Stillbirth

Question 1

What is stillbirth defined as

Answer 1

after 24 weeks gestation

Question 2

Cuases of stillbirth

Answer 2

Unexplained - 50%
Pre-eclampsia
Placental abruption
Vasa previa
Cord prolapse or wrapped around foetal neck
Obstetric cholestasis
Daibetes
THyroid disease
Infections - rubella, parvovirus, listeria
Genetic abnormalities or congenital malformations

Question 3

Factors that increase the risk of stillbirtj

Answer 3

Foetal growth restriction
Smoking
Alcohol
Increased maternal age
MAternal obesity
Twins
Sleeping on back

Question 4

What monitor if SGA

Answer 4

Serial growth scans monitor growth progress

Question 5

What assessment do all women have

Answer 5

SGA or FGR as increase risk of stillbirth

Question 6

Key symptoms of stillbirth

Answer 6

Reduced foetal movements
Abdominal pain
Vaginal bleeding

Question 7

How is intrauterine foetal death diagnosed

Answer 7

Visualise foetal heartbeat to confirm

Question 8

Can there be movements after IUFD?

Answer 8

Yes - passive foetal movements

Question 9

What do rhesus D negative women reuqire when IUFD diagnosed?

Answer 9

Anti-D prophylaxis
Kleihauer test - quantify dose needed

Question 10

First line after IUFD

Answer 10

Vaginal birth, unless other reasons for C section
Induction of labour or expectant management choice

Question 11

How do you induce labour

Answer 11

Oral mifepristone (anti-progesterone)
Vaginal or oral misoprostol (prostalgandin analogue)

Question 12

How to supress lactation after stillbirth

Answer 12

Dopamine agonists eg cabergoline

Question 13

What testing is carried out after stillbirth with parental consent?

Answer 13

Genetic testing of foetus + placenta
Postmortem examination of foetus incl xrays
Testing for maternal and foetal infection
Testing mother for conditions ass with stillbirth eg diabetes, thyroid disease and thrombophilia
Help with future pregnancies