Assessment

HISTORY. Obtain a thorough obstetric and medical history. Determine the gestational age of the fetus by asking the patient the date of her last menstrual period and using Nagele's rule. Inquire about any contractions, bleeding, or leakage of fluid. Ask about exposure to environmental teratogens or the use of recreational or prescription drugs. Ask the patient when she last felt the baby move. Also inquire about any cultural and religious preferences related to labor, delivery, postpartum care, autopsy, and receiving a blood transfusion.

PHYSICAL EXAMINATION. Attempt to auscultate a fetal heart rate with a Doppler or electronic fetal monitor. If no heart rate is heard, perform an ultrasound to be sure no heart rate is present. Determine McDonald's measurement and compare this with previous data; the measurement is usually less than that expected for the gestational age if an IUFD has occurred. Palpate the abdomen for rigidity, which is often present with abruptio placentae, or for change in shape, which is often present with uterine rupture. Inspect the perineum for bleeding, and note any foul odors. Perform a vaginal examination to check for a prolapsed cord, and note any cervical dilation and effacement. If possible, determine the fetal presenting part and the station. Check the patient's vital signs. A temperature higher than 100.4T may indicate the presence of infection. Weigh the patient; some may experience a weight loss. Because DIC is a potential complication of IUFD, monitor the patient for the following signs and symptoms of DIC: bleeding from puncture sites, episiotomy, abdominal incision, or gums; hematuria; epistaxis; increased vaginal bleeding, bruising, and petechiae.

A thorough physical examination is done of the fetus, umbilical cord, amniotic fluid, placenta, and membranes to determine the cause of death. Knowing the cause may be therapeutic for the parents and helps relieve guilt feelings.

PSYCHOSOCIAL. Assess the patient's reaction and ability to cope with the fetal death and her anxiety about going through the labor process. Determine the meaning of the pregnancy for the patient. Observe the interaction between the patient and her significant other to assess potential support.

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