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Submitted By:
Parash Phuyal
General Medicine Third Year
Koshi Health Institute
Biratnagar-1, Tinpaini
SOCIO-DEMOGRAPHIC STATUS
OF PATIENT:
• Name: Aarati Shah
• Age:24
• Sex: Female
• Address: Jahada-2
• Religion: Hindu
• Occupation: Housewife
• Date Of Admission: 2079/3(Aashad)/10
• Husband’s Name: Binod Shah
Vital Signs at the time of

admission
• Blood Pressure (BP): 130/90 mm of hg
• Pulse Rate(PR): 84 beat/minutes
• Respiration Rate(RR): 18 breaths/minute
• Temperature: 97.8°f
Clinical History
Obstetrics History
• G2 P1
• Previous SVD(Spontaneous Vaginal Delivery
Menstrual History:
• Last Menstrual Period (LMP):2078/07/01
• Estimated Date of Delivery (EDD):2079/04/08
Past History:
• Medicinal History: No previous medicinal
history
• General state of health: Excellent
• Surgery: No surgical History
• Immunizations: TD (tetanus and diphtheria)
vaccine 2 times
Present History:
• Vaginal Bleeding
• Vaginal Leaking
• Fetus suddenly stopped moving and kicking
Investigations:
CBC(Complete Blood Count)
• WBC: 13300
• PBC: 3.95
• Platelets: 3,99,000
• HB: 11.6
• PCV: 34.8
HIV: Negative
HBsAg: Negative
RBS(Random Blood Sugar): 98
Urea: 16
Creatinine: 0.53
USG(Ultra-Sonogram)
• Fetal heart rate - NO CARDIAC ACTIVITY
SEEN
• Liquor: Adequate (AFI ~ 16.9 cm, total 4
pockets)
• Fetal weight: 2612gms
• IMPRESSION ► Intra-uterine fetal demise
(IUFD) corresponding to 35 weeks 2 days of
gestational age (based on femur length) in
cephalic presentation.
Provisional Diagnosis
G2 P1 L1 with 36 weeks and 2 days of POG
(period of gestation)
Final Diagnosis
G2 P1 L1 with 36 weeks and 2 days of POG
(period of gestation) with IUFD(Intra-uterine
fetal death)
Introduction Of
Disease/Problem
• What Is Intrauterine Fetal Demise?
Intrauterine fetal demise (IUFD) is the

medical term for a child who dies in utero
after the 20th week of pregnancy in the
second trimester.
Although there is no agreed-upon time, most
doctors deem the death to be an IUFD if it
occurred after 20 weeks of gestation. This is
as opposed to a miscarriage, which happens
before the 20th week.
While the causes of IUFDs are not always

apparent, there are certain known risk
factors that doctors can screen for, diagnose,
and monitor throughout the pregnancy.
IUFD Risk Factors
While the cause of stillbirth is not always
known, there are some known risk factors that
have been linked to IUFD. These include:
• Diabetes
•Hypertension
•Obesity
•Multiple gestations
•Advanced Maternal Age
•A history of pregnancy complications, like
growth restrictions and preeclsmpsia
•Previous miscarriages or stillbirths
•Exposures during pregnancy such as alcohol
use, smoking, and drug use
Some common causes of IUFD
include:
• Placental Insufficiency.
• Placental Abruption.
• Fetal Infection.
• Genetic Abnormalities of the fetus.
• Congenital Anomalies of the fetus.
• Feto–maternal Hemorrhage (transfer of blood
from the baby into the maternal circulation)
• Umbilical Cord Complications.
Although there are some known causes and

risk factors, many cases of second
trimester IUFD do not present classically, and a
clear cause of IUFD
is not always found. in fact, in about half of all
cases, the cause of stillbirth
is unknown.
Epidemology OF
IUFD/Stillbirth
• In 2019, an estimated 1.9 million babies were
stillborn at 28 weeks of pregnancy or later,
with a global stillbirth rate of 13.9 stillbirths
per 1,000 total births
• The report reveals huge differences in

stillbirth rates across the globe, with a risk
that is up to 23 times higher in the worst
affected countries. Stillbirths were
concentrated in a few countries, with the
greatest number found in India, followed by
Pakistan, Nigeria, the Democratic Republic of
the Congo, China and Ethiopia. These six
countries accounted for half of the estimated
global number of stillbirths and 44 per cent of
global live births.
• In Nepal the prevalence of stillbirth across
three ecological zones indicates that the rate
was 28 per 1000 amongst mothers who
resided in the mountains whereas this rate
was 17 per 1000 in the terai, and 19 per
1000 in the hills.
Prevention Strategy of said

disease/problem:
• Usually, a stillbirth cannot be prevented. It
often occurs because the baby's development
was not normal. Helping improve the mother's
health, including managing preexisting
conditions and lifestyle choices, improve the
chances of a successful pregnancy.
• Go to all your antenatal appointments

