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FIBROIDS AND INTRAUTERINE FETAL DEATH

An intrauterine fetal death (IUFD) is said to have occurred when a conceptus whose gestational age is greater than 8 weeks dies. The following are challenges that can lead to IUFD •	Chromosomal abnormality that is not compatible with life •	Congenital infection •	Progesterone deficiency •	Antiphospholipid syndrome •	Fibroids Fibroid is an important reason for recurrent IUFDs. Fibroid in the intramural or submucous areas over which you have the chorion frondosum can prevent the full development of the placenta The placenta is completely formed and functioning from 10weeks after fertilization These are four layers of tissue separating the maternal blood from the fetal blood These include the following: •	The endothelial lining of the fetal blood vessels •	The mesoderm •	Cytotrophoblast •	Syncytiotrophoblast In its early stages it is a relatively loose structure, but becomes more compact as it matures. Between 12 and 20 weeks’ gestation the placenta weighs more than the fetus because the fetal organs are insufficiently developed to cope with the metabolic process of nutrition Later in pregnancy some of the fetal organs, such as the liver begin to function, so the cytotrophoblast and the syncytiotrophoblast gradually degenerate and this allows easier exchange of oxygen and carbon dioxide. In the presence of fibroid this process of maturity of the placenta can be hampered leading to poor passage of oxygen and nutrients from the maternal circulation to the baby. The maternal blood circulates slowly, enabling the villi to absorb food and oxygen and excrete waste. It appears the presence of fibroids further slows down the maternal blood flow to the blood spaces in the placenta. This makes it difficult for a growing fetus to meet its demands for oxygen and nutrients. Death can occur. The following can be seen on scan •	No heart beats •	Fetal scalp oedema •	Significant overlap of fetal skull bones (Spalding’s sign) This is caused by liquefaction of the brain. This is a process that requires several days to develop. •	Exaggerated curvature of the fetal spine. It takes several days to occur •	Gas in the fetus •	Red to brown turbid amniotic fluid. This takes days or weeks to occur.