Perinatal mortality and maternal mortality

Question 1

What is the rate of perinatal mortality?

Answer 1

24 weeks to term - 0.5% will die

Question 2

What are the main causes of perinatal mortality?

Answer 2

• Unexplained
• Preterm delivery
• Intrauterine growth restriction (IUGR)
• Congenital abnormalities
• Intrapartum, including hypoxia
• Placental abruption

Question 3

Define stillbirth.

Answer 3

Stillbirth occurs when a fetus is delivered after 24 completed weeks’ gestation showing no signs of life.

Question 4

What % of stillbirth occur intrapartum?

Answer 4

10% (much higher in developing countries with most occuring at term of intrapartum)

Question 5

What is the risk of recurrence?

Answer 5

x3-5

Question 6

What is the aetiology of stillbirth?

Answer 6

• IUGR/SGA - e.g. smoking and multiple pregnancy.
• Unexplained
• Fetal and chromosomal congenital abnormalities
• Pre-existing maternal disease, e.g. diabetes, autoimmune disease, sickle cell disease, renal disease.
• Pregnancy-related maternal disease, e.g. pre eclampsia, gestational diabetes. Due to placental disease.
• Infection
• Placental abruption
• Intrapartum hypoxia

Rarely: fetal exsanguination, as feto-maternal haemorrhage or vasa praevia, fatty liver and cholestasis.

Question 7

How does stillbirth often present?

Answer 7

Absent or reduced fetal movements

Question 8

What are some measures for prevention of stillbirth?

Answer 8

• Risk identification and reduction e.g. smoking, multiple pregnancy, PET
• Monitoring
• UA Dopplers
• Serial growth scanning

Question 9

How does risk of stillbirth increase with gestational age?

Answer 9

risk of perinatal mortality and morbidity rises rapidly, albeit still at a low absolute risk, between 41 and 42 weeks

Rate of stillbirth per 1000 continuing pregnancies rises from 0.35 at 37 weeks to 2.12 at 43 weeks

Question 10

What is the management of stillbirth?

Answer 10

Investigate for cause - placental histology and postmortem and microarray advised (or MRI if declined postmortem)

Maternal bloods for previously undiagnosed conditions

IOL - CS should be avoided if possible

Postnatal management - debrief, make a plan for future pregnancy

Psychological support - mother at risk of mental illness

Question 11

Define prolonged pregnancy.

Answer 11

≥42 weeks’ gestation are completed

Question 12

What are the benefits of IOL for prolonged pregnancy?

Answer 12

Prevents one fetal death for every 500 women induced - if the patient rejects this then offer daily CTG monitoring or membrane sweep at 40-41 weeks

Question 13

Summarise the management of prolonged pregnancy.

Answer 13