RFM, Stillbirth

Question 1

What is fetal movements based on?

Answer 1

-based on maternal perception
-not so much about individual kicks but pattern
—clinically important sign that if reduced/altered could impend fetal death (RCOG, 2011)

Question 2

Reduced fetal movements prior to 26/40

Answer 2

-FH monitoring via pinnard and Doppler
-full antenatal check should be carried out

Question 3

Reduced fetal movements after 26/40:

Answer 3

-CTG
-full antenatal check
-risk factor assessment

Question 4

Plan for recurrent episodes of RFM alongside risk factors

Answer 4

-DR review, assessment of USS and IOL

Question 5

Define IUFD

Answer 5

-babies with no sign of life in utero
-4:1000 are stillborn (Sands and tommys, 2024)

Question 6

Define neonatal death

Answer 6

-baby born at any gestation that dies within four weeks of life (MBRRACE, 2014)

Question 7

Define neonatal mortality

Answer 7

Baby dies within 28 days of being born

Question 8

Define early neonatal

Answer 8

Upto 7 days

Question 9

Define late neonatal

Answer 9

-between 7-28 days of life

Question 10

Define Infant mortality

Answer 10

Death in the first year following live birth

Question 11

Risk factors for stillbirth

Answer 11

-IUGR
-known abnormalities
-alcohol and substance abuse
-PET and recurrent RFM
-Post-dates
- BMI >30
-maternal age >20 and >40

Question 12

Why are the risk factors for stillborn relevant?

Answer 12

-placental and oxygen/nutrient insufficiency
-increased demand on maternal system
-altered passage of nutrients and oxygen

Question 13

How to confirm IUFD:

Answer 13

-ultrasonography must be used
-second opinion must be obtained

Question 14

Tests performed following IUFD

Answer 14

-kleihauer and anti D
-post-mortem with consent

Question 15

What must parents be told following IUFD:

Answer 15

-they may not find a reason for death
-results can take upto 12 weeks
-must be given support number if IOL not available the same day

Question 16

Intrapartum management for IUFD

Answer 16

-SVD recommended
-separate room for labour and postnatal
-mifepristone and prostaglandin is 1st step of IOL

Question 17

Post-natal management for IUFD

Answer 17

-not forced to hold baby
-leaflets given
-can name baby if they wish
-locks of hair and footprints

Question 18

Preparation for the mortuary:

Answer 18

-two arm bands
-baby must be wrapped in white sheet
-log book must be signed
-consent form must be in the cot
-parents must know where baby is