Care in pregnancies subsequent to stillbirth or perinatal death TOG 2020 Flashcards
What proportion of stillbirths occur in women with identifiable risk factors at booking?
18%
Previous stillbirth, what increased risk of future stillbirth?
4.8
Likely related to cause if stillbirth - higher is related to placenta dysfunction
How many stillbirths intrapartum?
1.8%
Histopathological examination of placenta
- Provides useful information in what proportion of stillbirths?
- Reduces risk of unexplained by?
- 50% more info
- 30 to 10% unexplained
How often does post portal change Dx of stillbirth?
Provides more info?
Confirms Dx?
9-34% changes Dx
22% more info
50% confirms Dx
If placental histology shows maternal vascular malperfusion -
What is the associated with and what can be done in future pregnancy?
FGR/PET/PTL
Assess maternal CV status
OGTT
Thrombohilia screen
Renal screen
LDA
Weight loss
10-25% recurrence risk
If placental histology shows fetal vascular malperfusion -
What is the associated with and what can be done in future pregnancy?
FGR/preterm & term stillbirth
Thrombophilia
OGTT
If placental histology shows ascending uterine infection
What is the associated with and what can be done in future pregnancy?
If spont PTB with chorio - recurrence risk 10-25%
If placental histology shows immune inflammatory lesions?
What is the associated with and what can be done in future pregnancy?
FGR/miscarriage/PTB
Maternal automimmunes testing, LDA +/- LMWH
20-25% recurrence - unknown aetiology
Chronic histiocytic intervillosisitis 75-90% recurrence
What proportion of women having stillbirth become pregnancy within 1 year
66%
Suggested pathway of care for patient with previous stillbirth
Specific tests and intervention for patient with previous stillbirth in pregnancy
LDA
Vitamin D
Growth USS
IOL from 38 weeks
Physiological support
