Nsd With Iufd Pathophysiology

PATHOPHYSIOLOGY OF INTRAUTERINE FETAL DEMISE

Fertilization (Union of sperm and ovum) Zygote - Unicellular (Intermingling of haploid paternal 23 X or Y and maternal 23 X chromosomes) Series of Mitotic Cell division - Cleavage (In 24 hours become two cell organism) In 72 hours become 16 cell organism called Morula Morula enters the uterus on the 3rd day through peristaltic movement Separate into two parts by fluid from the uterus on the 4th day The outer layer gave rise to the placenta ( trophoblast )

The inner layer gave rise to the embryo ( embryoblast ) blastocytes attaches to endometrium on the 6th day Implantation

Embryonic development begins during the second week and continues through the eighth week 3 Stages • 1st stage – increase in cell number and with elaboration of cell products • 2ndstage – morphogenesis / includes mass cell • 3rdstage – differentiation or maturation of physiologic processes

Predisposing Factors Age: 31 y/o AOG: 31 wks. Congenital anomalies

Abnormal Pattern of Fetal Development

Fetal Development is from ninth week to birth

Precipitating Factors Ineffective role performance Anxiety/stress in work

Normal Pattern of Fetal Development

arising from Congenital Anomalies resulting to Abnormal Fetal Heart Rate pattern Ominous Patterns

Late Decelerations

Variable Decelerations

due to

due to

uteroplacental insufficiency

Cord Compression

decreased blood flow and Oxygen supply to fetus increased peripheral resistance Fetal Hypertension stimulates baroreceptors in aortic arc and carotid arteries decreased heart rate (bradycardia) If untreated Extreme vagal inhibition Total cardiac arrest

If treated Maternal inhalation of oxygen Scalp stimulation test Fetal scalp blood sampling medications as ordered

Intrauterine Fetal Demise Stabilization of Fetal heart rate Immediate/ Forced Normal Vaginal delivery Continuous FHR monitoring until delivery