Stillbirth

Question 1

What is stillbirth?

Answer 1

Death in utero of a foetus from 24 weeks onwards

• 1 in 200 pregnancies
• Diagnosis is preceded by reduced foetal movements
• Confirmed by the absence of foetal heartbeat by 2 sonographers

Question 2

Investigations following stillbirth

Answer 2

• Take place after stillbirth has been confirmed
• No cause can be found in 50% of cases
• Parental consent is needed for investigations to determine cause of stillbirth - some parents don’t want their baby to have a post mortem or testing done

Examples:

• FBC, U&E, urate, CRP, bile salts: screening for pre-eclampsia, sepsis, obstetric cholestasis
• Coagulation profile: disseminated intravascular coagulation
• Kliehauer test: measures foetal Hb in mothers blood to test for fetomaternal haemorrhage
• Random blood glucose/ HbA1c
• Maternal thrombophilia screen
• Foetal and maternal microbiology

Question 3

What is the Kliehauer test?

Answer 3

Tests maternal blood for foetal Hb to determine if there has been and the size of foeto-maternal haemorrhage (FMH) FMH estimation is is performed to ensure that pregnant women who have undergone potentially sensitising events are given adequate quantities of anti-D

Question 4

Management of stillbirth

Answer 4

• Prevent the mothers condition deteriorating
• Determine cause of death
• Deliver baby
• Psychological support

Medication:

• Induce labour with mifepristone and misoprostol
• Vaginal delivery avoids uterine scarring

Surgery:

• C-section used of maternal condition warrants this e.g. septic or bleeding heavily

Psychological support:

• Families can hold baby, take photos, locks of hair and other mementoes
• Memory boxes are offered
• Parents may want to know why stillbirth occurred
• Referral to bereavement support worker
• SANDS - stillbirth and neonatal death charity

Question 5

Risk factors associated with stillbirth

Answer 5

• In women with a high BMI (over 26) the risk of stillbirth increases by around 20% with every 5 extra BMI points on the scale
• In women who smoke during pregnancy, the risk of stillbirth goes up depending on how much is smoked:
• the risk of stillbirth is 52% higher in pregnant women who smoked 10 or more
• the risk of stillbirth was 9% higher for those smoking 1 to 9 cigarettes a day.
• In women with a previous stillbirth, the risk of another increases 4 times, from 1% to 2.5%

Question 6

Consequences of maternal recreational drug use in pregnancy

Answer 6