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4: Y4 - Obstetrics [13] > [33] Stillbirth and Neonatal Death > Flashcards

[33] Stillbirth and Neonatal Death Flashcards

1
Q

What is stillbirth?

A

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

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2
Q

What is neonatal death?

A

Death of a baby in the first 28 days of life

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3
Q

What is the rate of stillbirths?

A

4.9/1000 live births

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4
Q

What is the rate of neonatal deaths?

A

2.8/1000

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5
Q

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

A

Fallen

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6
Q

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

A
  • Improvements in healthcare
  • Improvements in midwifery
  • Improvements in neonatal care
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7
Q

What are the risk factors for stillbirth and neonatal death?

A
  • 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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8
Q

What is the biggest risk factor for stillbirth?

A

Fetal growth restriction

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9
Q

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

A

If not detected antenatally

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10
Q

What is the biggest risk factor for neonatal death?

A

Pre-term birth

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11
Q

What maternal age ranges have higher rates of neonatal death?

A
  • Under 25

- Over 40

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12
Q

How does maternal age affect the rate of stillbirth?

A

Increases with age

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13
Q

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

A
  • Obesity
  • Smoking
  • Chronic diseases
  • Infection
  • Substance abuse, especially cocaine
  • Mental health problems
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14
Q

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

A
  • Diabetes
  • Renal failure
  • Hypertension
  • Haemoglobinopathy
  • Rhesus disease
  • Thrombophilias
  • Antiphospholipid syndrome
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15
Q

What infections increase the risk of stillbirth and neonatal death?

A
  • Erythema infectiousum
  • Varicella
  • Measles
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16
Q

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

A
  • Pre-eclampsia
  • Antenatal haemorrhage
  • Intrapartum complications
17
Q

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

A
  • Malpresentation

- Obstructed labour

18
Q

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

A
  • Lack of employment

- High deprivation index

19
Q

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

A

African and African-Caribbean women (significantly higher risk)

20
Q

What are the causes of neonatal death?

A
  • Prematurity
  • Congenital abnormality
  • Obstetric complications
  • Infection
21
Q

When in particular can prematurity cause neonatal death?

A

When it causes respiratory and neurological conditions

22
Q

What are the causes of stillbirth?

A
  • Congenital abnormality
  • Haemorrhage during pregnancy or labour
  • Placental insufficiency
  • Pre-eclampsia
  • Obstetric complications
  • Cord prolapse
  • IUGR
  • Liver diease
  • Diabetes
  • Infections during pregnancy
23
Q

What obstetric complications can cause stillbirth?

A
  • Spontaneous premature labour
  • Premature rupture of membranes
  • Polyhydraminos
  • Oligohydraminos
  • Intrapartum asphyxia
  • Birth trauma
24
Q

What liver disease can cause stillbirth?

A
  • Obstetric cholestasis

- Intrahepatic cholestasis of pregnancy

25
Q

How might a stillbirth be diagnosed?

A
  • Mother may be aware of a decrease in fetal movements

- May be discovered at the routine antenatal check

26
Q

How is stillbirth confirmed?

A

Ultrasound examination showing lack of visible heartbeat

27
Q

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

A

Labour is induced

28
Q

How is labour induced following the antenatal diagnosis of stillbirth?

A

Vaginal prostaglandins

29
Q

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

A

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

30
Q

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

A
  • BP
  • Urine tested for protein-
  • Temperature taken
  • Cervical and vaginal swabs for MC&S
  • Bloods
31
Q

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

A
  • FBC
  • Clotting screen
  • Kleihauer test
  • HbA1c
  • Cultures
  • Serology
32
Q

What additional care might the patient require after stillbirth?

A

Bereavement care

33
Q

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

A
  • Should be allowed to stress and spend time with their child
  • May wish to take photos and make some memories with the child
34
Q

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

A

Specially trained bereavement midwives

35
Q

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

A

The need for post-mortem, and consent

36
Q

Why is stillbirth registration important?

A
  • 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
37
Q

What needs to be provided to register a stillbirth?

A

Medical certificate of stillbirth

38
Q

Who issues a medical certificate of stillbirth?

A

Doctor or midwife

39
Q

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

A

Yes

4: Y4 - Obstetrics [13] (61 decks)

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