CLINICAL CASE
Unit Two: Obstetrics
Section A: Abnormal Obstetrics
Objective 21: Fetal Death
At the conclusion of this exercise, the student will be able to:
Discuss common causes of fetal death in each trimester of pregnancy.
Discuss symptoms and diagnosis of fetal death.
Discuss management of the patient with a fetal death or a history of fetal death in a prior pregnancy.
Case study #1
A 30-year-old Hispanic woman Para 0020 has been followed in your practice with insulin dependent diabetes and presents for a routine prenatal visit at 36 weeks’ gestation. She had a normal ultrasound at 20 weeks gestation with a normal fetal anatomic survey. She reports no problems and good fetal movement. Her blood sugar control has been reasonable. Her BP and urine dipstick were normal. Unfortunately, no fetal heart tones were heard by Doppler and an ultrasound evaluation confirmed no fetal cardiac activity. She is very upset and you spend time with her counseling her regarding causes of fetal death and options for management.
Case study #2
A 26-year-old woman Para 0100 presents to your office for her first prenatal care visit. She has no known medical problems. In her last pregnancy, she had an intrauterine fetal demise at 28 weeks gestation. She reports that she began itching two weeks before the baby died and her doctor did some blood tests and said everything was okay. At the time of her delivery, she said the obstetrician taking care of her told her that the baby’s umbilical cord was wrapped around its neck several times. She wants to discuss plans for managing this pregnancy.
Teaching points
Risk factors and causes of fetal death
Counseling and management of fetal death in the third trimester
Counseling and evaluation of a woman with a history of a fetal death in a prior pregnancy