Stillbirth: baby dies after 24 weeks of pregnancy and before or during birth

Pregnancy management of a patient who has had a stillbirth

• Detailed history of events during pregnancy and clinical examination for pre-eclampsia, chorioamnionitis and placental abruption
• Women who are RhD-negative should be advised to have a Kleihauer test undertaken urgently to detect large feto-maternal haemorrhage that might have occured a few days earlier
• Anti-RhD gammaglobulin should be adminstered as soon as possible after presentation
• If there has been a large FMH the dose of anti-RhD gammaglobulin should be adjusted upwards and the Kleihauer test should be repeated at 48 hours to ensure the fetal red cells have cleared
• It is important to know the babies blood group: if no blood sample can be obtained from the baby or the cord, RhD typing should be undertaken using free fetal DNA from maternal blood taken shortly after birth

Risk factors for stillbirth (UK)

• Placental causes
• Intrauterine growth restriction
• Congenital abnormalities - 6% stillbirths
• The common causes of intrapartum death include placental abruption, maternal and fetal infection, cord prolapse, idiopathic hypoxia–acidosis and uterine rupture
• Maternal infections (Cytomegalyvirus, Parvo, herpes, malaria and syphilis) 3% (much higher worldwide)
• Non-communicable diseases, nutrition and lifestyle factors (each about ten per cent)
• Extremes of age (Maternal age older than 40 years or in teenage years), ethnic minority groups and lower socioeconomic class
• Medical complications such as pre-eclampsia and eclampsia together contribute to 4%; other medical disorders include diabetes, obstetric cholestasis
• Multiple pregnancy, twin to twin transfusion
• Prolonged pregnancies
• Obesity is one of the most important modifiable risk factors
• Smoking