Stillbirth

Question 1

What are the top ten interventions to reduce global burden of stillbirth?

Answer 1

• Periconceptual folic acid supplementation.
• Prevention of malaria
• Detection and treatment of syphilis.
• Detection and management of hypertensive disorders of pregnancy.
• Detection and management of diabetes in pregnancy.
• Detection and management of fetal growth restriction.
• Routine induction to prevent post-term pregnancies (>= 41 weeks).
• Skilled birth attendant
• Availability of basic emergency obstetric care.
Availability of comprehensive emergency obstetric care.

Question 2

What are the main causes of stillbirth (PSANZ classification of perinatal death)?

Answer 2

• Congenital abnormality including structural, chromosomal, genetic.
	• Perinatal infection including:
		○ Bacterial: GBS, E coli, listeria, syphilis.
		○ Viral: parovirus, CMV, HSV, rubella.
		○ Protozoal: toxoplasmosis.
	• HTN in pregnancy
	• APH: especially placental abruption.
	• Maternal medical conditions other than HTN: diabetes, SLE, obstetric cholestasis, trauma.
	• Specific perinatal conditions:
		○ Fetomaternal haemorrhage
		○ Antepartum cord accidents
		○ TTTS.
	• Hypoxic peripartum death: intrapartum complications such as uterine rupture, cord prolapse, shoulder dystocia, non-reassuring fetal status.
	• Fetal growth restriction
	• Spontaneous preterm
	• Unexplained antepartum death
No obstetric antecedent.

Question 3

What % of stillbirths are preventable?

Answer 3

86%