Intrauterine fetal demise: Care in the aftermath, and beyond

In addition to routine obstetric care measures, these women should be offered antepartum fetal surveillance starting at 32 weeks gestation, or one to 2 weeks before the gestational age of the fetus at the time of the previous IUFD (whichever is earlier), as well as serial ultrasonography starting at 28 weeks to assess for fetal growth restriction.^12,21 Most experts advise delivery at 39 weeks unless indicated earlier.¹²

Psychological risks. IUFD is associated with posttraumatic stress disorder (PTSD) and anxiety in a subsequent pregnancy.^22,23 Approximately 21% of women in one There may be "false alarms" during the course of a woman's pregnancy if she's already experienced an IUFD.study met criteria for PTSD in the third trimester of the first subsequent pregnancy; this decreased to 4% at one year postpartum.²² Risk factors for PTSD and anxiety were conceiving within one year of IUFD and a perceived lack of support at time of loss.^22,23 Additionally, women who said they had poor partner support at the time of IUFD were more likely to have more severe PTSD symptoms, such as recurring, involuntary distressing memories of the IUFD, 6 to 8 years later.²⁴ Because women who become pregnant after having an IUFD are likely to be anxious, physicians should be aware that there may be “false alarms” during the course of these pregnancies.

CASE › Two years after experiencing an IUFD , Ms. T becomes pregnant. Her physician carefully reviews her medical records and begins fetal surveillance at 26 weeks gestation, including serial ultrasounds. Ms. T’s pregnancy and labor proceed without complications, and at 38 weeks, she delivers a healthy 6.3-lb. boy.

CORRESPONDENCE
Richard Temple, MD, Naval Hospital Camp Lejeune Family Medicine Residency, 100 Brewster Blvd., Camp Lejeune, NC 28547; richard.temple@med.navy.mil

ACKNOWLEDGMENT
The authors thank Anthony Viera, MD for his assistance in the preparation of this manuscript.