (using Dilation and Evacuation, or D&E). In some rare cases, cesarean delivery can be performed. 

After one of the above procedures, it’s important to perform a number of tests to ensure the health of the mother and assess her chances of future healthy pregnancies by limiting risk factors and causes. A fetal autopsy is the most likely test to reveal a cause of IUFD, but some parents are uncomfortable with this. Amniocentesis can be performed to test for genetic conditions that may have been causative. Additionally, the placenta should be examined. Then, a maternal fetal medicine specialist can help determine the mother’s next steps in family planning and further pregnancies. 

There are also some physical symptoms that a woman may experience after a stillbirth. Following the delivery of the placenta, the body may begin to produce breast milk. You may choose to let the lactation stop naturally or take medications that may stop your breasts from producing milk.

Mental and Emotional Health Following Stillbirth

Learning you have experienced a stillbirth can be a sad, shocking, and confusing time. Some women may feel physically and emotionally overwhelmed. If you are experiencing depression, anxiety, or intense sadness following a stillbirth, reach out to a qualified counselor, psychologist, or psychiatrist to help you and your family through this difficult time. There are also support groups that may help you to cope with your stillbirth. Depression is two to four times more common in women who have experienced a stillbirth than women who had given birth to a liveborn infant, so do not be afraid to reach out for help.

Healthcare providers should routinely screen for symptoms of depression and anxiety among women after stillbirth.  If you are in need of information regarding mental and emotional health specialists following a stillbirth, you can ask your healthcare provider for recommendations and referrals.

Schedule a Consultation 

Our award-winning team of maternal fetal medicine specialists can provide expert care in high-risk pregnancies in the New York City area. To schedule an appointment and learn more, we invite you to contact our office by calling or filling out our online form. 

Sources

  1. Society for Maternal Fetal Medicine
  2. American College of Obstetricians and Gynecologists
  3. Centers for Disease Control and Prevention
  4. March of Dimes (National Foundation for Infantile Paralysis)
  5. WebMD
  6. MGH Center for Women’s Mental Health

 

Carnegie Imaging for Women blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!

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