Stillbirth

Question 1

Number of unexplained SBs

Answer 1

50%

Question 2

Definition of BS

Answer 2

Australia: 20 weeks or 400 grams
NND up to 28 days of Ruth

NZ: same except
Early neonatal death - before 7th day of life and perinatal related mortality is fetal and neonatal deaths 20+ weeks, 400g, up to 28 days of life and includes SB and TOP

Question 3

Risk of SB from 20 weeks

Answer 3

1:165

Question 4

Perinatal mortality rate Aus

Answer 4

9.6 per 1000

Question 5

Rate of neonatal death

Answer 5

2.5 per 1000

Question 6

Rate of SB

Answer 6

7:1000

Question 7

Postmortem discussion with patients

Answer 7

Options for full, less invasive autopsies, minimally invasive autopsies, non-invasive autopsies or stepwise post-Mortem examinations
Issues related to retained tissues, organs and DNA for genetic and other tests
Value of autopsy
Cause of death may not be found
Some causes of death may be excluded
Info may not benefit family but may benefit others
Implications future pregnancies
Care and respect that will be given to the baby

Question 8

Investigations for SB

Answer 8

Non-selective approach/do it all

Comprehensive history
Kleihauer
External examination of baby
Clinical photographs
Autopsy
Detailed macroscopic examination of the placenta and cord
Placental histopathology
Cytogenetic

Question 9

Investigations for a lethal genetic metabolic disorder

Answer 9

Blood sample
Urine sample
Knee cartilage and or skin biopsy - to cytogenetic for fibroblast culture and store
Liver and muscle biopsies

Question 10

Diagnosis of late IUFD

Answer 10

USS
2nd opinion
If mother reports passive movement, repeat scan should be offered

Question 11

USS signs of IUFD

Answer 11

Absent FHR
Collapse of the fetal kill with overlapping bones
Hydrops
Maceration
Intrafetal gas

Question 12

Principles of investigations for SB

Answer 12

Assess maternal wellbeing
Determine cause of death
Chance of recurrence
Possible means of avoiding further pregnancy complications

Question 13

Risk of DIC

Answer 13

10% w/in 4 weeks after IUFD

30% thereafter

Question 14

Trans placental infections associated with SB

Answer 14

CMV
Syphillis
Parvo
Listeria
Rubella
Toxo
HSV
Coxsackievirus
Leptospira
Q fever
Lyme disease
Malaria

Question 15

Ascending infection cause of SB

Answer 15

Ecoli
Klebsiella
GBS
Enterococcus
Mycoplasma/ureaplasma
Haem Ophelia influenzas
Chlamydia

Question 16

Investigations for a late IUFD

Answer 16

CBS, U/Es, CRP, bile salts
Coag
Kleihauer
Blood cultures
MSU
Vaginal and cervical swabs
Viral screen
Glucose & HbA1c
TFTs
Thrombophlia screen
Anti-red cell antibody
Anti-Ro
Anti-la
Antiplatelet antibodies
Parental karyotyping
Urine drug screen

Question 17

Fetal investigations for late IUFD

Answer 17

Fetal blood
Fetal swabs
Placental swabs
Deep fetal skin
Fetal cartilage
Placenta
Postmortem: external, autopsy, microscopy, X-ray, placenta and cord

Question 18

Percentage of SB babies with chromosomal abnormality

Answer 18

6%

Question 19

Postmortem percentage identifying cause of death and recurrence risk

Percent changed management of next pregnancy

Answer 19

45. 9%
46. 1%

10%

Question 20

IOL for SB

Answer 20

200mg mifepristone

100mcg miso q6h if <27 weeks, 4hrly if >27

Question 21

Lactation suppression

Answer 21

Cabergoline (superior to bromocriptine)

Question 22

Future pregnancy care after SB

Answer 22

Obstetric antenatal care
Screen GDM
Serial growth assessment