Stillbirth Flashcards
What are the aetiologies of stillbirths?
Foetal growth restriction Foetal infection Genetic/chromosomal/structural anomalies Maternal factors/disease - obesity, IVF Hypertension during pregnancy Antepartum haemorrhage Preterm birth Hypoxic peripartum death Other specific conditions - twin-twin transfusion
How do you assess a delivered stillborn?
Hx and Ex
- Size and growth
- Obvious structural abnormalities
- History of teratogens
- Family history
Ix
- Photos
- Autopsy
- Imaging
- Genetic testing
Which perinatal infections can cause stillbirths?
GBS
E.coli
Listeria
Parvo CMV HSV Rubella H1N1
Toxoplasma
How do you advise women on flu vaccination?
Benefits outweigh the risk of having it during pregnancy
- Due to prevention of stillbirth, maternal ICU admissions, and respiratory illness in early life
Which maternal conditions are associated with stillbirths?
Diabetes
SLE
Heart disease
Cholestasis
What are some social contributors?
Increase maternal age
Obesity
Assisted reproduction - higher rate of stillbirths and multiple pregnancies
Why is it important to detect foetal growth restriction?
They are higher risk of being stillbirth but monitoring can prevent it
What is a stillbirth?
Foetal death after 20 weeks gestation but not during labour
How do SB present?
Reduced foetal movements
Frank medical illness eg sepsis
How do you Ix for maternal causes?
RBG, HbA1c Rh Kleihauer ANA LAC, ACLA, thrombophilia screen TORCH, parvovirus Clotting profile
How do you Ix for foetal causes?
US
Post mortem
Biopsies, swabs, X-rays
What do you do after confirming stillbirth?
Break bad news Delivery - Vaginal, usually induced with PGs - Analgesia - Plan how to manage stillborn at time of delivery
What needs to be managed post delivery?
Lactation suppression
Memorial
What is the incidence of stillbirth?
1:1000
What are is a maternal complication of stillbirth?
Coagulopathy - 25% of women who retain stillbirth for over 4 weeks will develop DIC
