IUFD GTG

Question 1

Why is mifepristone used to initiate induction of labout in IUFD?

Answer 1

Shorter time to birth, shorter induction to birth interval
Increases chance of vaginal birth

Question 2

Dosage of mifepristone for induction in IUFD?

Answer 2

200 milligram

Question 3

Dosage of misoprostol 24-25 weeks IUFD?

Answer 3

400 ucg every 3 hours
can be buccal, sublingual, vaginal, oral

Question 4

Dosage of misoprostol 25-28 weeks IUFD?

Answer 4

200 ucg every 4 hours

Question 5

Dosage of misoprostol 28+ weeks IUFD?

Answer 5

25-50ucg vaginal every 4 hours OR
50-100 microgram oral every 2 hours

Question 6

Non-modifiable risk factors late IUFD?

Answer 6

Nullip
>35 years <20
BAME
Previous SB
Previous PTB, PET, FGR
Multiple pregnancy
>41 weeks
SLE/Anti phospholipid

Question 7

Risks of delaying birth in IUFD?

Answer 7

DIC - test coag if delayed 48h+

Question 8

Investigations in IUFD?

Answer 8

Bloods - CRP, PET, coag, thyroid function, kleihauer, cultures, swabs, MSU, viral screen, glucosa/HbA1c
Fetal and plaental microbiology
Fetal and placental tissue for cytogenetics
If hydrops - anti-red cell antibodies
If suspicious of genetic anomaly - karyotype

Question 9

Risks in patients with IUFD who have has 1 previous CS having IoL?

Answer 9

Inform 2-3x increased chance of uterine rupture
Increased chance of needing CS
91% chance of vaginal del

Question 10

Doses in 1 previous CS and IoL for IUFD?

Answer 10

Same for 24-27 weeks
No evidence for doses after 28 weeks

Question 11

How to manage women with 2 or more previous CS and IUFD?

Answer 11

Safety of IoL is unknown
If 3 or more previous CS or upper segment incisions - do not recommend VBAC

Question 12

Should you give antibiotics?

Answer 12

Only if septic
Not required routinely

Question 13

How to suppress lactation

Answer 13

1mg cabergoline
Excessive discomfort in 1/3rd of women who decline pharm suppression

Question 14

MoA cabergoline?

Answer 14

Dopamine agonist

Question 15

Contraindications cabergoline?

Answer 15

Balance risks in PET/HTN
Can increase BP and associated with intraceberal haemorrhage

Question 16

How to send placental and cord samples for cytogenetic testing?

Answer 16

Placenta biopsy 1cm size, from fetal surface close to cord insertion
Cord biopsy 0.5cm length
Place in sterile tissue culture medium of lactated rengers solution

Question 17

If parents decline post-mortem, what substitutes can be offered?

Answer 17

Limited examinations, non-invasive, minimally invasive methods
USS and MRI can be offered

Question 18

Legal requirements for medical certification of stillbirth?

Answer 18

Medical certificate stating late IUFD - midwife or doctor needs to have been present at birth or examined baby afterwards
Should be registered within 42 days

Question 19

Care in subsequent pregnancies

Answer 19

USS 3-4 weekly, from 26-28 weeks
Offer aspirin 150mg as may be risk of placental insufficiency
IoL from 39 weeks reduces SB rate