Obs - stillbirth

Question 1

define stillbirth

Answer 1

A baby that is born with no signs of life at or after 24 completed weeks of pregnancy.

Question 2

what are the causes of stillbirth?

Answer 2

More than 50% of stillbirths have no cause identified.

Maternal:
Diabetes (pre-existing and gestational) 
Pre-eclampsia 
Sepsis 
Obstetric cholestasis 
Acute fatty liver 
Thrombophilias (e.g. protein C and protein S resistance, factor V Leiden mutation, antithrombin III deficiency)

Fetal:
Infection: Toxoplasma , Listeria , syphilis, parvovirus
Chromosomal abnormality
Structural abnormality
Rhesus disease leading to severe anaemia
Twin-to-twin transfusion syndrome (affects monochorionic twins only)
Intra-uterine growth restriction
Alloimmune thrombocytopaenia

Placental:
Postmaturity 
Abruption 
Placenta praevia: significant bleed 
Cord prolapse

Question 3

what is the rate of stillbirth?

Answer 3

common

3.87 in 1000

Question 4

how does stillbirth present?

Answer 4

Depends on cause: if abruption, tummy pain, shock etc

reduced fetal movements

Question 5

how is stillbirth ivx/diagnosed?

Answer 5

Reduced fetal mvmt -> handheld doppler & CTG

no HR -> Abdominal US (verify with 1 other trrained scanner)

Question 6

what tests are done to identify the cause of stillbirth?

Answer 6

History:
signs of APH
rupture of memebrane - chorioamnionitis
fever, rash - infection 
itching - obs cholestasis

Rh status
trisomies
anomaly scan review

Exam:
Basic obs and Abdo exm - for maternal wellbeing (inceased risk of sepsis/coagulopathy post IUD) and idenitfy cause

IVX:
Haematology, Biochemistry, Microbiology (including TORCH screen and fetal + placental swabs)

Postmortem: full or limited (certain organs) or external (not cut inside) - ask which they would like.

Question 7

What is the mx of stillbirth?

Answer 7

Vaginal delivery:
mifepristone (anti prog) given then 48hrs later:
misprostal PO/PV for preparation

Oxytocin (syntocinon infusion):
If nearer to term

C-section:
if labour contraindicated eg multiple previous deliveries

• Postpartum: refer to specialist midwife for support and counselling
• Stillbirth & Neonatal Death charity (SANDS) - support parents
  Cabergoline - suppress lactation

Follow up appnt with consultant discuss causes/ plan 4 future pregnancy
future: consultant-led antenatal care with regular growth scans

Question 8

what are the risks of stillbirth?

Answer 8

maternal:

post-partum depression