Stillbirth and Infant Death Flashcards
what is a stillbirth
when a baby dies after 24 weeks gestation and before/ during birth
what is a miscarriage
loss of baby before 24 weeks
what is a late miscarriage
loss of baby at 22-24 weeks
how common is a stillbirth
1 in 250 pregnancies (8 every day, 1/3rd of these over 37 weeks gestation)
rate of stillbirth reducing
what can cause a still birth
placental causes IUGR congenital abnormalities placental abruption maternal or fetal infection cord prolapse idiopathic hypoxia-acidosis uterine rupture nutrition lifestyle- extremes of maternal age, obesity, smoking ethnic minorities lower socioeconomic class pre eclampsia/eclampsia diabetes obstetric cholestasis multiple pregnancy- TTTT prolonged pregnancies previous stillbirth maternal antibodies-rhesus etc
what increases your risk of stillbirth
twins
black/asian
mothers aged 40 or over or teenage mothers
mothers living in poverty
why is education about a babies movements in pregnancy important
half of women who had still births felt their baby move less before hand
what advice should you give mothers to prevent still birth
sleep on you side in the third trimester quit smoking stay healthy weight avoid alcohol and drugs go to every antenatal appointment report any symptoms: bleeding, stomach pains, itching, leaking fluid/ discharge get vaccinations (flu) start folic acid before conception vit d for whole pregnancy (esp if obese)
what is the immediate management for a patient who has had a stillbirth
assess maternal wellbeing- prompt tx of any life threatening condition
take detailed Hx of eventsduring pregnancy and clinical examination for preclampsia/ chorioamnionitis /placental abruption
kleihauer test for rhesus -ve women
Anti-RhD gammaglobulin
what is a kleihauer test
detects large fet0-maternal haemorrhage by measuring how much fetal blood has mixed with mothers
what are the options for labour in a stillbirth
consider mothers preference and her medical condition + previous Hx
advise for immediate delivery is sepsis, pre eclampsia, placenta abruption or membrane rupture
vaginal delivery recommended for most, c section for some
test for disseminated intravascular coagulation (clotting studies, blood platelets count and fibrinogen)
delay of labour with intact membranes and no evidence of DIC has no immediate risk but may develop comps/ anxiety is delayed for a long time (if over 48 hours DIC testing twice weekly)
prolonged labour also makes autopsy less effective and babies appearance deteriorates. increases risk of DIC and sepsis
mifipristone and misoprostol to indice labour
Care in labour should given by an experienced midwife
analgesia should be offered and available
what investigations are done after stillbirth
maternal bacteriology (blood cultures, urine, vaginal and cervical swabs)
serology (viral screen, syphilis, tropical infections)
maternal random blood glucose and HBA1C (for gestation or diabetes mellitus)
maternal thyroid function
thrombophilia screen (if +ve get fragmin in next pregnancy)
anti body screen
parental bloods for karotype
toxicology
fetal and placental microbiology
fetal tissues for karotype
post mortem- external, autopsy, microscopy, x ray, placenta and cord
advice for next pregnancy after still birth
stop smoking, reduce weight or manage medical condition better
Continuity
Frequent contact
Parent led and agreed decision making
Likely to involve more frequent fetal surveillance/tests NIPT, scanning
Likely to involve more frequent maternal surveillance e.g GTT, more BP checks
May involve medication Aspirin/ fragmin if thrombophilia screen or PET
Likely Early delivery by IOL
what mental health conditions are common after a stillbirth
depression
post traumatic stress disorder
what is SUDI
sudden unexplained death of an infant
for which there is no apparent reason
