general obs

Question 1

Still birth

Answer 1

PMR 11/1000
8/1000 fetal deaths and 3/1000 neonatal deaths
However in approximately 20-30% of stillbirths, a cause is never identified.

Talk to both parents
offer a support person
culturally competent

 Comprehensive maternal (medical, social, family) and pregnancy history
 Kleihauer-Betke test/Flow cytometry for fetal to maternal haemorrhage
 External examination of the baby performed by the attending clinician
 Clinical photographs of the baby
 Autopsy
 Detailed macroscopic examination of the placenta and cord
 Placental histopathology
 Cytogenetics (Chromosomal microarray (CMA) or karyotype if CMA is not available).

The rest are targeted
VTE personal or FHx - APLS
Sx cholestasis - LFT and bile salts

LGA - HBA1c
SGA - TORCH APLS and HBA1c

Placenta abruption APLS

Question 2

NAIT

Dx mum HLA bb
with +ve HLA 1a antibodies
Test father
HLA1a

Answer 2

This is a condition when you create anti platelet antibodies that can cross the placenta and cause fetal thrombocytopenia
This can affect the first pregnancy
Risk depends on how severely previous pregnancies were affected

Severity of fetal/ neonatal consequence is a spectrum from petechiae to intracranial haemorrhage, venticulomegly GI or pulmonary haemorrhage and fetal or neonatal death

Management 
paternal screening 
Amnio to confirm fetal genotype (option)
IVIG depending on previously affected pregnancy 
Can perform cordiocentesis 8 weeks after IVIG started to assess response (risk may outweigh benefit) 
USS to screen for ICH 
All offered ELLSCS at 37-38 weeks
recurrence 70-90%
30% worse