Stillbirth

Question 1

what is a stillbirth?

Answer 1

when a baby dies after 24 weeks and before or during birth

Question 2

what is a miscarriage?

Answer 2

loss of a baby before 24 weeks

Question 3

risk factors and causes for stillbirth in the UK?

Answer 3

placental causes
IUGR
congenital abnormalities 
maternal/foetal infection
non-communicable diseases, nutrition and lifestyle
extremes of age
pre-eclampsia/eclampsia 
multiple pregnancy
prolonged pregnancy
obesity (BMI over 25)
smoking
previous stillbirth
antepartum haemorrhage
maternal antibodies

Question 4

normal movements in pregnancy?

Answer 4

no set number of movements
from 16-24 weeks on you should feel the baby move more and more up until 32 weeks then stay roughly the same until birth
should feel baby move right up until labour

Question 5

info for pregnant women?

Answer 5

going to sleep on your side in the third trimester
quit smoking
staying a healthy weight during pregnancy
avoid alcohol and drugs

Question 6

what is the PMRT?

Answer 6

comprehensive and robust local review of all perinatal deaths from 22+ weeks gestation to 28 days after birth as well as babies how die after 28 days following neonatal care
reviews the whole pathway of care

Question 7

outline the management of a patient who has had a stillbirth

Answer 7

assess maternal wellbeing
manage any potentially life-threatening maternal illness
advise a kleihauer test if rhesus negative
anti D then repeat kleihaier after 48 hrs

Question 8

advice in labour/birth if stillborn?

Answer 8

advice quick delivery if sepsis, preeclampsia, abruption or membrane rupture (more flexible if these not present)
recommend vaginal birth
risk of DIC

Question 9

what testing is done after a stillbirth?

Answer 9

post mortem
skin biopsy
placenta histopathology
blood tests (infection screen, thrombophilia screen, blood group, diabetes and thyroid screen)
microbiology

Question 10

advice for next pregnancy after a stillbirth?

Answer 10

depends on cause
frequent contact
patient led and agreed decision making
likely to have more frequent fetal surveillance tests, NIPT and scanning
likely to have more frequent maternal surveillance (GTT, BP etc)
may need medication (aspirin/fragmin etc)
likely to have early delivery by IOL