Vaccination against influenza and SARS-CoV-2 is recommended during epidemic periods for prevention.
Counseling or prescribing rest, aspirin, vitamin A, vitamin D, or micronutrient supplements is not recommended for preventing fetal death.
Fetal autopsy and placenta examination, along with chromosomal analysis by microarray testing, are recommended following fetal death.
Patient management should consider individual preferences regarding labor induction timing and delivery mode in cases of fetal death.
There is no increased incidence of recurrence after unexplained fetal death in subsequent pregnancies.
In monochorionic twin pregnancies, the surviving twin should be monitored for acute fetal anemia after the death of one twin.
Simplified
is defined as the spontaneous cessation of cardiac activity after 14 weeks gestational age (GA). Regarding prevention of fetal death in the general population, it is not recommended to counsel or prescribe rest, aspirin, vitamin A, vitamin D, or micronutrient supplementation; systematically look for nuchal cord during prenatal screening ultrasound; or perform systematic antepartum monitoring by cardiotocography for the sole purpose of reducing the risk of fetal death. It is recommended to offer vaccination against influenza in epidemic periods and against SARS-CoV-2. Regarding evaluation in the event of fetal death, it is recommended that a fetal autopsy and anatomopathologic examination of the placenta be performed; chromosomal analysis be performed by microarray testing, rather than by conventional karyotype (with postnatal sampling of the fetal placental surface preferred for genetic purposes); testing for antiphospholipid antibodies be performed, with systematic Kleihauer-Betke testing and for irregular agglutinins; and summary consultation to discuss these examination results be offered. Regarding announcement and support, it is recommended that fetal death be announced without ambiguity, using simple words adapted to each situation, after which the couple should be supported with empathy across the different stages of their care. Regarding patient management in cases of fetal death, it is recommended that: in the absence of risks for disseminated intravascular coagulation or maternal demise, the patient's wishes regarding the timing between the fetal death diagnosis and labor induction should be considered; return home is possible, according to the patient's wishes; in all situations except maternal life-threatening emergencies, the preferred mode of delivery is vaginal, regardless of previous cesarean section(s); mifepristone 200 mg be prescribed at least 24 h before induction; and perimedullary analgesia be initiated at the start of induction if requested by the patient, regardless of GA. Of note, there is insufficient evidence to recommend either the administration route (i.e., vaginal or oral) of misoprostol or prostaglandin type. Regarding the risk of recurrence after unexplained fetal death: the incidence does not appear to be increased in subsequent pregnancies; in cases with a history of fetal death due to vascular problems, low-dose aspirin is recommended to reduce perinatal morbidity (otherwise, evidence is insufficient to recommend the prescription of aspirin); no optimal delay in initiating another pregnancy should be recommended based solely on a history of fetal death; fetal heart rate monitoring is not indicated based solely on a history of fetal death; although systematic labor induction is not recommended, induction may be considered depending on the context and parental request, and considering fetal age, benefits, and risks, especially before 39 weeks GA. Note that if the cause of fetal death is identified, management should be adjusted on a case-by-case basis. Regarding fetal death in a twin pregnancy, it is recommended that the surviving twin be examined immediately upon fetal death diagnosis; in a dichorionic twin pregnancy, preterm delivery induction is not recommended; in a monochorionic twin pregnancy, the surviving twin should be immediately evaluated for signs of acute fetal anemia, with weekly ultrasound monitoring for the first month, though immediate labor induction is not recommended.
Key numbers
3.2 to 4.4/1000 births
rate
Prevalence of after 22 weeks gestational age.
strong recommendation
Vaccination recommendation
Recommended vaccinations against influenza and SARS-CoV-2.
11.2%–64.6%
Placental lesions explanation
Percentage of cases where placental lesions could explain .
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Olivia Anselem has attended board meetings and symposia for Sanofi and Pfizer and has attended symposia in the last 3 years. Julie Blanc has attended board meetings for Organon and Effik in the last three years. Matthieu Dap has attended a symposium for Exeltis in the last three years. Charles Garabedian has attended board meetings for Organon and symposia for Ferring and General Electrics in the last three years. Paul Guerby has attended board meetings for Norgine and Alexion and symposia for Organon, Theramex and General Electrics in the last three years. Alexandre Vivanti has attended a board meeting for Norgine in the last three years. The other authors declare no conflicts of interest.
