Intrauterine fetal demise (IUFD) refers to fetal death prior to delivery and may occur at any time prior to delivery. Determining the timing of the IUFD is important both for counseling the parents and for anticipating the likelihood of successful neonatal resuscitation after delivery. The appearance of the fetus at delivery can be used to estimate whether the fetal demise occurred antepartum or peripartum.
The process of tissue degeneration (maceration) is due to the effects of autolytic enzymes on the fetus in a sterile environment. Lysis occurs at the epidermal-dermal junction with subtle changes in the gross appearance of the fetus (skin desquamation, positive Nikolsky sign) seen as early as 6 hours. Further changes involve desquamation and bullae formation of the face, back, or abdomen by 12 hours, at least 5% of the body surface at 18 hours, and generalized skin desquamation at 24 hours. Sloughing of skin from a large area indicates a prolonged interval between death and delivery. Mummification occurs after approximately 2 weeks.
Management and Disposition
If the mother is in active labor, prepare for a normal delivery. Obtain obstetric consultation immediately as for any emergency delivery. The presence of fetal heart tracings during delivery or a normal-appearing infant without significant skin changes indicates peripartum demise and neonatal resuscitation should be attempted. If signs of maceration are present at birth, no resuscitative efforts are indicated.
Desquamation and/or sloughing of skin from large or numerous areas in an unresponsive fetus indicate antepartum IUFD.
With the exception of loss of heartbeat detected on live fetal monitoring, it may not be possible to pinpoint the time of fetal death prior to delivery. With loss of heartbeat in labor, assume the demise was peripartum and prepare for neonatal resuscitation.
Intrauterine Fetal Demise. Desquamation of the entire skin surface, with sloughing of the abdominal and scrotal skin, is seen in this IUFD. (Photo contributor: Lawrence B. Stack, MD.)