A woman comes in obstructed labour and is grossly dehydrated. Investigations reveal fetal demise. What will be the MOST appropriate management in this patient?
In cases of fetal demise, delivery is the best treatment due to the risk of DIC from retained IUFD. Since this patient is in obstructed labor and is grossly dehydrated, Caesarean section is the treatment of choice. Before 20 weeks of gestation the products are evacuated from the uterus by dilation and evacuation or with mifepristone and misoprostol in some cases. After 20 weeks pregnancy is usually terminated by induction of labor with prostaglandins or high dose oxytocin. Intrauterine fetal demise refers to fetal death after 20 weeks of gestation. Signs: absence of fetal hea tones at a prenatal visit beyond 20 weeks of gestation and absence of uterine growth. Lab: Declining levels of HCG may aid in diagnosis early in pregnancy. Investigation: Ultrasound shows absent fetal cardiac activity beyond 6 weeks of gestation, scalp edema, and fetal maceration. Ref: Blueprints Obstetrics and Gynecology By Tamara Callahan page 101. Manual Of Obstretics, 3/e By Daftary page 324
Craniotomy
Decapitation
Cesarean section
Forceps extraction