Stillbirth and Neonatal Death Flashcards
What is stillbirth?
The death of a baby before or during birth after 24 weeks gestation in the UK
What is neonatal death?
Death of a baby in the first 28 days of life
What is the rate of stillbirths?
4.9/1000 live births
What is the rate of neonatal deaths?
2.8/1000
What has happened to the rates of stillbirth and neonatal death over the last 2 decades?
Fallen
What is thought to be responsible for the fall in rates of stillbirth and neonatal death?
- Improvements in healthcare
- Improvements in midwifery
- Improvements in neonatal care
What are the risk factors for stillbirth and neonatal death?
- Fetal growth restriction
- Pre-term birth
- Age of mother
- Maternal health
- Obstetric complications
- Multiplicity of pregnancy
- Nulliparous
- Congenital abnormality
- Low birth weight
- Social factors
- Ethnicity
What is the biggest risk factor for stillbirth?
Fetal growth restriction
When is fetal growth restriction an even bigger risk for stillbirth?
If not detected antenatally
What is the biggest risk factor for neonatal death?
Pre-term birth
What maternal age ranges have higher rates of neonatal death?
- Under 25
- Over 40
How does maternal age affect the rate of stillbirth?
Increases with age
What maternal health factors increase risk of stillbirth and neonatal death?
- Obesity
- Smoking
- Chronic diseases
- Infection
- Substance abuse, especially cocaine
- Mental health problems
What maternal chronic diseases increase the risk of stillbirth and neonatal death?
- Diabetes
- Renal failure
- Hypertension
- Haemoglobinopathy
- Rhesus disease
- Thrombophilias
- Antiphospholipid syndrome
What infections increase the risk of stillbirth and neonatal death?
- Erythema infectiousum
- Varicella
- Measles
What obstetric complications increase the risk of stillbirth and neonatal death?
- Pre-eclampsia
- Antenatal haemorrhage
- Intrapartum complications
What intrapartum complications increase the risk of stillbirth and neonatal death?
- Malpresentation
- Obstructed labour
What social factors increase the risk of stillbirth and neonatal death?
- Lack of employment
- High deprivation index
What ethnicity is at increased risk of stillbirth and neonatal death?
African and African-Caribbean women (significantly higher risk)
What are the causes of neonatal death?
- Prematurity
- Congenital abnormality
- Obstetric complications
- Infection
When in particular can prematurity cause neonatal death?
When it causes respiratory and neurological conditions
What are the causes of stillbirth?
- Congenital abnormality
- Haemorrhage during pregnancy or labour
- Placental insufficiency
- Pre-eclampsia
- Obstetric complications
- Cord prolapse
- IUGR
- Liver diease
- Diabetes
- Infections during pregnancy
What obstetric complications can cause stillbirth?
- Spontaneous premature labour
- Premature rupture of membranes
- Polyhydraminos
- Oligohydraminos
- Intrapartum asphyxia
- Birth trauma
What liver disease can cause stillbirth?
- Obstetric cholestasis
- Intrahepatic cholestasis of pregnancy
How might a stillbirth be diagnosed?
- Mother may be aware of a decrease in fetal movements
- May be discovered at the routine antenatal check
How is stillbirth confirmed?
Ultrasound examination showing lack of visible heartbeat
What should be done when the death of a baby is diagnosed antenatally?
Labour is induced
How is labour induced following the antenatal diagnosis of stillbirth?
Vaginal prostaglandins
When should labour be induced after the antenatal diagnosis of stillbirth?
Does not need to be immediate, but should happen within 2-3 days
What investigations does the mother need after the antenatal diagnosis of stillbirth?
- BP
- Urine tested for protein-
- Temperature taken
- Cervical and vaginal swabs for MC&S
- Bloods
What bloods should be done after the antenatal diagnosis of stillbirth?
- FBC
- Clotting screen
- Kleihauer test
- HbA1c
- Cultures
- Serology
What additional care might the patient require after stillbirth?
Bereavement care
What bereavement care can be given to the patient after stillbirth?
- Should be allowed to stress and spend time with their child
- May wish to take photos and make some memories with the child
What member of staff should all maternity units have to help with stillbirth care?
Specially trained bereavement midwives
What needs to be discussed regarding post-mortem in stillbirth?
The need for post-mortem, and consent
Why is stillbirth registration important?
- Gives a source of historical and statistical information
- Gives the parents the opportunity to have their child officially recognised and to give them a name if they wish to, which can help with grief
What needs to be provided to register a stillbirth?
Medical certificate of stillbirth
Who issues a medical certificate of stillbirth?
Doctor or midwife
Are parents entitled to maternity/paternity leave and pay when there is a stillbirth/neonatal death?
Yes
