[33] Stillbirth and Neonatal Death Flashcards by Elliot Jones

What is stillbirth?

The death of a baby before or during birth after 24 weeks gestation in the UK

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What is neonatal death?

Death of a baby in the first 28 days of life

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What is the rate of stillbirths?

4.9/1000 live births

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What is the rate of neonatal deaths?

2.8/1000

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What has happened to the rates of stillbirth and neonatal death over the last 2 decades?

Fallen

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What is thought to be responsible for the fall in rates of stillbirth and neonatal death?

Improvements in healthcare
Improvements in midwifery
Improvements in neonatal care

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What are the risk factors for stillbirth and neonatal death?

Fetal growth restriction
Pre-term birth
Age of mother
Maternal health
Obstetric complications
Multiplicity of pregnancy
Nulliparous
Congenital abnormality
Low birth weight
Social factors
Ethnicity

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What is the biggest risk factor for stillbirth?

Fetal growth restriction

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When is fetal growth restriction an even bigger risk for stillbirth?

If not detected antenatally

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What is the biggest risk factor for neonatal death?

Pre-term birth

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What maternal age ranges have higher rates of neonatal death?

Under 25

- Over 40

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How does maternal age affect the rate of stillbirth?

Increases with age

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What maternal health factors increase risk of stillbirth and neonatal death?

Obesity
Smoking
Chronic diseases
Infection
Substance abuse, especially cocaine
Mental health problems

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What maternal chronic diseases increase the risk of stillbirth and neonatal death?

Diabetes
Renal failure
Hypertension
Haemoglobinopathy
Rhesus disease
Thrombophilias
Antiphospholipid syndrome

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What infections increase the risk of stillbirth and neonatal death?

Erythema infectiousum
Varicella
Measles

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What obstetric complications increase the risk of stillbirth and neonatal death?

Pre-eclampsia
Antenatal haemorrhage
Intrapartum complications

What intrapartum complications increase the risk of stillbirth and neonatal death?

Malpresentation

- Obstructed labour

What social factors increase the risk of stillbirth and neonatal death?

Lack of employment

- High deprivation index

What ethnicity is at increased risk of stillbirth and neonatal death?

African and African-Caribbean women (significantly higher risk)

What are the causes of neonatal death?

Prematurity
Congenital abnormality
Obstetric complications
Infection

When in particular can prematurity cause neonatal death?

When it causes respiratory and neurological conditions

What are the causes of stillbirth?

Congenital abnormality
Haemorrhage during pregnancy or labour
Placental insufficiency
Pre-eclampsia
Obstetric complications
Cord prolapse
IUGR
Liver diease
Diabetes
Infections during pregnancy

What obstetric complications can cause stillbirth?

Spontaneous premature labour
Premature rupture of membranes
Polyhydraminos
Oligohydraminos
Intrapartum asphyxia
Birth trauma

What liver disease can cause stillbirth?

Obstetric cholestasis

- Intrahepatic cholestasis of pregnancy

How might a stillbirth be diagnosed?

- Mother may be aware of a decrease in fetal movements | - May be discovered at the routine antenatal check

How is stillbirth confirmed?

Ultrasound examination showing lack of visible heartbeat

What should be done when the death of a baby is diagnosed antenatally?

Labour is induced

How is labour induced following the antenatal diagnosis of stillbirth?

Vaginal prostaglandins

When should labour be induced after the antenatal diagnosis of stillbirth?

Does not need to be immediate, but should happen within 2-3 days

What investigations does the mother need after the antenatal diagnosis of stillbirth?

- BP - Urine tested for protein- - Temperature taken - Cervical and vaginal swabs for MC&S - Bloods

What bloods should be done after the antenatal diagnosis of stillbirth?

- FBC - Clotting screen - Kleihauer test - HbA1c - Cultures - Serology

What additional care might the patient require after stillbirth?

Bereavement care

What bereavement care can be given to the patient after stillbirth?

- Should be allowed to stress and spend time with their child - May wish to take photos and make some memories with the child

What member of staff should all maternity units have to help with stillbirth care?

Specially trained bereavement midwives

What needs to be discussed regarding post-mortem in stillbirth?

The need for post-mortem, and consent

Why is stillbirth registration important?

- Gives a source of historical and statistical information - Gives the parents the opportunity to have their child officially recognised and to give them a name if they wish to, which can help with grief

What needs to be provided to register a stillbirth?

Medical certificate of stillbirth

Who issues a medical certificate of stillbirth?

Doctor or midwife

Are parents entitled to maternity/paternity leave and pay when there is a stillbirth/neonatal death?

Yes