Aim
The aim of this good practice point is to highlight the importance of prompt ultrasound assessment for diagnosis (or other) of fetal death inutero (FDIU) shortly after presentation to a health facility.
Background
A review of several cases where a woman presented to a health facility in pregnancy with a suspected FDIU has identified instances where assessment by formal ultrasound has not been made promptly due to, but not limited to:
- The absence of a skilled sonographer/obstetrician perform obstetric ultrasound to confirm diagnosis of FDIU
- Priority not being made to schedule in an urgent obstetric ultrasound due to hierarchy of need.
Whilst recognising the challenges some services face that may inhibit their ability to perform an immediate obstetric ultrasound to confirm or exclude the diagnosis of fetal death, it is important that women and their partners are not left waiting an unnecessarily long time to have a fetal death confirmed.
The emotional impact of waiting several hours, or until the following day, to confirm a diagnosis of FDIU, can cause psychological distress – anxiety, fear, and uncertainty which can exacerbate parents’ grief and have negative long term psychological impact.
Ultrasound Confirmation of FDIU
Formal ultrasound is the gold standard for confirming suspected fetal demise and should be performed by a qualified sonographer or obstetrician with expertise in fetal imaging.
Timing and Access
Rapid access is critical to reduce parental distress and to initiate appropriate care and support.
Many hospitals have on call ultrasound services or emergency imaging protocols for suspected FDIU, especially after 20 weeks' gestation.
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