10/11) Labour & Delivery - IUFD and Stillbirth Flashcards
Incidence of stillbirth
1 in 200
What proportion of stillbirths are SGA babies?
Over 1/3
What proportion of stillbirths are unexplained?
50%
What percentage of stillbirths are associated with suboptimal care?
> 50%
How to diagnose IUFD?
Real-time ultrasound (with second opinion where practical) demonstrating absence of FH.
Sensitivity of USS for detecting abruption
15%
Risk of DIC within 4 weeks of IUFD and risk after that
10% within 4 weeks and 30% after 4 weeks
What investigations to do if mother opting for expectant management beyond 48 hours?
Twice weekly clinical assessment and bloods to detect DIC.
What investigations should be done in a Rh NEG woman after an IUFD?
- Anti-D given
- Urgent Kleihauer and repeat 48 hours if large FMH
- Establish baby blood group
What maternal blood tests to do after IUFD/SB?
FBC UE/LFT CRP Clotting Kleihauer Random blood glucose & HbA1c Thyroid
Which microbiology investigations to do after IUFD/SB?
Parvo, rubella, CMV, HSV, toxoplasma and syphilis serology.
Feral blood (cord or cardiac), fetal swabs, placental swabs.
If maternal fever, flu-like symptoms, abnormal liquor or PROM: Blood cultures, MSU, HVS, Cervical swabs.
When to do maternal thrombophilia screen?
If evidence IUGR or placental disease.
When to do maternal antibodies?
Anti-red cell if feral hydrops.
Anti-Ro/La if hydrops, endomyocardial fibro-elastosis or AV node calcification.
Antiplatelet antibodies if fetal intracranial haemorrhage.
What tissue to take for karyotype?
Deep fetal skin, fetal cartilage and placenta.
Percentage of SB/IUFD with chromosomal abnormality
6%
What percentage of postmortems will give a classification of death?
46%
What percentage of postmortems will provide information on recurrence and management of future pregnancies?
40-50%
When to do parental bloods for karyotype?
Fetal unbalanced translocation.
Fetal aneuploidy.
Fetal genetic testing fails and history suggestive of aneuploidy.
When do women labour spontaneously after IUFD?
> 85% labour within 3 weeks
When to induce labour after IUFD?
If maternal health well and membranes intact - risk of delaying labour 48 hours is low.
If sepsis, PET, abruption or SROM then advise immediate steps toward delivery.
Consequences of prolonged expectant management
Need for twice weekly bloods for DIC.
Value of PM may reduce.
Appearance of baby may reduce.
After induction how long will it take for vaginal birth?
90% of IUFD can achieve vaginal birth within 24 hours.
Protocol for induction in women with unscarred uterus.
200mg mifepristone and then misoprostol.
<26+6: 100 micrograms misoprostol 6h
>27: 25-50 micrograms misoprostol 4h
Induction of labour for women with scarred uterus
Can use mifepristone alone to increase chance of labour significantly within 72 hours.
Miso can be used at doses 25-50 micro grams.
What percentage of women using simple measures to manage lactation report extreme pain?
1/3
Dose of carbergoline
1mg STAT
Success rate of carbergoline in suppressing lactation
90%
Risk of parental relationships dissolving after SB compared to live birth
40% increased risk
Who is responsible for registering birth?
Parents but can delegate to healthcare professional (42 days)
Care of pregnancy following a SB
CLC
GTT
Serial growth scans
Consider scheduled delivery
Risks in future pregnancies
Future SB PET Placental abruption Placental disease Fetal distress Chorioamnionitis Extreme PTB Early neonatal mortality GDM
What proportion of SB occur in low/middle income countries?
99%
In high income countries, what percentage of SB occur intrapartum?
<10%
What percentage of SB variation do maternal risk factors account for?
19%
What is the only antenatal intervention shown to reduce SB rate?
Aspirin in women at risk of PET
What would be the reduction in perinatal death from routine IOL at term?
50%
