Stillbirth & intrauterine fetal death Flashcards
Definition of stillbirth
Baby delivered >24 weeks with no signs of life
Definition intrauterine death
Baby no signs of life in utero
Risk of still birth
1 in 200
What % of stillborn babies are SGA
1/3rd
How to diagnose intrauterine death
Colour doppler USS
Obtain 2nd opinion where possible
What Ix should be performed for late uterine death?
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
Risk of DIC within 4 weeks
10%
Risk of DIC after 4 weeks
30%
It what % of cases is not specific cause of stillbirth identified?
50%
When should kleihaur test be sent if Rh-ve?
As soon as IUD diagnosed
If large FMH and kleuhauer high, what should be done?
Give higher dose anti-D and repeat kleihauer in 48hrs to ensure fetal red cells have cleared
If baby blood group not know an unable to get blood from cord or baby?
ffDNA from material blood shortly after birth
How to sex the baby?
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
What stillborn babies have chromosomal abnormality?
6-10%
What samples for karyotype?
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%
Are all post-mortem invasive
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<
What % of women with IUD will deliver spontabously within 3 weeks>
85%
When is immediate delivery recommended?
Sepsis
PET
PROM
DIC
If delay in delivery >48hrs, how often should blood be performed for DIC
What can happened to baby?
2 x weekly
If delay in delivery, value of PM may be reduced, appearance of baby will deteriorate
What % deliver within 24 hours of IOL
90%
For IOL of IUD what drugs care given?
Mife 200mg
Misoprostol
<26+6 100mcg 6 hourly
>27 25-50mcg 4 holt
Can Miso be given PV or PO?
Can be given PV or PO, PV has less SE and shorter labour
PO SE include diarrhoea, vomiting, shivering , pyrexia
Risk of rupture with VBAC being IOL with prostaglandins? 1 CS and 3 CS
1 LSCS 0.7%
2 LSCS 1.8%
Discuss with consultant
Pain relief options
Diamorphine PCA
Regional (if no DIC/Sepsis)
Discuss Obstetric anaesthetist
What medications should be considered post-partum
Calculate VTE score
Domaine agonist to suppress lactation
Contraception, fertility likely to return quickly
Who can you not give domaine agonist to?
HTN or PET - associated with higher BP and intracerebral haemorrhage
What % of couples break up follow stillbirth?
40%
What additional care should be offered in future pregnancies following stillbirth?
Obs led care
Screen for GDM
Serial USS
Birth on labour wards
Aware maternal mental health and bonding with baby
What is the chance of PET in pregnancy following stillbirth?
12 fold increase
