Embryonic Demise

 

Ms. Harpreet Kaur Sodhi

HOD Nursing Foundation, Clinical Instructor, Army College of Nursing, Jalandhar, Cantt

*Corresponding Author E-mail: preetnoor131411@yahoo.com

 

ABSTRACT:

The foetal development is done at the end of 10th week of gestation period generally and in case of normal menstruation it is count as 12Th week of gestation. In this captious time of development a single cell changes in to an embryo which further form as human. In this difficult period several changes occurs in the seed. These complex events can be evaluated by TVS (Trans vaginal sonography). It shows the growth of unhatched offspring in to a foetus along with gestational sac and yolk sac. If we do a survey on Embryonic Demise the rate is 6 per 1000 live birth. Mostly at 7week -8 week of gestation period. The women is not aware about the demise. Only the investigations like on real time B-mode sonography shows missed abortion with tiny foetal pole of 3mm with no cardiac output. In some cases women do not know the actual reason of death. It can be due to maternal factors, foetal factors and oligospermia or azospermia. It can be detected in investigations before conception. At this critical stage physician give two options one is medical evacuation and surgical evacuation it is truly depends upon the patient’s condition. After the expulsion TVS is done to see the condition of uterus and ET lining. Proper guidance is given to the patient regarding medication, rest and diet. Counselling of the couple helps to relive from grief and anxiety and motivate to try again after a gap of 2-3 months.

 

KEYWORDS: Embryonic, Menstrual, Gestational, Fertilized Cell, Trans -Vaginal -Ultrasongraphy, Implantation and Embryo, Labour, oligospermia, azospermia, guidance and counselling.

 

 


INTRODUCTION:

The embryonic demise is the condition when embryo is not getting proper oxygen & has any chromosomal abnormality. Due to this death of foetus in the uterus occurred. It is most common in 6 weeks of pregnancy when embryo is not getting proper nourishment and also women have some chromosomal abnormality. In some cases age is the basic reason of foetal death sometime embryos are not able to cope up with the environment.1

 

Definition:

Embryonic Demise is defined as death of foetus at the 7 week to 8 week of gestation period due to absence of cardiac output & any chromosomal abnormality2.

 

Incidence:

According to national vital statistics report from 2006, the rate of IUFDs is 6.05per 1000 births or less than 1 %. (JUN 20, 2019)2.

 

Causes:

Maternal causes3:

·       Age (>35)3

·       Preeclampsia or eclampsia3

·       Rupturing of uterus3

·       Obesity (>30kg/m2)3

·       RH incompatibility3

·       Hyperpyrexia3

·       Trauma3

·       Infection (malaria, hepatitis, influenza, syphilis,toxoplasma)3

·       Pre existing disease (epilepsy)3

·       Poorly controlled diabetes3

·       Smoking (alcohol ,drug abuse)3

·       Anaemia3

·       Placental abruption3

·       Genetic abnormalities3

 

Foetal causes5:

·       Multiple gestation5

·       IUGR5

·       Nuchal translucency5

·       Foetal hydrops (congenital infection with paravirus)5

·       Foetal hemodynamic5

·       Congenital defects5

·       Infections5

·       Chromosomal abnormality5

·       Tuberculosis in uterus5

 

According to %age8:

·       Maternal 5-10%8

·       Foetal 25-40%8

·       Placental 20-35%8

·       Unexplained 15-35%8

 

Placental causes8:

·       Umbilical cord accident8

·       Abruption8

·       Premature rupture of membrane8

·       Fetomaternal haemorrhage8

·       Placental insufficiency8

·       Placenta previa8

·       TTTS8

 

Male factors3:

·       Oligospermia3

·       Azospermia3

·       Structural problems3

·       Chromosomal abnormality3

 

Symptoms7:

·       Pain in the abdomen7

·       Infection7

·       Bleeding from vagina7

·       Uterine tone is diminished7

·       Foetal movements are not feeling during palpation7

·       Foetal heart sound is not audible7

 

Diagnostic test4:

