Antenatal - Stillbirth & cardiac arrest

Question 1

what is stillbirth?

Answer 1

defined as birth of a dead fetus after 24 weeks gestation. result of intrauterine fetal death

occurs in 1 in 200 pregnancies

Question 2

what are some causes of stillbirth?

Answer 2

• Unexplained (around 50%)
• Pre-eclampsia
• Placental abruption
• Vasa praevia
• Cord prolapse or wrapped around the fetal neck
• Obstetric cholestasis
• Diabetes
• Thyroid disease
• Infections, such as rubella, parvovirus and listeria
• Genetic abnormalities or congenital malformations

Question 3

what factors increase risk of stillbirth?

Answer 3

• Fetal growth restriction
• Smoking
• Alcohol
• Increased maternal age
• Maternal obesity
• Twins
• Sleeping on the back (as opposed to either side)

Question 4

how is stillbirth prevented?

Answer 4

all women are assessed for risk of having a baby that is small for gestational age

and those at risk have serial growth scans

modifiable risk factors for stillbirth are treated - stop smoking, avoid alcohol, sleep on side not back

Question 5

what are 3 key symptoms to ask about during pregnancy which women would most likely report immediately?

Answer 5

reduced fetal movements

abdominal pain

vaginal bleeding

Question 6

how is still birth diagnosed?

Answer 6

ultrasound scan to diagnose intrauterine fetal death (IUFD) - visualise fetal heartbeat to confirm still alive

Question 7

once intrauterine fetal death has been confirmed how is stillbirth managed?

Answer 7

passive fetal movements may be felt to repeat scan to confirm situation is often done

rhesus D negative women require anti-D prophylaxis

vaginal birth is first line for most women unless reason for CS

choice of IOL or expectant management (as long as immediate is not required and involves waiting for natural labour, often need close monitoring)

Question 8

what can be given to suppress lactation after stillbirth?

Answer 8

dopamine agonists eg cabergoline

Question 9

with parental consent, what tests can be carried out after stillbirth to determine the cause?

Answer 9

genetic testing of fetus and placenta

postmortem of fetus

testing for maternal and fetal infection

testing mother for conditions associated with stillbirth - diabetes, thyroid disease, thrombophillia

Question 10

give 3 causes major causes of cardiac arrest

Answer 10

obstetric haemorrhage

pulmonary embolism

sepsis - metabolic acidosis and septic shock

aortocaval compression

Question 11

explain aortocaval compression and explain what can be done to help

Answer 11

after 20 weeks the uterus can compress the vena cava reducing the venous return, reducing cardiac output and leading to hypotension

venca cava is slightly on the right so lie woman in left lateral position

Question 12

what additional things are done in resuscitation in pregnancy

Answer 12

15 degree tilt to left side for CPR

early intubation

early supplementary oxygen

aggressive fluid resuscitation

deliver baby after 4 mins and within 5 mins for CPR

Question 13

when is immediate CS performed in pregnant women

Answer 13

1. no response after 4 minutes to CPR performed correctly
2. CPR continues for more than 4 minutes in a woman more than 20 weeks

aim to deliver within 5 minutes of CPR

primary reason to deliver is to improve survival of the mother as delivery improves venous return, cardiac output and reduces oxygen consumption