Late Intrauterine Fetal Death and Stillbirth

RCOG Green-Top guideline 2010

What are the infections associated with late IUFD?

Transplacental infections associated with IUFD include

  • cytomegalovirus

  • syphilis

  • parvovirus B19

  • listeria

  • rubella

  • toxoplasmosis

  • herpes simplex

  • coxsackievirus,

  • leptospira,

  • Q fever,

  • Lyme disease

  • Malaria parasitaemia

Ascending infection, with or without membrane rupture

  • Escherichia coli, Klebsiella,

  • Group B Streptococcus, Enterococcus,

  • Mycoplasma/Ureaplasma, Chlamydia

  • Haemophilus influenzae.

Tests recommended for women with a late IUFD

Blood culture, midstream urine, vaginal and cervical swab

  • Test for Listeria and Chlamydia spp.

  • Test when present with fever, flu-like symptom, abnormal (purulent/offensive) liquor & prolonged rupture of membrane before late IUFD

Serology

  • Check saved serum for baseline serology

  • Parvovirus B19, Rubella (if non-immune at booking)

  • CMV, Herpes, Toxoplasma (routinely)

  • Syphilis

  • Other - if risk factors present.

Foetal blood/swab/Placental swab

  • More informative than maternal blood

  • Cord or cardiac blood (if possible/may need consent) in lithium heparin


Stillbirth related to infection varies from 5-22%

Bacterial causes are Escherichia coli - commonest, Group B streptococcus , Enterococcus , Listeria monocytogenes (rare), Chlamydia

Virus - Cytomegalovirus (commonest), Parvovirus, syphilis, herpes simplex virus, Rubella

Other - Toxoplasma