·       Ultrasound4

·       TVS4

·       Non- Stress Testing: The foetus is connected to foetal heart monitor for 20minutes to ensure heart rate.4

·       Biophysical profile: an ultrasound & non stress test is done to check vital signs4

·       Umbilical cord artery Doppler velocimetry: check for blood flow in the umbilical cord.4

 

MANAGEMENT:

MEDICAL EVACUATION9:

·       The women on early stage of pregnancy can have the single dose of mifepristone 200mg orally and 36-48 hrs later vaginal misoprostol.9

·       800ug .Three hours following the first dose, two further dose of misoprostol and 400ug each were administered vaginally or orally. Women who fail to evacuate were offered repeat regimen of misoprostol. Successful evacuation will be done in 3 days.9

 

SURGICAL EVACUATION:10

·       Dilatation and curettage is the surgical procedure to remove the dead foetus. It is usually done after first trimester to remove the dead tissue in the uterus. It is successful in 95% to 100 % cases but there are small surgical risks.10

 

NURSE ROLE IN EMBRYONIC DEMISE:

·       Nurse should collect information through observation, interview & physical assessment.

·       Nurse should reduce the shock & pressure of the patient and family.

·       Nurse should provide courage to the patient to fight with the situation &to bear the fact of losing her child.

·       Nurse can communicate with the patient &her husband well & establish support system.

·       Nurse can provide psychological accommodation, her functional role, interdependence &than accepting the fact of losing child &maintain healthy body image.

 

RESULTS /DISCUSSION:

The result depicts that the ratio of embryonic demise is increasing day by day. It can be cured due to provide changes in lifestyle and dietary modifications. Moreover the couples can try again with motivational support and can have successful results.

 

CONCLUSION:

Every cloud has silver lining. Proper guidance and counselling can resolve the problem and can act as a boon for the couples.

 

IMAGES:

 

Image 1: depicts the on real B-mode sonography gravid uterus shows a single gestational sac with small foetal pole of 5.5wks size CRL.cardiac activity is not seen. Yolk sac is present. Cervix is closed, no mass seen in the walls.

 

Image 2: on real B- time sonography shows gravid uterus with elongated G-SAC of 8.5wks by GSD.tiny 3mmfetal pole without cardiac output is seen. No sac separation is seen. Impression of missed abortion at 8.5wks.

 

REFERENCES:

1.     Gordon Sherri (Dotadash Publication, September 20,2019 ) Https://WWW.Verywell Family.com>

2.     Gaufberg V Slava (Meds Cape Editorial, November 5, 2018) https://Emedicine.Medscape.com>2.

3.     Trivedi Neha, Laurent Louise (American Journal of Obstetrics and Gynecology, Volume 201,Issue 6, Supplement, December 2009,PAGE 93) Https://Www.Sciencedirect.Com>Pii

4.     Https://Academic.Oup.Com>Article

5.     Having A Baby, Miscarriage (Health Information For Westerns Australians) Https://Healthywa.Wagov.Au>Articles

6.     Press Green Winter, (Empty Arms Ilse Sherokee Paper Book) Edition 2015, jan 10 page no: 6, 9, 14, 16.

7.     Davis L.Deborh, (Empty Cradle Broken Heart Paper Book) Edition 2016, Nov 1 Page No :90,96,154

8.     Dutta D.C, Text Book of Gynecology, 7th Edition, Jaypee Publisher, New Delhi, Page No: 186,204,207.

9.     Approach Based Gynecology in Methods, Habeebullah S, Soundaraghavan, Oumachigui Asha, 18th Edition, Published by Elsevier, Page no: 36, 41,122.

10.  Gynecology Novak’s & Berek ,14th Edition, Published by Lippincott, Page no: 601,671,749,

 

 

Received on 19.03.2020          Modified on 10.04.2020

Accepted on 01.05.2020     © AandV Publications all right reserved

Int. J. Nur. Edu. and Research. 2020; 8(3):388-390.

DOI: 10.5958/2454-2660.2020.00083.6