Stillbirth Flashcards
1
Q
What investigations would you perform for all stillbirth?
A
- Comprehensive maternal (medical, social, family) and pregnancy history
- Kleihauer
- External exam of baby
- Clinical photographs
- Autopsy
- Detailed examination of placenta and cord
- Placental histopathology
- Cytogenetics (chromosomal microarray)
2
Q
What selective investigations could you arrange for stillbirth investigation?
A
- Hx thrombosis → APLS screen, thrombophilia screen
- ?Cholestasis → bile acids, LFTs
- LGA → HbA1c
- IUGR → TORCH screen, HbA1c, APLS screen
- Placental abruption or infarction → APS
- Infection → further testing as directed by pathologist
- Parents decline PM → offer MRI
3
Q
Common causes of stillbirth
A
- Unexplained
- Congenital anomalies
- FGR
- Infection
- Genetic
- Hydrops
- Fetal arrhythmias
- Feto-maternal haemorrhage
- Placental abruption
- Umbilical cord anomalies
4
Q
Outline management of a woman diagnosed with stillbirth
A
- Comprehensive assessment of maternal and pregnancy history.
- Formal ultrasound confirming SB.
- Refer to bereavement care and/or cultural support worker.
- Discuss IOL including method (mifepristone then misoprostol), in hospital, pain relief, retained placenta.
- Validate parenthood and support memory making if they choose to.
- Investigations
- Breastfeeding: dostinex
- Contraception
- VTE prophylaxis
- Follow-up to discuss results and recommendations for next pregnancy.
