Stillbirth Flashcards
How should pregnancy be managed?
Assess maternal wellbeing and ensure prompt management of any potentially life threatening maternal disease
What should pregnant mothers be examined for?
Pre-eclampsia, chorioamnionitis and placental abruption
What should women who are RhD negative be advised to do?
Have a Kleihaner test to detect any large feto-maternal haemorrhage
How quickly should anti-RhD gammaglobulin be given after presentation?
As soon as possible
What is a stillbirth?
When a baby dies after 24 weeks of pregnancy
What is a miscarriage?
Loss of a baby < 24 weeks pregnancy
When does antepartum refer to?
Before labour
When does intrapartum refer to?
During labour
What can MBRRACE reviews lead to?
Change in government policy and redistribution of resources
In what ethnic group are still births more common in?
BAME = 80% higher risk in black babies, 60% higher risk in asian babies
What area does MBRRACE recommend extra emphasis be placed on?
Reducing preterm birth
What are the most common causes of intrapartum death?
Placental abruption Maternal and foetal infection Cord prolapse Idiopathic hypoxia-acidosis Uterine rupture
What are some risk factors for stillbirth in the UK?
Placental cause or intrauterine growth restriction
Extremes of age and lifestyle factors
Obesity and diabetes
Prolonged pregnancy and previous stillbirths
What are the most common reasons for babies dying?
Unknown cause = 46%
Placental problems = 22%
Congenital abnormalities = 6%
Complications during labour = 6%
What is the UK government target?
Aims to reduce stillbirth by half by 2025
What are some ways the UK government is trying to reduce stillbirths?
Ensure women are cared for by the same midwife
Roll out of maternity outreach clinics
Smoking cessation programmes
What is the purpose of the Moments Matter movement?
To tell women to get in touch with medical professionals if there is a reduction in foetal movement = discussed at 24 week appointment
What are some of the recommendations made by Tommy’s?
Going to sleep on side in 3rd trimester
Smoking cessation
Avoiding alcohol and drugs
Staying a healthy weight throughout pregnancy
Attending appointments
Contact hospital in leaking fluids/vaginal discharge
What is the PMRT tool?
Local review of all perinatal deaths from 22 weeks gestation to 28 days after birth as well as babies who die after 28 days following neonatal care
What are some situations where immediate delivery would be recommended?
Sepsis, pre-eclampsia, placental abruption or membrane rupture
What is the recommended mode of delivery for most women?
Vaginal delivery
What is there a moderate risk of during labour?
Maternal disseminated intravascular coagulation (DIC)
How is maternal DIC tested for?
Clotting studies, blood placental count and fibrinogen measurement
What should women who delay labour by > 48 hrs be advised to do?
Have weekly testing for DIC
What are some investigations that can be done?
Infection screening and genetic testing
Maternal antibodies and maternal wellbeing
Post mortem is gold standard
What are some investigations that may be part of a debrief?
Post mortem, skin biopsy, placental histopathology, blood test and microbiology
What are mothers who have had a stillbirth at higher risk of?
4x higher risk of depression
7x higher risk of PTSD
What are some things that are involved in planning another pregnancy following a stillbirth?
Plan depends on previous cause of stillbirth (if known)
Likely to involve frequent foetal surveillance and tests
May involve medication
Likely early delivery by IOL
