Stillbirth, miscarriage and infant mortality Flashcards
(48 cards)
what are the leading causes of stillbirth?
fetal growth restriction
structural e.g. neural tube defects/genetic defects
fetal infection in utero
maternal disease e.g. diabetes, HT etc
what perinatal infections can cause stillbirths?
GBS, E coli, Listeria, Parvovirus, CMV, HSV, rubella, H1N1, toxoplasmosis, influenza
define fetal death in utero?
fetal demise after 20 weeks but before the onset of labour
what are the prenatal/maternal causes of stillbirth
• Congenital abnormality (e.g. structural/chromosomal/genetic)
• Perinatal infection (GBS, E coli, Listeria, Parvovirus, CMV, HSV, rubella, H1N1, toxoplasmosis)
• Hypertension (chronic HT, gestational HT, pre-eclampsia)
• Antepartum haemorrhage
• Maternal medical conditions e.g. diabetes, SLE, heart disease
• Increased maternal age
• Maternal obesity
• Increasing assisted reproduction
• Fetal growth restriction
• Fetal anaemia
Twin to twin transfusion syndrome
how might we confirm fetal death in utero and what do we need to do?
- Reduced or no fetal movements
- Unable to locate fetal heart sounds
- Diagnosed by ultrasound
Search for maternal coagulopathies. RISK of HAEMORRHAGE
what medications do we use for induction of stillborn baby and which do we use and why?
prostaglandins are used for induction
misoprostol for early gestational period
PGE2 for near term babies
what are some general things we need to consider when managing/breaking bad news to parents who have lost a baby in utero?
- Breaking bad news- SPIKEs
- At some point, you will need to ask for consent for post-mortem autopsy/further investigations for cause
- No rush for delivery if completely well
- Talk about methods of induction or spontaneous labour
- Talk about pain relief
- Pastoral care, bereavement services, contact the GP
- Monitor for maternal coagulopathy
- Suppression of lactation
- Review frequently postpartum
If required, have discussion about another pregnancy
what exactly IS fetal hydrops and what can cause it?
fetal hydrops refers to a fetus with fluid accumulation in two or more body cavities (pleural fluid, pericardial fluid, ascites or skin oedema
it can be caused by CAUSTIC C- cardiac cause A- anaemia U- unexplained S-structural abnormalities T- twins I- infections C- chromosomal abnormalities
what does missed miscarriage mean?
Non-viable intrauterine pregnancy that has not had any vaginal bleeding as yet
what does a threatened miscarriage mean?
early trimester 1 bleeding but still viable intrauterine pregnancy
Bleeding in early pregnancy should be considered…… or otherwise? fill in the gap
ectopic pregnancy
what are the options of managing miscarriage during the first trimester?
expectant management especially if confirmed inevitable miscarriage
medical management using misoprostol
surgical management- definitive; dilation and curettage or dilation and suction
what are the risks of surgically managing a miscarriage?
anaesthetic risk
risk of uterine perforation
usual surgical risks including infection etc
what are some risk factors for ectopic pregnancies?
previous STIs/PID causing adhesions previous ectopics use of emergency contraceptive pill use of intrauterine device IVF
what are the management options for ectopic pregnancy?
- conservative (if bHCG levels falling) and woman is otherwise medically stable
- medical management using methotrexate
- surgical management- type depending on where the ectopic pregnancy is located and haemodynamic status of the woman
what are some key practice points of using methotrexate for medical management of ectopic pregnancy?
There is still a risk of ectopic rupture during medical management. Hence follow up appointment is ESSENTIAL
Women who choose this method require WEEKLY bHCG serum measurements to ensure the ectopic pregnancy has resolved
Methotrexate can either be given single dose IM or as a multi-dose regimen
A quantitative bHCG drop of >15% day 4-7 of methotrexate is consistent with treatment success
Contraindications or patient refusal to methotrexate warrants surgical management of ectopic pregnancy
tell me about the surgical management of ectopic pregnancies?
Type of surgery depends on location of ectopic pregnancy and state of maternal haemodynamic status.
Since tubal ectopic pregnancies are most common; generally laparoscopic salpingectomy is performed.
A salpingostomy which removes the products of conception but retains the fallopian tube can be performed in those who have contralateral disease.
what are some contraindications of using methotrexate in ectopic pregnancies?
- poor patient compliance/inability to follow up
- hypersensitivity/liver dysfunction etc direct contraindications to methotrexate
- presence of fetal heart beat
- bHCG > 5000 IU
- patient refusal of using methotrexate
what drug is RU486?
mifepristone
what is the role of RU486 in medical termination of pregnancy?
Primes the uterus and cervix for the actions of the prostaglandin, and reverses the acceptance of the fetal allograft
what drugs do we use in medical termination of pregnancy?
misoprostol and mifepristone
what are some complications of termination of pregnancy (medical/surgical)?
Complications include endometritis, negative psychological impact, Asherman syndrome and retained products of conception
describe dilation and suction method of surgical termination of pregnancy?
Misoprostol is used prior to surgery. This is a day procedure.
Cervix is grasped and gently dilated from 6 to 10 mm depending on gestation. Suction curettage is performed using a plastic catheter.
when do most miscarriages occur?
less than 12 weeks (first trimester)
