Sudden Intrauterine foetal death
By defination Intrauterine foetal death (Stillbirth) is any foetal loss at 20 or more weeks of gestation.
Risk factors:
Maternal Thrombophillias:
a) Antiphospholipid antibody syndrome: characterised by presence of antiphospholipid antibodies, thrombosis and obstetrical complications, exact cause is uncertain but placental infalammation, thrombosis and decidual vasculopathy maay be involved.
b)Heritable Thrombophilias: that involves deficiency of anticoagulant protein or an increase in procoagulent protein. commonly associated with factor V Leiden mutation (FVL), prothrombin gene mutation, deficiency of anticoagulent proteins that are Protein C, S and Antithrombin III. various studies have shown poor associatin with stllbirth hence routine throm bophillia testing after stillbirth is not recommended.
thrombophillic defects may play a significant role in pacental abruption or infarction.
Infection: CMV is the most common congenirtally acquired infection during pregnancy.It can cause foetal and placental damage but its role in stillbirth is not clear.
infections with proven role are:
Bacterial pathogens: E. Colli, Group B Streptococci, Ureaplasm Urealyticum, Mycoplasm Hominis, Bacteroides species, Gardnerella, Mobilincus species and various enterococci.syphillis,
viral infections like Parvovirus B19 and enterovirus group.
Spirochetal disease: Syphillis, leptospirosis and lyme disease.
Foetal factors:
1. red cell alloimmunization:anti RhD, Anti Rhc and anti kell are most important in this respect.
2. platelet alloimmunization: result of maternal alloimmunization against fetal platelet antigens inherited from father.severe alloimmunization can cause intracranial hemorrhage and death.
3.chromosomal abnormality: overall fetal cytogenetic sbnormalities accounts for 6% to 10% of foetal loss, proportion is higher in malformed or macerated fetus.The distribution of chromosomal abnormality associated with stillbirths are as follows: trisomy21 31%, Monosomy X 22%, Trisomy18-22%, Trisomy 13- 6%and other chromosomal anomalies-19%
4. fetal single gene and mendelian disorders may also result in stillborn.common associations are:
Inborn errors of metabolism: Smith-Lemli-optiz Syndrome, Glycogen storage disease, peroxismal disorders and amino acid disorders
X-linked dominant mutations: lethal in male fetus due to skewed X-inactivation
autosomal dominent disorders: long QT interval, skeletal dysplasia
5. fetal structural anomalies: 25% of still
maternal : age less than 15 and more than 35 years, lowest risk is between 30-34 years, Obesity, gestational diabetes, hypertension, smoking, alcohol use, illicit drug use, Hypothyroidism, presence of TPO antibodies, Systemic Lupus arythromatosis, Intrahepatic chelestasis of pregnancy, inadequate prenatal care,
Obsterical profile: previous history of still birth or recurrent pregnancy loss,
Foetal factors: multiple gestation, IUGR
demographic factors: race and ethnicity
Causes:
By defination Intrauterine foetal death (Stillbirth) is any foetal loss at 20 or more weeks of gestation.
Risk factors:
Maternal Thrombophillias:
a) Antiphospholipid antibody syndrome: characterised by presence of antiphospholipid antibodies, thrombosis and obstetrical complications, exact cause is uncertain but placental infalammation, thrombosis and decidual vasculopathy maay be involved.
b)Heritable Thrombophilias: that involves deficiency of anticoagulant protein or an increase in procoagulent protein. commonly associated with factor V Leiden mutation (FVL), prothrombin gene mutation, deficiency of anticoagulent proteins that are Protein C, S and Antithrombin III. various studies have shown poor associatin with stllbirth hence routine throm bophillia testing after stillbirth is not recommended.
thrombophillic defects may play a significant role in pacental abruption or infarction.
Infection: CMV is the most common congenirtally acquired infection during pregnancy.It can cause foetal and placental damage but its role in stillbirth is not clear.
infections with proven role are:
Bacterial pathogens: E. Colli, Group B Streptococci, Ureaplasm Urealyticum, Mycoplasm Hominis, Bacteroides species, Gardnerella, Mobilincus species and various enterococci.syphillis,
viral infections like Parvovirus B19 and enterovirus group.
Spirochetal disease: Syphillis, leptospirosis and lyme disease.
Foetal factors:
1. red cell alloimmunization:anti RhD, Anti Rhc and anti kell are most important in this respect.
2. platelet alloimmunization: result of maternal alloimmunization against fetal platelet antigens inherited from father.severe alloimmunization can cause intracranial hemorrhage and death.
3.chromosomal abnormality: overall fetal cytogenetic sbnormalities accounts for 6% to 10% of foetal loss, proportion is higher in malformed or macerated fetus.The distribution of chromosomal abnormality associated with stillbirths are as follows: trisomy21 31%, Monosomy X 22%, Trisomy18-22%, Trisomy 13- 6%and other chromosomal anomalies-19%
4. fetal single gene and mendelian disorders may also result in stillborn.common associations are:
Inborn errors of metabolism: Smith-Lemli-optiz Syndrome, Glycogen storage disease, peroxismal disorders and amino acid disorders
X-linked dominant mutations: lethal in male fetus due to skewed X-inactivation
autosomal dominent disorders: long QT interval, skeletal dysplasia
5. fetal structural anomalies: 25% of still
maternal : age less than 15 and more than 35 years, lowest risk is between 30-34 years, Obesity, gestational diabetes, hypertension, smoking, alcohol use, illicit drug use, Hypothyroidism, presence of TPO antibodies, Systemic Lupus arythromatosis, Intrahepatic chelestasis of pregnancy, inadequate prenatal care,
Obsterical profile: previous history of still birth or recurrent pregnancy loss,
Foetal factors: multiple gestation, IUGR
demographic factors: race and ethnicity
Causes:
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