Late IUD and stillbirth Flashcards
1
Q
Stillbirth and IUD definition
A
SB- Baby born w no signs of life >24w
IUD- Fetal death in utero
2
Q
Diagnosis
A
Use USS- confirm by 2 people
Difficulties- High BMI, scars, oligo.
3
Q
Testing
A
- 50% no cause found
- Test maternal bloods- FBC, U+E, coag, LFT, CRP.
BM, TFT, viral screen, Thrombophilia screen - Causes- Coagulapathies, PET, cholestasis, sepsis
Fetal:
- Postmortem if wanted
- Karyotyping- Skin/placenta
- Infection screen
4
Q
Kleihauer
A
- Test on diagnosis of IUD
- give anti-D after bloods, adjust dose if large FMH
- Test babys blood group from cord if needed
5
Q
Management
A
- Expectant- Twice weekly FBC- HIGH risk for DIC
10% in 4 weeks of IUD - IOL for SVD
- Some might need CS
6
Q
IOL doses
A
- Single dose mifepristone 200mg
- After 24h, Misoprostol PV
7
Q
Miso doses
A
- <27 weeks- 100mcg every 6h
- > 27 weeks- 25-50mcg every 4h
- Prev CS- low dose 25-50 mcg
8
Q
Risks of miso if prev CS
A
- 1xCS- no inc risk
- 2 xCS - slightly higher risk
- > 2 xCS - safety is unknown
9
Q
Analgesia
A
- Diamorphine instead of pethedine
- Epidural, if needed
10
Q
Lactation
A
- Offer dopamine agonist- carbagoline
(DO NOT use if HTN/PET) - 1/3 women who do not have medication will be in discomfort
11
Q
PN care
A
- Breavement support
- High risk for PND- offer counselling and debriefing
12
Q
Baby momentos
A
- Do not force parents to have contact with the baby
- Support ay desires expressed
13
Q
Birth registration
A
- All babies if alive at 24 weeks but SB must be registered
- Registration in 42 days
- Gender- can be undetermined
- Name (if wanted) cannot be changed once registered
- Coroner/police if concerns about cause of SB
14
Q
F/u
A
- Discuss fertility/contraception
- Offer f/u with results
- Offer support for reversible factors- Wt loss, stop smoking
- Explain they can conceive again when they want
15
Q
Future preg
A
- Mark history cearly
- Obs ANC
- Serial scans if indicated
- Birth on LW
