General Obs

Question 1

Associations with DFM

Answer 1

Stillbirth
FGR - occult or known
FMH
Congenital abnormalities
Placental insufficiency
TPL
Adverse perinatal outcomes -> stillbirth, emergent delivery, low apgars, disability

Question 2

What proportion of women presenting with FDIU had DFM prior?

Answer 2

55%

Question 3

What is the current perinatal mortality rate in Aus?

Answer 3

9.6 per 1000 births
Stillbirths 7 per 1000
NND 3 per 1000

Question 4

What is the perinatal mortality rate in ASTI?

Answer 4

14 per 1000

Question 5

Stillbirth risk factors

Answer 5

prev stillbirth
Smoking
Medical co-morbidities (eg DM, HTN, APLS)
Obesity
Extremes of age (AMA >35)
Primip
Low SES

Question 6

Assessment for DFM prior to 28 week

Answer 6

CTG not recommended
Consider US and FMHq

Question 7

What is the evidence for foetal movement monitoring?

Answer 7

cochrane review -> no RCTs 2012
Cochrane 2012 -insufficient evidence to guide FM counting vs not

Question 8

DIC risk post FIDU at term?

Answer 8

10% at 4 weeks from Dx

Question 9

How likely spont labour with FDIU ?

Answer 9

85% will labour in 3 weeks

Question 10

Risks of prolonged gestation with FDIU (ie expectant mx)

Answer 10

risk of DIC (>after 4 weeks)
Maceration of baby
Value of post mortem declines

Question 11

Can you VBAC with PGD in setting of FDIU?

Answer 11

yes, though risk of scar rupture persists