Stillbirth & neonatal death Stillbirth Early neonatal death Late neonatal death Perinatal death Perinatal mortality rate (PNMR) Post natal death Infant death – any baby born with no signs of life after 24 weeks – in 1st 6 days of life – 7-27 days – stillbirths + first 7 days – no perinatal deaths / 1000 live & still births – 28 days to 1 year – under 1 year Immediate management Usually present with reduced fetal movements Fetal heart not heard with Pinard/Doppler Confirm diagnosis with US scan (& check for obvious anomalies in case post mortem refused) Inform parents in suitable setting Labour will need to be induced – 48hrs of mifepristone, analgesia essential, delay membrane rupture as long as possible to reduce risk of chorioamnionitis Encourage parents to see/hold baby, have photos etc Arrange for some form of bereavement counselling & discuss funeral arrangements Investigation Maternal bloods to check congenital infection (toxoplasmosis, rubella, CMV, human parvovirus) Lupus anticoagulant & antiphospholipid (assoc with recurrent miscarriage, stillbirth, TED, PET, IUGR, thrombocytopenia). Low dose aspirin during future pregnancy can help Diabetes (random blood glucose or HbA1C Fetomaternal haemorrhage (kleihauer test) Isoimmunisation (Rh / other blood groups) Post mortem May be resticted to genotyping or full examination Placenta examination For evidence of clots, abruption, vasa praevia etc Causes Unexplained - >50% Antepartum haemorrhage = 16% Congenital anomaly = 9% (Includes structural, genetic & biochemical causes) Others – Hypertension, maternal injury/illness, isoimmunisation, trauma to fetus/cord Follow up 4-8 weeks later with obs team to explain findings, implications for future Close follow up in future pregnancy with reassurance and usually induction at 38-9 weeks Neonatal Mortality 29% are congenital anomaly, 23% lung immaturity, 16% chronic lung disease, 14% anoxia/birth trauma 80% of deaths are in prems – mostly from RDS / infection 2/3 of infant deaths in 1st month, 2/3 of deaths in 1st month occur in 1st week, 2/3 of deaths on 1st week occur in 1st 24 hrs Risk factors Age - Safest age 25-29yrs. (in younger = lack of support, older = higher incidence of medical conditions Parity – 1st preg assoc with PET & obstructed labour, >3 = older mother Social class – increase in NNM as social class falls Global causes Infection 32% – tetanus, sepsis, pneumonia, diarrhoea Complications of delivery 29% - birth asphyxia & birth injuries Complications of prematurity 24% Congenital anomaly 10%