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Laura MRCOG Part 2 > 10/11) Labour & Delivery - IUFD and Stillbirth > Flashcards

10/11) Labour & Delivery - IUFD and Stillbirth Flashcards

1
Q

Incidence of stillbirth

A

1 in 200

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2
Q

What proportion of stillbirths are SGA babies?

A

Over 1/3

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3
Q

What proportion of stillbirths are unexplained?

A

50%

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4
Q

What percentage of stillbirths are associated with suboptimal care?

A

> 50%

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5
Q

How to diagnose IUFD?

A

Real-time ultrasound (with second opinion where practical) demonstrating absence of FH.

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6
Q

Sensitivity of USS for detecting abruption

A

15%

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7
Q

Risk of DIC within 4 weeks of IUFD and risk after that

A

10% within 4 weeks and 30% after 4 weeks

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8
Q

What investigations to do if mother opting for expectant management beyond 48 hours?

A

Twice weekly clinical assessment and bloods to detect DIC.

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9
Q

What investigations should be done in a Rh NEG woman after an IUFD?

A
  • Anti-D given
  • Urgent Kleihauer and repeat 48 hours if large FMH
  • Establish baby blood group
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10
Q

What maternal blood tests to do after IUFD/SB?

A 
FBC
UE/LFT
CRP
Clotting
Kleihauer
Random blood glucose & HbA1c
Thyroid
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11
Q

Which microbiology investigations to do after IUFD/SB?

A

Parvo, rubella, CMV, HSV, toxoplasma and syphilis serology.

Feral blood (cord or cardiac), fetal swabs, placental swabs.

If maternal fever, flu-like symptoms, abnormal liquor or PROM: Blood cultures, MSU, HVS, Cervical swabs.

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12
Q

When to do maternal thrombophilia screen?

A

If evidence IUGR or placental disease.

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13
Q

When to do maternal antibodies?

A

Anti-red cell if feral hydrops.
Anti-Ro/La if hydrops, endomyocardial fibro-elastosis or AV node calcification.
Antiplatelet antibodies if fetal intracranial haemorrhage.

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14
Q

What tissue to take for karyotype?

A

Deep fetal skin, fetal cartilage and placenta.

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15
Q

Percentage of SB/IUFD with chromosomal abnormality

A

6%

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16
Q

What percentage of postmortems will give a classification of death?

A

46%

17
Q

What percentage of postmortems will provide information on recurrence and management of future pregnancies?

A

40-50%

18
Q

When to do parental bloods for karyotype?

A

Fetal unbalanced translocation.
Fetal aneuploidy.
Fetal genetic testing fails and history suggestive of aneuploidy.

19
Q

When do women labour spontaneously after IUFD?

A

> 85% labour within 3 weeks

20
Q

When to induce labour after IUFD?

A

If maternal health well and membranes intact - risk of delaying labour 48 hours is low.
If sepsis, PET, abruption or SROM then advise immediate steps toward delivery.

21
Q

Consequences of prolonged expectant management

A

Need for twice weekly bloods for DIC.
Value of PM may reduce.
Appearance of baby may reduce.

22
Q

After induction how long will it take for vaginal birth?

A

90% of IUFD can achieve vaginal birth within 24 hours.

23
Q

Protocol for induction in women with unscarred uterus.

A

200mg mifepristone and then misoprostol.

<26+6: 100 micrograms misoprostol 6h
>27: 25-50 micrograms misoprostol 4h

24
Q

Induction of labour for women with scarred uterus

A

Can use mifepristone alone to increase chance of labour significantly within 72 hours.
Miso can be used at doses 25-50 micro grams.

25
Q

What percentage of women using simple measures to manage lactation report extreme pain?

A

1/3

26
Q

Dose of carbergoline

A

1mg STAT

27
Q

Success rate of carbergoline in suppressing lactation

A

90%

28
Q

Risk of parental relationships dissolving after SB compared to live birth

A

40% increased risk

29
Q

Who is responsible for registering birth?

A

Parents but can delegate to healthcare professional (42 days)

30
Q

Care of pregnancy following a SB

A

CLC
GTT
Serial growth scans
Consider scheduled delivery

31
Q

Risks in future pregnancies

A 
Future SB
PET
Placental abruption
Placental disease
Fetal distress
Chorioamnionitis
Extreme PTB
Early neonatal mortality
GDM
32
Q

What proportion of SB occur in low/middle income countries?

A

99%

33
Q

In high income countries, what percentage of SB occur intrapartum?

A

<10%

34
Q

What percentage of SB variation do maternal risk factors account for?

A

19%

35
Q

What is the only antenatal intervention shown to reduce SB rate?

A

Aspirin in women at risk of PET

36
Q

What would be the reduction in perinatal death from routine IOL at term?

A

50%

Laura MRCOG Part 2 (56 decks)

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