FDIU/NND

Question 1

FDIU initial mx

Answer 1

Dx

• USS - 4 chamber, color doppler, umbi
• formal USS

• pain/fever/bleeding/pruritis
• AN hx of concern or VTE hx
• Past OGHx - outcomes/MOD
• HR/BP/Temp/Ut irrit
• FH/Lie
• PET/abrupt/chorio

• FBE/UEC/CRP/LFT/Coag
• G&S/Kleihauer
• BA/TFT/HbA1c/BSL
• sTORCH/aPLS
• +/- amnio for TORCH/MCS - MSU

Question 2

FDIU IOL options

Answer 2

Expectant

• 90% deliver in 3/52
• DIC risk high >4/52
• regular monitor - weekly bloods

• > =15/40
• immediate vs delayed IOL
• mife/miso - in hospital, PO/PV
• SE, PCA, previous CS

• <15/40
• D&E - bleeding risks
• Hysterotomy
• Investigation post
• Follow-up post

Question 3

FDIU mx post delivery

Answer 3

• MDI - Obs/MW/SW/Psych/Path
• sx rv -pain/peri/bleed/blad/bowel
• +/- death certificate
• PM discussion - autopsy
• Further none autopsy testing

Further testing
- MCS - fetal/placental
- Cord/Placenta histology
- Cord blood
- Chromosomal analysis - placenta/skin

• LS - 1mg Carbergoline or natural
• Contraception
• SW - funeral…
• Bereavement support
• Follow-up in OPC 6/52
  1. results
  2. recurrence of issues
  3. future preg planning
  4. recommend pre-preg counselling/optimisation

Question 4

PM ix - autopsy vs alternatives

Answer 4

• involve senior obs
• PM include a range of Ix
• PM Ix - 50% remain unexplained
• autopsy gold std identify/exclude ddx
• assist in grieving/alleviate guilt
• assist in planning of future preg
• autopsy - full, limited, step-wise
• retained tissue for testing
• written information/consent

Alt to autopsy w variable yield
(for parents declining autopsy)
- external exam
- babygram (full body xray)
- USS at time of dx
- MRI

Question 5

Adverse outcome communication

Scenario 1 - 2/52 post CS & stillbirth for vase previa + FMH + IUGR

Scenario 2 - post FDIU CS hysterectomy for uterine rupture

Scenario 3 - post SB F/U comm station

Scenario 4 - post preterm DCDA delivery c/b NND of 1

Answer 5

• setting/support
• apologies
• perception - events/outcomes/results
• PP physical health
• use EPDS
• future pregnancy timing
  1. routine preg interval
  2. emotional recovery
• further follow-up
• link to support services
• written information