The rate of IUFD is 5.74 per 1,000 live births and decreases to 2.78 per 1,000 live births after 28 weeks. All of these patients should be offered fetal autopsy, genetic evaluation, and examination of the placenta, umbilical cord, and membranes. Other testing is individualized by case. The SMFM and ACOG have proposed an algorithm to assist clinicians: www.smfm.org/publications/322-acog-smfm-occ-10-management-of-stillbirth. Dilation and evacuation and induction of labor are delivery options prior to 28 weeks and depend on patient preference and history. After 28 weeks, general obstetrical protocols for induction of labor are recommended. Antepartum surveillance is recommended starting at 32 weeks and is individualized in patients with a history of IUFD prior to 32 weeks. Consideration can be made to fetal growth scan. Delivery timing is determined by a discussion of the fetal and maternal risks of delivery at or before 39 weeks

A 35-year-old female, gravida 1, para 0, presents to the clinic for her anatomy ultrasound at 20 weeks’ gestation. She denies any complaints and has not yet begun feeling fetal movements. Her prenatal course thus far has been unremarkable. She declined aneuploidy screening earlier in her pregnancy. Her past medical history is significant for chronic hypertension, which has been controlled with labetalol. She has no other relevant past medical or surgical history. She has no known allergies.