Stillbirth

Stillbirth is the birth of a dead foetus after 24 weeks as a result of Intrauterine Foetal Death (IUFD). Causes of it are:

• Unexplained – Most common at 50%

• Pre-eclampsia

• Placental abruption (concealed)

• Vasa praevia

• Cord prolapse or wrapped around foetal neck

• Obstetric cholestasis – Puts stress on baby’s liver

Risk factors:

• IUGR

• Smoking and Alcohol

• Increased maternal age

• Obesity

• Multiple pregnancy

• Sleeping on the back instead of side

Presentation

• Reduced foetal movements – Important to ask about this in a hx!

• PV bleeding

• Abdominal pain

Prevention

• Risk assessment for having a foetus that’s small for gestational age or with growth restriction is done for all pregnant women

• Any modifiable risk factors are treated e.g. stopping smoking, alcohol, diabetes control, and sleeping on side

Investigations

• TVUS to check for IUFD – Used to visualise the foetal heartbeat

Management

• Vaginal delivery, which can be:

  • Induced – Combination of Mifepristone (anti-progesterone) and Misoprostol (prostaglandin analogue to ripen cervix)

    • Progesterone readies the endometrium, so blocking its activity will reduce the conditions of it for pregnancy

  • Expectant – awaiting natural labour and delivery

• Anti-D prophylaxis given to Rh-D -ve women

• Dopamine agonists can be used to supress lactation after delivery