Stillbirths

Dead children include children born dead at the end of 24 weeks of pregnancy. Intrauterine fetal death can occur at any time of pregnancy or in childbirth. The birth of a dead fetus causes a strong emotional tension in both the mother and the obstetric staff, so the pain and the process of delivery in these circumstances may seem useless and vain, and mothers can feel guilty and consider that what happened to some extent is a punishment for them .

A few hours after the fetal death of the fetus, his skin begins to peel off. In such fruits, the skin has a characteristic macerated appearance (the so-called macerated stillborn), which is not observed at the birth of the fetus that has just died in the womb (the so-called fresh stillborn). In case of intrauterine fetal death, spontaneous delivery occurs (in 80% of cases it occurs within the next 2 weeks, in 90% - within 3 weeks), however, as a rule, the birth is induced immediately after fetal death is diagnosed to prevent prolonged expectation by the mother of spontaneous childbirth, and also to minimize the risk of coagulopathy. Development of DIC-syndrome is observed quite rarely, except for cases when the gestation period exceeds 20 weeks, and its postmortal fetal stay in the womb lasts more than 4 weeks; however, for the onset of delivery, the presence of coagulopathy is highly undesirable.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12]

Causes of stillbirth

Toxemia, chronic arterial hypertension, chronic kidney disease, diabetes, infection, febrile conditions (with a body temperature above 39.4 ° C), fetal malformations (11% of macerated stillbirths and 4% of stillbirths are due to chromosomal abnormalities), jaundice, . Detachment of the normally located placenta and torsion of the umbilical cord can be the causes of fetal death during childbirth. In 20% of cases, there is no apparent cause for stillbirth.

[13], [14], [15], [16], [17]

Recognition

Mothers usually tell the doctor about the cessation of fetal movements. The palpitation of the fetus is not listened to (using a Pinard stethoscope or cardiotocography). Also, it is not possible to detect cardiac contractions of the fetus during ultrasound examination.

Tactics of reference

Childbirth is caused by using the prostaglandin dosage form for vaginal administration, or by injecting them so that they do not enter the amnion (the dose varies depending on the uterus reaction). The use of oxytocin intravenously entails the risk of concomitant injury to the uterus or its cervix, so it is recommended that it be administered only after the infusion of prostaglandins has ceased. Infusion of oxytocin alone can be used to induce labor in cases where the cervix is "ripe" (the indicator is more than 4 on the Bishop scale, the gestation period is more than 35 weeks). Conducting an amniotomy is contraindicated, since it is accompanied by a risk of infection.

Provide adequate analgesia in childbirth (with epidural anesthesia, tests that control the state of the hemostasis system). It is desirable that when a child is present a close person - for moral support. After the birth of a dead child, he should be swaddled, like any other newborn, and give the mother to look at him and hold him in his arms (if she so wished). A photograph of the child can be taken and given to the mother home. If a stillborn child is given a name and a full funeral rite is performed with the help of ritual services, then this can also help to alleviate the bitterness of the loss.

The procedure for controlling the birth of a dead fetus (to determine the possible cause of stillbirth). A thorough analysis of the case of births by a dead fetus is being conducted, and clinical pictures are being studied. Provide autopsy and histological examination of the placenta. The smears are taken from the upper parts of the vagina for bacteriological examination. The blood of the mother and fetus is examined for infections that are combined in the English medical terminology under the abbreviation TORCH-infection: T - toxoplasmosis, O - other (eg AIDS, syphilis), R - rubella, C - cytomegaly, herpes (and hepatitis). Mother's blood is subjected to the Kleihauher-Betke acid test (revealing the interchange of maternal and fetal blood as a possible cause of unexplained stillbirth), as well as the detection of lupus anticoagulant. Conduct a chromosomal analysis of the blood and skin of the fetus.

Rodilnitsa proposed suppression of lactation (bromocriptine 2.5 mg orally on the 1st day, then 2.5 mg every 12 hours inside for 14 days). After receiving the results of the study, parents are given an appointment to discuss the causes of stillbirth. If necessary, parents are referred for genetic counseling.

Activities to help parents with stillbirths (in the UK)

• On the fact of stillbirth on the dates of more than 24th week of pregnancy, a certificate for stillbirth is required (by an obstetrician), which parents must pass to the registry-registrar of births and deaths within 42 days from the date of birth, the father's name is fixed in the register only when the parents are married or if the registration is made by both parents.
• The archivist registrar issues a certificate of burial or cremation, which parents must present to the funeral home or hospital administration. If the parents chose a private funeral, they should pay for their own cost if they chose a "hospital" funeral, their cost is paid by the hospital administration. The certificate of registration should include the name of the stillborn child (if given the name), the name of the registrar and the date of stillbirth.
• Hospitals, based on documents signed by both parents, offer "hospital" funerals for stillbirths (on terms agreed with funeral service representatives). If the parents wish to pay for the "hospital" funeral, the hospital administration has the right to accept this payment. The administration must notify parents in advance of the date and time of the funeral so that they can attend them, if they so wish. At "hospital" funerals, a coffin is provided, funerals are often produced in multi-seated graves located in sections of cemeteries specially reserved for children. The hospital administration should inform the parents about the location of the grave. The graves are not labeled, so if parents are not present at the funeral but would later want to visit the cemetery, then they are recommended to contact the responsible officer of the cemetery so that temporary signs are placed on the corresponding grave. If desired, parents can buy a single grave, on which to later install a tombstone. The hospital can arrange cremation, but this procedure is paid by the parents.
• Parents of the stillborn child should contact the local branch of the organization that provides counseling and psychological assistance to people who have lost loved ones or relatives, for example, SANDS (Society for Assistance to Parents who Have Been Born to a Dead Child or the Death of a Newborn). The bitterness of the loss persists for a very long time, and the parents can be difficult to contact the medical workers because of the constant apology of the latter.

[18], [19], [20], [21], [22]