Still Births Flashcards
What are the leading contributors to still birth?
Fetal growth restriction, placental insufficiency fetal infection, genetic and structural defects, maternal medical disease
Name some strategies involved in reducing the global burden of still births, some of them may not be relevant to Australia.
- Periconceptional folic acid
- Insecticide treated bed nets or other malaria prophylaxis
- Syphilis detection and treatment
- Detection and management of hypertensive disease or pregnancy
- Detection and management of diabetes in pregnancy
- Detection and management of fetal growth restrictions
- Identification and induction of pregnancy women >41 weeks gestation.
- Comprehensive emergency obstetric care
- Name the broad causes of perinatal death:
- Congenital abnormality
- Perinatal infection
- Hypertension in pregnancy
- Antepartum haemorrhage, particularly placental abruption
- Maternal medical conditions; diabetes, SLE< obstetric cholestasis
- Hypoxic peripartum death, including intrapartum events
- Preterm Birth
- Fetal growth restrictions
- Specific perinatal complications: twin twin transfusion syndrome, fetal anaemia
Name some infective causes of perinatal infections which could cause a still birth?
- E coli
- Listeria
- Spirochaetal
Viral - Parvovirus
- CMV
- HSV
- Rubella
- H1N1
Protozoal - Toxoplasmosis
Name important maternal medical conditions which could lead to still birth?
- Hypertension
- Diabetes
- SLE
- Cholestasis
- Heart disease
Uncontrolled diabetes in pregnancy is a teratogen, they cause the 4 M’s, name the 4 M’s.
- Miscarrige
- Malformation
- Macrosomia
- Mortality
How is the population profile of women giving birth changing? Why would a changing population of conception? Including more IVF therapy lead to more still births?
- There increasing average maternal age, increasing risk of hypertension, diabetes, fetal growth restriction.
- Greater chance of multiple pregnancies
- IVF is also associated with increased FGR and still births
What is hypoxic peripartum death ?
- Labour is a stress test, it is a hypoxic stress test. As you have contractions blood supply to the placenta goes down by 40% . Most babies have adequate reserve, but some babies are unable to cope. This leads to hypoxic pericardial death.
How is hypoxic perpartum death prevented?
- Pick Fetal growth restriction, and monitor, antenatal detection is very important.
- Timely delivery must be made in the event of a compromise
What is the definition of fetal death in utero?
- fetal demise post 20 weeks of gestation but prior to the onset of labour
What is maternal aetiology of fetal death in utero ?
- Diabetes
- Hypertension including PIH (pregnancy induced hypertension), PET (pre-eclamptic toxaemia)
- SLE, connective tissue disorders, anti-phospholipid syndrome, Thrombophilia
What is fetal aetiology of fetal death in utero?
- malformation (structural / chromosomal)
- Infection
- Immune haemolytic disease
- non immune fetal hydrops (accumulation of fluid in atleast two fetal compartments)
- metabolic disease
What is placental aetiology of fetal death in utero?
- Placental abruption
- Placental insufficiency: IUGR, Post term pregnancy
- Twin Twin transfusion syndrome
- Feto- maternal transfusion
CORD
- Cord accident: Cord tightens very tightly around the neck
If there is fetal death in utero, how do these women generally ?
- Severe pre-eclamptic toxaemia
- Placental abruption
- Sepsis
Mostly present with absent or reduced fetal movement - Unable to locate fetal heart
- Ultrasound confirms no fetal movement,
- Post mortem spalding sign, overriding of cranial bones
What are the complications of fetal death in u-tero?
- may develop chronic consumptive coagulopathy , with decreased fibrinogen, plasminogen, Antithrombin III, platelets, FDP increases.
- 2 % will develop haemorrhagic complications