It's important not to miss any of your
antenatal appointments. Some of the tests and
measurements that can identify potential
problems have to be done at specific times.
• Eat healthily and keep active
Try to swap unhealthy foods for healthier
options, and try to keep active. Being
overweight or obese can increase the risk of
problems in pregnancy.
• Stop smoking
If you smoke, the best thing you can do is
to stop. Stopping at any time in pregnancy
will help, though the sooner the better.
• Avoid alcohol in pregnancy

The safest way to ensure your baby is not
damaged by alcohol is not to drink while
you're pregnant.
• Wash your hands
Be strict about good hygiene wherever you are.
This includes washing your hands to reduce the
risk of infection
• Tell your doctor about any drug use

If you use or have used street drugs (such as
cannabis, cocaine, ecstasy or heroin) or other
substances, tell your midwife.
Daily Progress Note
Admission Day
• Women with G2P1L1 with symptoms of

vaginal bleeding and vaginal discharge
arrived at the gyne admission ward on
2078/03/10 at 36 WOG(Week of gestation).
Her general condition was well assessed. She
was well oriented to time, place and person.
Her OS was closed as per the per vaginal
examination.
In the doctors round it was instructed to start

IOL(induction of labor) on her. Her vital signs
and os was both monitored from time to time.
Her medications for IOL was also started which
consisted of Misoprostol 25 μgm 12 o’clock
S/L (SubLingual) 4 o’clock
8 o’clock
Day 1
• Women’s general condition was
assessed. She was well oriented to the
time, place and person.
She had some progress with her IOL.
Her os was 3 cm . So doctor’s plan for
her was to continue the induction till
tomorrow to see the progress.
Her vitals were closely monitored as
well as her dilation of cervix.
Vitals at the time of 6 pm

BP: 100/60 mm of hg
Pulse rate: 78 b/m
Temperature: 97.4° f
Respiration rate: 22 breaths per minute
Day 2
assessed. Her vitals at the time 6pm
were
BP: 110/70 mm of hg
Pulse rate: 76 beat per minute
Temperature: 97° f
Her os had dilated to 6 cm and the

crowning phase had started at around 4
pm time. She was taken in the delivery
room where she birthed a stillborn
baby. At the doctor’s round the doctor
adviced to continue to observe her till
tomorrow when she would be
discharged.
Discharge Day
assessed. Her vitals at the time 6 pm
were
BP: 110/70 mm of hg
Pulse rate: 84 beat per minute
Temperature: 98.4° f
She was well oriented to time, place and

person. Her condition was fine. At the
round, the doctor discharged her per
the request of her guardians and as her
condition was inproving.
Learning Experience
Through this case study, I gained the knowledge
of
• To identify what type of care the patient needs

and ways to fulfill those needs.
• To study about a specific subject and provide

others with the knowledge I gained.
• I got the opportunity to learn about/ and the

ways to carry out investigations needed in
order to diagnose said problem.
• I was able to put my theoretical knowledge

into a proper practical field.
• I got the knowledge to put together a case

study properly and effectively.
THANK YOU
Submitted By:
Parash Phuyal
General Medicine
Third Year

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Vital Signs at the time of

RBS(Random Blood Sugar): 98

Intrauterine fetal demise (IUFD) is the

While the causes of IUFDs are not always

Although there are some known causes and

• The report reveals huge differences in

Prevention Strategy of said

• Go to all your antenatal appointments

• Avoid alcohol in pregnancy

• Tell your doctor about any drug use

• Women with G2P1L1 with symptoms of

In the doctors round it was instructed to start

Vitals at the time of 6 pm

Her os had dilated to 6 cm and the

She was well oriented to time, place and

• To identify what type of care the patient needs

• To study about a specific subject and provide

• I got the opportunity to learn about/ and the

• I was able to put my theoretical knowledge

• I got the knowledge to put together a case

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