Antenatal Care - Stillbirth Flashcards
What is Stillbirth?
Birth of a dead foetus after week 24 gestation.
Aetiology of Stillbirth.
Intrauterine Foetal Death (IUFD).
Causes of Stillbirth - IUFD (9).
- Idiopathic (50%).
- PET.
- Placental Abruption.
- Vasa Praevia.
- Cord Prolapse/Wrapped Around Neck.
- Obstetric Cholestasis.
- Diabetes.
- Thyroid Disease.
- Infections e.g. Rubella, Parvovirus, Listeria.
- Genetic Abnormality or Congenital Malformation.
Risk Factors of Stillbirth (7).
- FGR.
- Smoking.
- Alcohol.
- Increased Maternal Age.
- Maternal Obesity.
- Twins.
- Supine Sleep.
Prevention of Stillbirth.
- Risk Assessment - SGA or FGR.
2. Close Monitoring if at Risk with Serial Growth Scans.
Important Red Flags in any Problematic Pregnancy (3).
- Reduced Foetal Movements.
- Abdominal Pain.
- Vaginal Bleeding.
Investigations in Stillbirth.
- US - Investigation of Choice for IUFD.
2. Repeat US if Passive Foetal Movements.
Ultrasound Finding.
Foetal Heartbeat - confirms life in foetus.
Management of Stillbirth.
- Anti-D Prophylaxis after IUFD Diagnosis.
- Vaginal Birth (1st Line).
- Choice : Induction of Labour or Expectant Management (Natural Labour and Delivery with Close Monitoring).
What test is required in Anti-D Prophylaxis?
Kleihauer Test : Quantify how much foetal blood is mixed with maternal blood to determine the dose of anti-D required.
How is Labour Induced in Stillbirth?
Combination of Oral Mifepristone (Anti-Progesterone) and Vaginal/Oral Misoprostol (Prostaglandin Analogue).
Why may Dopamine agonists be used after stillbirth?
Suppress lactation.
How can the cause of Stillbirth be investigated?
With Parental Consent :
- Genetic Testing of Foetus and Placenta.
- Post-Mortem Examination of Foetus.
- Tests for Maternal and Foetal Infection.
- Testing Maternal Conditions.
