Stillbirth & intrauterine fetal death Flashcards

1
Q

Definition of stillbirth

A

Baby delivered >24 weeks with no signs of life

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2
Q

Definition intrauterine death

A

Baby no signs of life in utero

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3
Q

Risk of still birth

A

1 in 200

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4
Q

What % of stillborn babies are SGA

A

1/3rd

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5
Q

How to diagnose intrauterine death

A

Colour doppler USS
Obtain 2nd opinion where possible

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6
Q

What Ix should be performed for late uterine death?

A

Clinical assessment
Bloods: FBC, U+E, LFT, Clotting + fibrinogen, CRP, BA
Infective: Blood culture, MSU, HVS, NAAT, viral screen, syphilis, topical infections
DM: Maternal glucose, Hba1c
Autoimmune: TFTs, thrombophilia screen, anti-red cell antibodies, anti-ro and anti-la, anti platelet antibodies
Toxic: Urrine toxicology (cocaine)

Placental: fetal blood, fetal seabs, placental swab Plancetal histology
Fetal and plancetal tissues for karyotype +/- patronal blood for karyotype

Post mortum - extrnal, autopsy, microscopy, X-ray, placenta and cord

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7
Q

Risk of DIC within 4 weeks

A

10%

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8
Q

Risk of DIC after 4 weeks

A

30%

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9
Q

It what % of cases is not specific cause of stillbirth identified?

A

50%

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10
Q

When should kleihaur test be sent if Rh-ve?

A

As soon as IUD diagnosed

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11
Q

If large FMH and kleuhauer high, what should be done?

A

Give higher dose anti-D and repeat kleihauer in 48hrs to ensure fetal red cells have cleared

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12
Q

If baby blood group not know an unable to get blood from cord or baby?

A

ffDNA from material blood shortly after birth

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13
Q

How to sex the baby?

A

Explain may be difficult before birth
2 healthcare professionals
If in doubt → QF-PCR or FISH
Can register without gender if parents do not want testing

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14
Q

What stillborn babies have chromosomal abnormality?

A

6-10%

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15
Q

What samples for karyotype?

A

Multiple samples of tissue required from different areas to reduce risk of culture failure

Need written consent from parents

e.g. skin failure rate 60%

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16
Q

Are all post-mortem invasive

A

If parents declined full PM

Can offer external examination - weight/histology/skeletal XRAY or needles biopsy but less reliable

Can have pathological examinationof cord/membranes placenta without PM

Need written consent for P<

17
Q

What % of women with IUD will deliver spontabously within 3 weeks>

A

85%

18
Q

When is immediate delivery recommended?

A

Sepsis
PET
PROM
DIC

19
Q

If delay in delivery >48hrs, how often should blood be performed for DIC

What can happened to baby?

A

2 x weekly

If delay in delivery, value of PM may be reduced, appearance of baby will deteriorate

20
Q

What % deliver within 24 hours of IOL

A

90%

21
Q

For IOL of IUD what drugs care given?

A

Mife 200mg
Misoprostol
<26+6 100mcg 6 hourly
>27 25-50mcg 4 holt

22
Q

Can Miso be given PV or PO?

A

Can be given PV or PO, PV has less SE and shorter labour

PO SE include diarrhoea, vomiting, shivering , pyrexia

23
Q

Risk of rupture with VBAC being IOL with prostaglandins? 1 CS and 3 CS

A

1 LSCS 0.7%
2 LSCS 1.8%

Discuss with consultant

24
Q

Pain relief options

A

Diamorphine PCA
Regional (if no DIC/Sepsis)

Discuss Obstetric anaesthetist

25
Q

What medications should be considered post-partum

A

Calculate VTE score
Domaine agonist to suppress lactation
Contraception, fertility likely to return quickly

26
Q

Who can you not give domaine agonist to?

A

HTN or PET - associated with higher BP and intracerebral haemorrhage

27
Q

What % of couples break up follow stillbirth?

A

40%

28
Q

What additional care should be offered in future pregnancies following stillbirth?

A

Obs led care
Screen for GDM
Serial USS
Birth on labour wards
Aware maternal mental health and bonding with baby

29
Q

What is the chance of PET in pregnancy following stillbirth?

A

12 fold increase