OGCO-C2.5 Investigation and management of stillbirth

Question 1

Define stillbirth in HK
How to make dx?

Answer 1

Baby born without sign of life, at or after 24 weeks of gestation, or with a birthweight of more than 500g when the gestational age is uncertain
Dx by real time USG and 2 practioners

Question 2

What are Ix before delivery for stillbirth?

Answer 2

Question 3

What are Ix at delivery for stillbirth?

Answer 3

Question 4

What is the classification for causes of stillbirth (ICD-PM system)?

They include antepartum death, intrapartum death, neonatal death, maternal condition

Answer 4

Question 5

What are the Mx options for stillbirth?

Answer 5

Expectant mx: wait for spontaneous onset of labor and delivery is safe for most cases of antepartum stillbirth.

Induction of labor for antepartum stillbirth: for induction labor, any methods below can be used but in general, amniotomy should be avoided to minimize chance of ascending infection. Perform T&S before inuction
* Prostin 3mg vaginally, reassess 6 hours, repeat the dose once if needed. If not delivered, after 2nd dose, can consider resting for the night and repeating the same regimen or changing to misoprostol the nextd day. If cervix fully effaved and at least 3-4 cm dilated, can consider amniotomy followed by syntocinon infusion after discussion with senior staff.
* Misoprostol (for intrauterine death): sensitivity of uterus to misoprostol increases with gestational age –> dose used is lower than that used for abortion before 24 weeks. The vaginal route is also more effacious that the oral route.
24-34 weeks: 100ug vaginally q3h x 4 or 200ug orally q3h x 4
>34 weeks: 50ug vaginally q3hx4 or 100ug orally q3h x 4
Patient assess before admin of each dose of misoprostol –> withheld if there are strong and frequent uterine contractions.

Question 6

What is the bereavement support for couples with fetal loss?

Answer 6