Stillbirth (2)

Question 1

What is this?

What are its causes?

What are its risk factors?

What are its 3 key symptoms?

Answer 1

➊ Birth of a dead foetus after 24 wks as a result of Intrauterine Foetal Death (IUFD)

➋ • Unexplained – Most common at 50%
• Pre-eclampsia
• Placental abruption (concealed)
• Vasa praevia
• Cord prolapse or wrapped around foetal neck
• Obstetric cholestasis – Puts stress on baby’s liver

➌ • IUGR
• Smoking and Alcohol
• Increased maternal age
• Obesity
• Multiple pregnancy
• Sleeping on the back instead of side

➍ • Reduced foetal movements – Important to ask about this in a hx!
• PV bleeding
• Abdominal pain

Question 2

How can it prevented?

How is it investigated?

How is it managed?

Answer 2

➊ • Risk assessment for having a foetus that’s small for gestational age or with growth restriction is done for all pregnant women
• Any modifiable risk factors are treated e.g. stopping smoking, alcohol, diabetes control, and sleeping on side

➋ TVUS to check for IUFD – Used to visualise the foetal heartbeat

➌ Vaginal delivery, which can be:
• Induced – Combination of Mifepristone (anti-progesterone) and Misoprostol (prostaglandin analogue to ripen cervix)
‣ Progesterone readies the endometrium, so blocking its activity will reduce the conditions of it for pregnancy
• Expectant – awaiting natural labour and delivery
• Anti-D prophylaxis given to Rh-D -ve women
• Dopamine agonists can be used to supress lactation after delivery