What is a stillbirth?
Baby dies >24 weeks of pregnancy and before or during birth
WHat is considered a late stillbirth?
> 37 weeks
i.e. at term
The rate of stillbirths is decreasing. TRUE/FALSE?
TRUE
What are the main causes of still birth during labour?
- placental abruption
- maternal and fetal infection
- cord prolapse
- hypoxia
- uterine rupture
What factors increase the risk of stillbirth?
- IUGR
- Congenital abnormalities
- infections
- Multiple Pregnancy (especially monochorionic - TTTS)
- Prolonged pregnancies
- Obesity
- Extremes of age
- Medical complications such as Pre-eclampsia
- Smoking
- Previous stillbirth
How are the UK Government attempting to improve care and decrease the number of stillbirths?
- Saving Babies Lives Care Bundle in maternity units
- Preventing preterm births (<37weeks)
- Best Start Initiative (continuity of midwives)
- Support women in their health choices (smoking cessation)
HOw is a pregnant mother’s smoking assessed at booking appointment, and what occurs based on the results?
- Carbon monoxide monitor - if >10 then woman = significant smoker
- this increases risk of stillbirth, so further growth scans should be organised in pregnancy
What should midwives discuss with pregnant woman at their 24 weeks appointment that could make them more aware of stillbirth?
- counselled on reduced foetal movements
What information do charities promote for mothers to prevent stillbirth?
- Sleep on side in the third trimester (avoid caval compression and safer for baby)
- Quit smoking and avoid alcohol and drugs
- Staying a healthy weight during your pregnancy
- Go to all your antenatal appointments
=> allows to report symptoms to midwife and get vaccinations - Beware of leaking fluid/blood/ vaginal discharge in pregnancy
How are stillbirths investigated?
Perinatal Mortality Review Tool
Review of care from pre-conception to bereavement care
Includes parents perspectives in review process
Allows learning points in many aspects of care to prevent further stillbirths
How are mothers managed after a stillbirth?
- Treat any potentially life-threatening maternal disease
- Take a history of events during pregnancy and clinical examination for pre-eclampsia/chorioamnionitis/abruption
- If Rhesus negative - Kleihauer test for foetal-maternal haemorrhage, if this has occurred, further ANti-D may be needed
Vaginal birth is the recommended mode of delivery for stillbirth in most women. TRUE/FALSE?
TRUE
Mothers are given the choice to go home or stay on the ward if going into stillbirth labour. Where are they kept if they choose to stay in hospital?
sideroom further away from labour ward (TULIP room)
- so they cannot hear other mothers going into labour
How soon after stillbirth are women recommended to go into labour via induction?
48 hours
- otherwise risk to mother (infection or DIC)
mothers can choose to wait for longer but must have regular check ups due to these risks
Epidurals can be given in stillbirth labour if patients are in hospital. TRUE/FALSE?
TRUE
- patient can also be transferred to theatre if required
What should be discussed at a stillbirth follow up care appointment?
- Check on emotional and physical wellbeing of women and their partner
- Go through any results of investigations
- If woman is ready discuss potential next steps (pregnancy or contraception)
- Encourage and support any lifestyle changes
- Plan care in next pregnancy (stopping smoking, optimising weight etc)
What mental health conditions are common after stillbirth
- PTSD
- depression
How can the next pregnancy be planned to minimise the risk of stillbirth?
- if cardiac abnormalities => extra scans
- screen for infection regularly
- NIPT for Trisomy21
- consider early delivery with Induction of Labour
