IUFD

Question 1

Obstetrical causes of stillbirth represent 29%. Name 3 examples of obstetrical complications related to stillbirth.

Answer 1

1) Abruption
2) Multifetal gestation
3) PPROM

Question 2

What is the fold increase of stillbirth, in a woman with a previous stillbirth?

What is the baseline risk of stillbirth per 1000 births?

Answer 2

1) 5 fold

2) 6.4 per 1000 births

Question 3

What are maternal risk factors for Stillbirth? (10)

Answer 3

1) Chronic HTN
2) SLE
3) Diabetes
4) Renal Disease
5) Thyroid disease
6) Thrombophilia
7) Smoking > 10 cig
8) Obesity BMI >30
9) Advanced maternal age >35
10) African

Question 4

What are the pregnancy associated risk factors for stillbirth? (5)

Answer 4

1) Previous stillbirth
2) Multifetal pregnancy
3) Pre-eclampsia
4) Cholestasis
5) Previous IUGR

Question 5

What are the options for investgations following delivery of stillbirth (related to fetus and placenta)?

Answer 5

1) Cytology (amnio vs placenta below cord insertion vs umbilical cord segment 1.5 cm vs patella)
2) fetal autopsy and placental pathology
3) inspection of fetus and placenta (HC, weight, length of fetus, weight of placenta, gross abnormalities, photos)

Question 6

Recommendations for subsequent pregnancy per each trimester?

Answer 6

1) First trimester: dating US, genetic screening
2) Second trimester: GDM screening, anatomy US,
3) Third trimester: fetal kicks at 28 weeks and fetal growth at 28 weeks to r/o IUGR), start routine US at 32 weeks or 1-2 weeks earlier than prior stillbirth; IOL at 39 weeks

Question 7

What are your recommendations pre-preg for subsequent pregnancy?

Answer 7

1) smoking cessation
2) weight loss (if obese)
3) genetic counselling
4) determine cause of previous stillbirth and review risks
5) diabetes screen
6) thrombo w/u (if meets criteria)

Question 8

What is the single most predictive factor of stillbirth?

Answer 8

Previous stillbirth

Question 9

What are 3 adverse pregnancy outcomes that women with previous stillbirths are at risk for?

Answer 9

1) PTB
2) LBW
3) Abruption
4) Pre-eclampsia

Question 10

Are uterine artery Dopplers recommended universally in women with previous stillbirth?

Answer 10

NO

Question 11

What are the laboratory and pathological testing required at the time of identification of IUFD?

Answer 11

1) CBC, group and screen
2) HgbA1C
3) Nierhauss
4) Coagulation
5) TORCH + syphillis
6) Parvovirus
7) Hgbelectrophoresis
8) Thrombophillia (6-8 weeks postpartum if meet criteria)
9) External examination of fetus
10) Karyotype
11) Fetal autopsy
12) Placental pathology

Question 12

What is the threshold for a low PAPP-A

Answer 12

< 0.4 MoM

Question 13

If SB secondary to placental insufficiency what medication and dose would you recommend?

And at what gestation?

Answer 13

1) ASA 162 mg PO qhs

2) Between 12 and 16 weeks and discontinue at 37 weeks