Stillbirth Flashcards
Stillbirth
Birth of a dead fetus after 24 weeks gestation due to intrauterine fetal death (IUFD)
Causes of still birth
Unexplained (around 50%)
Pre-eclampsia
Placental abruption
Vasa praevia
Cord prolapse or wrapped around the fetal neck
Obstetric cholestasis
Diabetes
Thyroid disease
Infections, such as rubella, parvovirus and listeria
Genetic abnormalities or congenital malformations
Risk factors for stillbirth
Fetal growth restriction Smoking Alcohol Increased maternal age Maternal obesity Twins Sleeping on the back (as opposed to either side)
Preventing stillbirth
Risk assessment for SGA (small for gestational age) or fetal growth restriction
Serial growth scans of high risk
Pre - eclampsia - given aspirin
Planned delivery - if growth is static
Address modifiable risk factors - e.g. sleep on side
Symptoms of still birth
Reduced fetal movements
Abdominal pain
Vaginal bleeding
Management of intrauterine fetal death
Vaginal birth is first-line for most women after IUFD, either induced labour or expectant
Investigations for diagnosing intrauterine fetal death
USS - no fetal heart beat
Passive fetal movements
Passive fetal movements are possible after IUFD, and a repeat scan is offered to confirm the situation.
Rhesus D women with still birth
Require anti-D prophylaxis when IUFD is diagnosed
Inducing labour
Combination of oral mifepristone (anti-progesterone) and vaginal or oral misoprostol (prostaglandin analogue)
Suppressing lactation after a stillbirth
Dopamine agonists (e.g. cabergoline) can be used to suppress lactation
Testing after stillbirth
With parental consent, testing is carried out after stillbirth to determine the cause:
Genetic testing of the fetus and placenta
Postmortem examination of the fetus (including xrays)
Testing for maternal and fetal infection
Testing the mother for conditions associated with stillbirth, such as diabetes, thyroid disease and thrombophilia
Management after the stillbirth
Counselling provided
