September 2002 · Vol. 14, No. 9Intrauterine fetal death: What is the right follow-up?
Besides being emotionally challenging, fetal demise raises a host of questions and increases an obstetrician’s medicolegal risk. An expert recommends strategies for determining etiology, counseling the patient, and protecting against litigation.
NANCY
C.
CHESCHEIR,
MDDr. Chescheir is professor of OBG and radiology and director of the fetal therapy program at the University of North Carolina at Chapel Hill. She also serves on the OBG Management Board of Editors.
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KEY POINTS
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Fetal chromosomal abnormalities are associated with 5% to 10% of late fetal losses.
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Since amniocytes can survive for several weeks following a fetal demise, amniocentesis can be used to obtain material for karyotyping.
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Once the patient delivers, a careful gross examination of the fetus, cord, membranes, and placenta should be documented in the chart, even if an autopsy is planned.
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Perinatal autopsy continues to play an important role in determining the cause of death, yielding new information in more than 25% of cases.
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Very few circumstances in obstetrics evoke feelings as strong as those brought on by third-trimester fetal demise. These events demand that we provide not only emotional support, but also a thorough, objective evaluation of the cause of the death. But because such losses differ significantly from those that occur early in pregnancy, their assessment is unique. The patient and her family will ask “why,” seeking answers ranging from the theological to the medical. Our goals should include:
To ensure all these goals are met, a systematic protocol, such as the one described in this article, is vital.
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