From the Guidelines
The most likely explanation for the intrauterine fetal demise (IUFD) in this patient is the placenta previa, which can compromise blood flow to the fetus and increase the risk of bleeding, leading to reduced oxygen and nutrient delivery to the fetus. According to the study by 1, placenta previa is a significant risk factor for placenta accreta spectrum disorder, which can lead to severe and life-threatening hemorrhage. The study also notes that the incidence of placenta accreta spectrum disorder has increased over the past decades, and that placenta previa is the single most important risk factor for this condition.
The patient's history of placenta previa, as well as her previous spontaneous abortion, may have contributed to the development of IUFD. However, it is essential to note that the exact cause of IUFD cannot be determined without further investigation. Other potential causes could include umbilical cord accidents, placental abruption, or maternal-fetal conditions that weren't detected during routine prenatal care.
Key points to consider in this case include:
- Placenta previa is a significant risk factor for IUFD
- The patient's history of placenta previa and previous spontaneous abortion may have contributed to the development of IUFD
- A comprehensive workup, including autopsy, placental examination, and genetic testing, should be performed to potentially identify the cause and inform future pregnancy management
- The patient should be offered emotional support and counseling to help her cope with the loss of her baby
As noted in the study by 1, abnormal results of placental biomarkers can increase the risk of placenta accreta spectrum disorder. However, these biomarkers are not accurate enough to be clinically useful. Therefore, a thorough evaluation of the patient's medical history and prenatal care is necessary to determine the cause of IUFD. The patient should be informed that many cases of IUFD remain unexplained even after thorough evaluation, and that a comprehensive workup and emotional support are essential in this situation.
From the Research
Possible Causes of Intrauterine Fetal Demise
- The patient's history of placenta previa may have contributed to the intrauterine fetal demise (IUFD) 2.
- Maternal vascular malperfusion (MVM) is a common cause of IUFD, and it may have played a role in this case 3.
- Uteroplacental insufficiency, which can be caused by placental infarct, poor vascularity of the chorionic villi, intravascular thrombi, and vascular occlusion, is also a possible cause of IUFD 4.
Communicating with the Patient
- When discussing the possible causes of IUFD with the patient, it is essential to use patient-centered communication skills, such as eliciting the patient's agenda, active listening, and expressing empathy 5.
- The patient's prior knowledge and preferences for information should be assessed before discussing the diagnosis and possible causes of IUFD.
- The patient's emotional response to the diagnosis should be explored, and shared decision making should be used to empower the patient in making decisions about her care.
Placental Abnormalities
- Placental abnormalities, such as placenta previa, can increase the risk of IUFD 2, 6.
- The placenta plays a critical role in maternal-fetal health, and its dysfunction can have significant clinical repercussions 6.
- Further evaluation of the placenta and umbilical cord may be necessary to determine the underlying cause of IUFD in this case.