Still birth Flashcards
Definition of SB
Perinatal mortality?
Rate of SB in NZ
PNMR
> 20 weeks or >400g if gestation unknown
20weeks to 28 days
1in 165 or 7 in 1000
9.6 in 1000 births
Leading cause of death?
What proportion have sub-optimal/avoidable outcomes?
Congenital abnormalities
Spont PTB
Idiopathic 20-30%
30-50%
Causes
Use PSANZ classification system and can have one cause with two associated factors
Congenital anomaly
eg Down Syndrome, diaphragmatic hernia etc
Perinatal Infection
eg GBS strep, e.coli
Hypertension
eg PET, chronic, gestational
APH
eg Abruption, previa, vasa
Maternal Conditions
eg GDM, T2DM, maternal injury, maternal sepsis, APLS, OC, maternal suicide, TOP
Complications of multiple pregnancy
eg TTTS, sFGR
Specific perinatal conditions
eg feto-maternal haemorrhage, cord complications, alloimmune disease, subdural haematoma
Hypoxic peripartum death
eg uterine rupture, cord prolapse, SD, complications of breech presentation
Placental dysfunction or causative placental pathology
eg maternal vascular malperfusion, fetal vascular malperfusion, high grade villitis of unknown aetiology
Spontaneous preterm labour or ROM
Unexplained antepartum fetal death
Neonatal death without obstetric antecedent
Neonatal infection
Neurological
Gastrointestinal
Other
Investigations (Core)
Maternal:
Maternal history and pregnancy history
Maternal bloods
- Kleihauer for fetal maternal haemorrhage
Fetal/baby
Examination of baby, clinical photographs
Autopsy
Placenta histology and swabs for infection
Cytogenetics
Less invasive: MRI, babygram, USS, post-mortem needle biopsy, laparoscopic autopsy, small incision acces
Other investigations
History of thrombosis or signs of abruption
- Investigate for PET, thrombophilia disorders and APLS
Testing for infectious diseases if FGR/SGA
- CMV, HSV, syphilis, toxo, rubella
- Parvovirus only if signs for infection
If suspected OC
- LFTS and bile salts
HbA1c + BSL (plus OGTT 6-8 weeks later)
Blood group and antibody screen
- If not done antenatally
If macrosomic but no diabetes consider Beckwith Wiedemann SYN
Consider maternal drug screen
Maternal CBC, renal function, thyroid, USS are no longer recommended investigations for determining the CAUSE
Investigations for NND
Infectious causes
- GBS swabs (low vaginal and anorectal)
- Mat BC
- Infant blood work
- Placental swabs
- Placental histology
- Maternal CMV, toxo, parvovirus, sika, rubella, syphilis serology
Thrombophilic
- APLS
- Microarray
- Autopsy
Congenital anomalies
- All the TORCH stuff
- Viral placenta culture and biopsy
- HbA1c
- Microarray
