Stillbirth

Question 1

How should pregnancy be managed?

Answer 1

Assess maternal wellbeing and ensure prompt management of any potentially life threatening maternal disease

Question 2

What should pregnant mothers be examined for?

Answer 2

Pre-eclampsia, chorioamnionitis and placental abruption

Question 3

What should women who are RhD negative be advised to do?

Answer 3

Have a Kleihaner test to detect any large feto-maternal haemorrhage

Question 4

How quickly should anti-RhD gammaglobulin be given after presentation?

Answer 4

As soon as possible

Question 5

What is a stillbirth?

Answer 5

When a baby dies after 24 weeks of pregnancy

Question 6

What is a miscarriage?

Answer 6

Loss of a baby < 24 weeks pregnancy

Question 7

When does antepartum refer to?

Answer 7

Before labour

Question 8

When does intrapartum refer to?

Answer 8

During labour

Question 9

What can MBRRACE reviews lead to?

Answer 9

Change in government policy and redistribution of resources

Question 10

In what ethnic group are still births more common in?

Answer 10

BAME = 80% higher risk in black babies, 60% higher risk in asian babies

Question 11

What area does MBRRACE recommend extra emphasis be placed on?

Answer 11

Reducing preterm birth

Question 12

What are the most common causes of intrapartum death?

Answer 12

Placental abruption
Maternal and foetal infection
Cord prolapse
Idiopathic hypoxia-acidosis
Uterine rupture

Question 13

What are some risk factors for stillbirth in the UK?

Answer 13

Placental cause or intrauterine growth restriction
Extremes of age and lifestyle factors
Obesity and diabetes
Prolonged pregnancy and previous stillbirths

Question 14

What are the most common reasons for babies dying?

Answer 14

Unknown cause = 46%
Placental problems = 22%
Congenital abnormalities = 6%
Complications during labour = 6%

Question 15

What is the UK government target?

Answer 15

Aims to reduce stillbirth by half by 2025

Question 16

What are some ways the UK government is trying to reduce stillbirths?

Answer 16

Ensure women are cared for by the same midwife
Roll out of maternity outreach clinics
Smoking cessation programmes

Question 17

What is the purpose of the Moments Matter movement?

Answer 17

To tell women to get in touch with medical professionals if there is a reduction in foetal movement = discussed at 24 week appointment

Question 18

What are some of the recommendations made by Tommy’s?

Answer 18

Going to sleep on side in 3rd trimester
Smoking cessation
Avoiding alcohol and drugs
Staying a healthy weight throughout pregnancy
Attending appointments
Contact hospital in leaking fluids/vaginal discharge

Question 19

What is the PMRT tool?

Answer 19

Local review of all perinatal deaths from 22 weeks gestation to 28 days after birth as well as babies who die after 28 days following neonatal care

Question 20

What are some situations where immediate delivery would be recommended?

Answer 20

Sepsis, pre-eclampsia, placental abruption or membrane rupture

Question 21

What is the recommended mode of delivery for most women?

Answer 21

Vaginal delivery

Question 22

What is there a moderate risk of during labour?

Answer 22

Maternal disseminated intravascular coagulation (DIC)

Question 23

How is maternal DIC tested for?

Answer 23

Clotting studies, blood placental count and fibrinogen measurement

Question 24

What should women who delay labour by > 48 hrs be advised to do?

Answer 24

Have weekly testing for DIC

Question 25

What are some investigations that can be done?

Answer 25

Infection screening and genetic testing
Maternal antibodies and maternal wellbeing
Post mortem is gold standard

Question 26

What are some investigations that may be part of a debrief?

Answer 26

Post mortem, skin biopsy, placental histopathology, blood test and microbiology

Question 27

What are mothers who have had a stillbirth at higher risk of?

Answer 27

4x higher risk of depression

7x higher risk of PTSD

Question 28

What are some things that are involved in planning another pregnancy following a stillbirth?

Answer 28

Plan depends on previous cause of stillbirth (if known)
Likely to involve frequent foetal surveillance and tests
May involve medication
Likely early delivery by IOL