Reduced Fetal Movement Flashcards
When are fetal movements felt
18-20 weeks
Reduced movements prior to 26 weeks
Appt arrange for fetal heart rate monitoring via Doppler and Pinard
A routine full AN check up
Deuces movement after 26 weeks
Ctg assessment of fetal wellbeing via MAU
Full AN check
Assessment of risk factors for care plan
UHL guidelines
Under 26 weeks - no evidence in ctg use. Referred to CMW/homebirth team for AN check and FH within 72 hours, if no movements have been fet at all at 24 weeks then a referral to fetal medicine is needed
Over 26 weeks - MAU admissio, ctg and assessment of fetal well-being
If 1st epodsde and no risk factors can be discharged home without doctor review or USS
an if recurrent episodes or risk factors dr review and assssment of USS or IOL
From 39weeks/ 40 weeks discussion of IOL if applicable
Midwife role
Gestational age
Addirional needs - SGA diabetes
Normal pattern of movement
Unsure, deduced or absent
Repeated episode
Duration
Risk factors for stillbirth
Early miscarriage
Before 13/40
Late miscarriage
Between 13 and 24/40
Miscarriage
Complete, incomplete, missed, threatened or navigable on the basis of clinical history and findings o speculum and digital pelvic examiniation
Complete miscarriage
When all products o conception have been expelled from uterus and bleeding has stopped
Incomplete miscarriage
Diagnoses non viable pregnancy in which bleeding ahs begun but pregnancy tissue remains in the uterus
Missed miscarriage
Non viable pregnancy is identified on USS without associate pain and bleeding
Hreatened miscarriage
When vaginal bleeding in the presence of viabl pregnancy in first 24 weeks
Intrauterine fetal death
Babys with no signs of life in uteri
Stillbirth
A baby deleivered with no dons of life known to have died after 24 completed weeks of pregnancy
Neonatal death
Babay a born at any gestational during pregnancy who lived even briefly but dies within four weeks of being born
Neonatal mortality - death before the age of 28 completed days following live birth
Early 0 is up to 7 days
Late from 7 to 28 days
Infant mortality - earth is first year following live birth
Risk factor for stillbirth
Fetal growth restriction
Low Papp- a - likely to have small. Baby and preeclampsia - its a sigh that placenta hasn’t implanted well
Known fetal abnormality or genetic abnormality
Maternal obesity
Maternal age
Alcohol or substance misuse
2 or more consequential do not attend appr
Post dates over 42 weeks
Pre eclampsia and obstretric coolest air
Recurrent episodes of reduce fms
Confirmation of IUFD
Auscultation and cardiotocograhy should not be used to investigate suspected IUFD
Ultrasonography i essential for the accurate diagnosis of IUFD
Second opinion should be obtained whenever practically possible
Clinical assessment and lab test should be recommended to assess maternal wellbeing and to determine the cause of death the chance of recurrence and possible means of avoiding further pregnancy complication
Loss of baby checklist
Kleihauer and anti d given at the time of diagnosis
Parents informed about post mortem
Bloods - FBC,HbA1C, U&E, LFT, rates, thyroid function tests, kleihauer, IgG and IgM antibodies, lupus like anticoagulant screen, HVS for C & s if required, amnio/CVS
Placenta
- biopsy - for listeria and histology
Swab
Placenta for histology
Baby
- skin/ear swabs for C&S
Skin biopsy for karyotype wih consent
Consent and care plannning
Written consent for any invasive procedure on baby
Consent sought by supervision by obstetrician or midwife trained in special consen issues
Tell parent about how baby may loo
Recommendations about labour and birth taken into account mum preferences
Prior to mifepristone midwif liase with delivery suite to arrange suitable room
Delivery
Women com=note plating prolonged excpetant management should be advise that the appearance f the baby may detoriate vaginal birth is recommended mode of delivery
Ceasarian section in indicated in certain circumstances
Combination of mifepristone and prostaglandin should be recommended as first line intervention for IOL
MDT team
Community midwife
Specialist midwife
Go
Health visitor
Named consultant
Bereavement midwife
Social care team
Antenatal records re cancellaing appts
SANDS
Promotes emotional. Psychological and physical well-being of parents and their families
Work with health and social care professionals t improve practice for bereaved parents
Pro ted research and best practice that will help to identify causes and reduce the incidence of death of a baby in uteri, at birth or soon after birth
After delivery plans
Guidance and upper from elders of all common faiths and non religious spiritual organisations should be Availble ad can be accessed through chaplaincy service
Legal responsibility of the child’s body lies with parents but can be delegated to hospital services
Parents allowed o choose funeral services freely
Leaflets offered
Memory making activities
Memory boxes
Preparation for th mortuary
Midwife make the inital exam of baby
Two arm band to baby
Spa baby in white sheet
Can go with toy and clothes
Cot card attached to top
Call porter and sign log book
