IUFD at 22 Weeks: Causes, Risks, and Future Pregnancies - Obstetrics and Gynecology

Fetal intrauterine fetal demise (IUFD) at 22 weeks of gestation?

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Hello, Doctor.
I am 38 years old and have been married for three and a half years without becoming pregnant.
My menstrual cycle is approximately 28-30 days, but every three months or so, it extends to 40-42 days, lasting about 5-7 days.
I have not been working during the pregnancy and mostly stay at home.
My last menstrual period was on May 31, and on July 7, I noticed brown discharge (mistakenly thought it was menstruation).
On July 10, I had pink discharge and went to the clinic to confirm the pregnancy (natural conception) (7.4mm/4.2mm).
I took the small white pill home for care.
On July 17, I experienced some discharge and abdominal pain, so I returned to the clinic (11.1mm/11.6mm) and took the small white pill home again.
On July 25, I noticed pink discharge on toilet paper and went to the clinic (6w2d/CRL 6.0mm/expected due date 3/18/2024).
I took the small white pill home for care to ensure the fetus's condition and switched to a larger hospital for examination on August 14 (8w4d/CRL 19.8mm).
The doctor measured the expected due date as 3/14/2024.
On August 30, I experienced severe abdominal pain but no bleeding.
After examination, the doctor said it was likely due to a fibroid pressing on the bladder (a fibroid was found to be 2cm in February and grew to 4cm during pregnancy).
However, there was some vaginal inflammation, and I was prescribed pain medication and vaginal suppositories.
On September 3 (12w4d/CRL 61.9mm), everything else was normal.
On September 29 (16w2d/136g), the doctor said the fetus was a bit small, and due to discharge, the doctor performed an internal examination and noted some inflammation, prescribing suppositories and ointment.
On October 8 (17w3d/242g), I underwent amniocentesis (at a different hospital from the prenatal check-up), and the doctor estimated the due date to be 3/21/2024 with normal chromosomes.
On October 27 (20w2d/254g), the doctor noted the fetus was still a bit small, and due to slight discharge, the doctor did not perform an internal examination but prescribed suppositories and ointment.
On November 10, I underwent a high-level ultrasound, and the doctor determined IUFD (intrauterine fetal demise) occurred about a week prior (I had no abdominal pain or bleeding during that week).
On November 11, I underwent induction, and blood tests revealed low platelet count (30,000) and elevated liver enzymes (the doctor did not specify how high), but both hematology and obstetrics stated that my 12-week blood test results were normal.
After induction, the fetus weighed 270g and measured 22cm, and the placenta appeared normal.
The doctor only mentioned that the embryo was not viable (at that time, I did not think to pursue further testing and relied solely on visual assessment).
I would like to ask the doctor: 1.
Can a poor-quality embryo lead to IUFD in the mid-pregnancy? What is the incidence rate of this? 2.
Could my frequent vaginal inflammation have affected the fetus and caused a bacterial infection leading to IUFD? 3.
In the early stages of pregnancy, every doctor assessed the fetus as being behind in development, and starting from 16 weeks, the doctor indicated the fetus was too small.
If I have another opportunity to become pregnant, are there other ways to prevent this? Is the small size of the fetus related to maternal nutrition? However, I have been eating small, frequent meals, my weight has been steadily increasing normally, and I generally eat a very cautious diet.
4.
Does the doctor have any other recommendations?

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RITA, 30~39 year old female. Ask Date: 2014/11/21