Intrauterine death

Early worries about risk of cancer or leukaemia have proven unfounded in prolonged follow-up studies. However radioactive treatment is contraindicated in pregnant woman or nursing mothers. Other risks for the fetus are abortion, intrauterine death, congenital malformation and congenital hypothyroidism (if administered after 12 weeks gestation). It is customary to avoid pregnancy for the first... 

The prenatal developmental toxicity study design includes sacrifice of the rodent or rabbit dam one day prior to expected delivery, in order to ensure that malformed fetuses are not lost to maternal cannibalism. .. Nevertheless, even the prenatal developmental toxicity study does not allow the researcher to distinguish the source or cause of prenatal mortality. Intrauterine deaths may be the result of malformations that are incompatible with continuing viability... The contribution of malformed fetuses to overall effect on litter viability can be appropriately analysed by combining the litter incidence of conceptuses that are malformed, resorbed (early and late), and dead (full term but nonviable at caesarean section) and performing appropriate statistical analyses of group values (13). 

Prostaglandins have been used intravenously, both for induction of mid-trimester abortion and for induction of labor in cases of intrauterine death. The same adverse effects as described above occur, and are usually very pronounced. Routine premedication with an antiemetic and an antidiarrheal agent significantly reduces gastrointestinal adverse effects. 

Thavarasah AS, Achanna KS. Uterine rupture with the use of Cervagem (prostaglandin El) for induction of labour on account of intrauterine death. Singapore Med J 1988 29(4) 351-2. 

Fairley TE, Mackenzie M, Owen P, Mackenzie F. Management of late intrauterine death using a combination of mifepristone and misoprostol—experience of two regimens. Eur J Obstet Gynecol 2005 118 28-31. 

Land JM, A Court CH, Gillmer MD, Ledingham JG. Severe non-diabetic keto-acidosis causing intrauterine death. Br J Obstet Gynaecol 1992 99(l) 77-9. 

Most of the developmental toxicity evaluations of DEHP are traditionally designed studies in which physical development was evaluated just prior to birth in pups of rodents that were orally exposed during gestation only. These studies clearly show that gestational exposure to DEHP was embryotoxic and teratogenic in rats and mice. A range of effects were observed including intrauterine deaths, skeletal and cardiovascular malformations, neural tube closure defects, increased perinatal mortality, and developmental delays. 

Prenatal developmental toxicity studies (e.g. OECD Test Guideline 414) are very suitable for the demonstration of intrauterine death resorption after implantation. In studies where dosing is started before implantation, preimplantation loss may also be assessed by comparing the number of corpora lutea in the ovaries of the pregnant animals with the number of implantations. Uteri that appear non-gravid should be further examined. 

There was no evidence that fluoxetine or other SSRIs caused an increase in intrauterine death, significant birth defects, or growth impairment. Follow-up behavioral studies of infants exposed to SSRIs during pregnancy also showed no difference from controls. In a summary of systematic reviews of the safety of SSRIs in pregnancy and lactation the authors concluded that thus far there is little evidence that SSRIs cause birth defects... 

The homozygous state of a-thalassemia type-1 (a-Thi) leads to a form of erythroblastosis fetalis and intrauterine death [ (K2, L18, L20, L21, L22, L23, L24, L26, P4, T6, T7, T8) and others]. This form of hydrops fetalis is found in Chinese from various countries, in Filippinos, and in Thais. All children are either stillborn or die within hours after birth. The hematological observations usually include anemia with reticulo-cytosis, hypochromia with macrocytosis, aniso- and poikilocytosis, and many erythroblasts. The red cells sickle rather easily. Most fetuses are hydropic (but not all). 

Intrauterine death and teratogenicity have not been demonstrated convincingly. 

Teratogenic effects of tetracyclines have been demonstrated (158-160), as evidenced by increased rates of intrauterine death, congenital anomalies in general (161), and congenital cataracts (162) in fetuses exposed to tetracyclines. However, it is often impossible to distinguish between the drug and an underlying unidentified viral infection as a cause of the observed abnormalities. 

Wright C, Hinchliffe SA, Taylor G. Fetal pathology in intrauterine death due to parvovirus B19 infection. Br J Obstet Gynaecol. 1996 103 133-136. 

Fig. 4 Liley graph. Bilirubin absorbs light of 450 nm. The absorbance is directly related to its concentration and this enables the risk of intrauterine death to be estimated.

Friedland JS, Jeffrey I, Griffin GE, Booker M, Courtney-Evans R. Q fever and intrauterine death. Lancet. 1994 343 288. 

An 18-year-old woman in her 34th week of pregnancy experienced severe peripheral neuropathy followed by intrauterine death of the fetus after professional application of a 25% solution of podophyllum resin in tincture of benzoin on vulval warts. A total of 7.5 ml (equivalent to 1.88 g podophyllum) was applied. The woman was under general anesthesia at the time of application. After 3 months, the woman was walking without aid and was able to type, but very slowly and clumsily. Complete recovery from neuropathy and a subsequent healthy pregnancy was reported (Chamberlain et al. 1972). 

---