STILLBIRTH

Question 1

What is the definition of a stillbirth?

Answer 1

A baby that is born with no signs of life after 24 weeks of gestation.

Question 2

What is the incidence of stillbirth?

Answer 2

1 in 200 pregnancies

Question 3

How is intrauterine death most often diagnosed?

Answer 3

Reduced fetal movement leading to ultrasound scan, looking for heart beat.

Question 4

What are the maternal causes of stillbirth (as opposed to fetal or placental)?

Answer 4

Diabetes
Pre-eclampsia
Sepsis
Obstetric cholestasis
Acute fatty liver
Thrombophilia eg protein C and protein S resistance, factor V Leiden, antithrombin III deficiency

Question 5

What are fetal causes of stillbirth (as opposed to maternal or placental)?

Answer 5

Infection: toxoplasma, listeria, syphilis, parvovirus

Chromosomal abnormality
Rhesus disease
Twin-to-twin transfusion syndrome
IUGR
Alloimmnune thrombocytopenia

Question 6

What are the placental causes of stillbirth (as opposed to maternal or fetal)?

Answer 6

Postmaturity
Abruption
Praevia: significant bleed
Cord prolaspe

Question 7

In what proportion of cases of stillbirth will no cause be found?

Answer 7

50%

Question 8

What investigations would you do to look for a cause of stillbirth?

Answer 8

FBC - haemorrhage, WCC, platelets

CRP - infection

U+Es - pre-eclampsia, haemorrhage

LFTs - obstetric cholestasis, haemorrhage, sepsis, pre-eclampsia

Coagulation screen - VTE

Kleihauer - Rh-ve, also estimate fetomaternal haemorrhage,

Maternal thrombophilia screen - VTE

HbA1c

TFTs

Parental karyotyping - if fetal karyotyping indicates unbalanced translocation

Urine dip/MSU - infection

Cultures and serology - infection

Post-mortem

Question 9

How do we manage confirmed intrauterine fetal death?

Answer 9

Allow parents time to grieve

Most cases vaginal delivery will be most suitable

Anti-progesterone is given orally - Mifepristone

48 hours later, course of prostaglandins - Misoprostol

For gestation nearer term, oxytocin infusion might be indicated instead of prostaglandings

Refer for post-delivery counselling and support networks such as SANDS.

Offer cabergoline to suppress lactation