Intrauterine Death

INTRAUTERINE DEATH, occurs either as a result of detachment of the ovum from the uterine wall to some extent, or on the basis of an infectious process affecting the pregnant woman. In the first case, the cause of death of the fetus is rooted in the local lesion of the uterine mucosa (endometritis, hemorrhages), thanks to which the detachment of the ovum and its subsequent death occurs, while in the second case, the death of the fetus depends on intrauterine infection (see Infection): For certain infectious diseases (smallpox, malaria, scarlet fever), this pathway of infection penetration has been conclusively proven. Among infections in which the fetus most often dies in the mother's womb, syphilis should be placed first. The cause of death of the fetus in acute infections may be severe hyperemia of the uterine mucosa with subsequent hemorrhage into the shedding membrane, or the death of the ovum occurs due to premature contractions of the uterus, as well as due to overheating on the basis of high temperature. In typhoid fever, about _1/3 of fetuses generally die in utero. In almost half of all cases, cholera causes the death of the fetus. Less frequently is the death of the fetus observed in smallpox, scarlet fever, erysipelas, measles, and diphtheria; the mechanism of death of the ovum in these diseases is the same as in other infections. In influenza, interruption of pregnancy and death of the fetus may also occur due to the development of endometritis, although this is rarely observed. In anthrax, glanders, and rabies, the fetus usually dies, and pregnancy is interrupted. Pneumonia affects the fetus extremely unfavorably, especially in the second half of pregnancy. High temperature and poisoning with CO₂ usually kill the fetus, while at the same time causing labor activity soon after the initial shaking chill. Cases of combination of pneumonia with pleurisy particularly severely affect the fetus. As for tuberculosis, by itself it does not disrupt the course of pregnancy and only in far advanced, progressive stages can cause detachment of the ovum, death of the fetus, and premature labor. In diseases of the circulatory organs, death of the fetus can occur only in cases where there is an uncompensated heart defect, with degeneration of the heart muscle, with severe edema, dropsy, shortness of breath, etc. With such heart defects, about ^1/3 of fetuses die. Among diseases of the urinary organs, nephritis of pregnant women is of great importance, which represents one of the most frequent causes of premature labor, occurring as a result of death of the fetus due to destruction of placental tissue by extensive white infarcts or due to premature separation of the placenta. Eclampsia also plays a significant role in intrauterine death of the fetus. Mortality of fetuses in eclampsia reaches almost 42%. Among poisonings causing death of the fetus, lead and phosphorus poisoning should also be mentioned. Cases of interruption of pregnancy due to death of the fetus on the basis of chronic alcoholism of parents are known. In addition to the listed causes, it is necessary to mention improper positions of the uterus, mainly its retroflexions (retroflexio uteri gravidi) and infantilism. Both of these anomalies can lead to detachment of the ovum, death of the fetus, and miscarriage. The fate of the intrauterine dead ovum varies. Its death does not always lead to its immediate expulsion from the uterus. Whole weeks may pass before labor pains appear in the uterus and it is freed from the dead fetus. The changes undergone by the latter during this time come down to the following processes: 1) young embryos may dissolve in the amniotic fluid, 2) fetuses of older age may undergo maceration (see), 3) the dead fetus may undergo mummification (see), 4) sometimes a dead fetus that has remained in the uterus for a long time may become encrusted with lime salts and give what is known as a petrified fetus (see Lithopedion). This is a rather rare phenomenon observed in the so-called missed abortion, resp. missed labour (see Abortion as a medical phenomenon); 5) finally, in case of access of microorganisms to the uterine cavity, ichorous decomposition of the fetus with the excretion of its individual parts may occur. Treatment, besides those cases where complete resorption of the dead fetus occurs, must be surgical, in each individual case according to its peculiarities.