Stillbirth

Question 1

define stillbirth

Answer 1

when a baby dies after 24 weeks gestation, before or during birth

Question 2

define miscarriage

Answer 2

loss of a baby before 24 weeks gestation

Question 3

when is the term late miscarriage used

Answer 3

loss of a baby between 22-24 weeks

Question 4

list some risk factors for stillbirth

Answer 4

placental causes
IUGR 
congenital abnormalities 
maternal infections 
nutrition and lifestyle factors 
extremes of age 
PET and eclampsia 
obstetric cholesatsis 
multiple pregnancy - TTTS
>42 weeks gestation 
obesity 
smoking in pregnancy 
antepartum haemorrhage 
antibodies 
ethnicity - black/asian babies 
poor socioeconomic class

Question 5

causes for intrapartum stillbirth

Answer 5

placental abruption 
infection 
cord prolapse 
idiopathic hypoxia-acidosis 
uterine rupture

Question 6

what is a sign that your baby is doing well

Answer 6

regular foetal movements

Question 7

how should women sleep in their 3rd trimester

Answer 7

on their side

Question 8

what lifestyle modifications should be made prior to pregnancy and throughout

Answer 8

healthy BMI
folic acid + vit D
smoking cessation
no alcohol or drugs

Question 9

which vaccinations should mother get in pregnancy

Answer 9

flu and whooping cough

Question 10

what investigations can be done to assess maternal wellbeing

Answer 10

examine for PET, chorioamnionitis, placental abruption

Kleihauer test for anti-D

Question 11

what is a Kleihauer test

Answer 11

assesses if there was mixing of maternal and foetal blood and the need for more anti-D

Question 12

how can the baby’s blood group be assessed

Answer 12

blood sample from the umbilical cord

Question 13

how can you deliver a stillborn baby and which is more recommended

Answer 13

c-section

vaginal delivery - recommended

Question 14

what is the mother at risk of if labour is delayed

Answer 14

infection and DIC

Question 15

the longer the baby stays inside the mother, the better/worse the value of the post mortem

Answer 15

worse

Question 16

how can you induce labour for women with a stillborn baby

Answer 16

mifepristone and misoprostol

Question 17

what investigations can be done to identify the cause of stillbirth after labour

Answer 17

post mortem 
skin biopsy 
placental histology 
maternal glucose, TFT and thrombophilias
microbiology 
antibodies 
karyotyping 
toxicology

Question 18

how long can it take before the results of the post mortem are complete

Answer 18

6-8 weeks

Question 19

what mental health conditions are women at risk of who delivered a stillborn baby

Answer 19

PTSD

depression

Question 20

how should you approach a woman wanting to try for another pregnancy after a previous stillbirth

Answer 20

depends on previous cause eg
continuity of care, more frequent appointments, increased surveillance, tests and scanning
OGTT, BP, urinalysis 
aspirin, fragmin 
IOL

Question 21

what is grief

Answer 21

individual response to loss where bereaved adjust to life without the deceased

Question 22

what are the stages of grief

Answer 22

denial 
anger
depression 
bargaining 
acceptance

Question 23

consent is needed from the procurator fiscal before removing IV lines, clothing etc from the baby, true or false

Answer 23

true

Question 24

who does the bereavement service support

Answer 24

miscarriages >14 weeks
TOP for congenital abnormalities only
stillbirth
neonatal death

Question 25

what are some counselling methods

Answer 25

CBT
psychodynamic
complicated grief therapy 
memory building 
memorial services