From the Guidelines
When documenting a fresh stillbirth case, it is essential to include the gestational age, which is calculated by the best obstetric estimate determined by assessments, including early ultrasound, and the date of the last menstrual period, and/or perinatal details, as defined in the study by 1. To ensure comprehensive documentation, the following information should be included in the medical notes:
- Date and time of delivery
- Gestational age at birth, reported as a median and interquartile range, as recommended by 1
- Maternal history, including prenatal care, risk factors, and previous pregnancies
- Circumstances surrounding the stillbirth
- Baby's weight, in grams, as birth weight should be collected within 24 h of birth and assessed using a calibrated electronic scale with 10-g resolution, as stated in the study by 1
- Sex of the baby
- Any visible abnormalities, which should be classified using a standardized taxonomy for major congenital anomalies, as defined by 1
- Interventions attempted, including resuscitation efforts if applicable
- Placental condition, umbilical cord appearance, and any meconium staining
- Maternal vital signs during labor and delivery
- Medications administered
- Fetal heart rate patterns prior to the stillbirth
- Parents' emotional response and any support provided, including bereavement counseling referrals It is crucial to ensure all documentation is objective, factual, and chronological, avoiding subjective statements or speculation about the cause of death, as this comprehensive documentation is essential for quality improvement, potential legal proceedings, and most importantly, to help determine the cause of the stillbirth, which may provide closure for the family and inform care in future pregnancies, as implied by the guidelines outlined in the study by 1.
From the Research
Fresh Stillbirth Case Notes
- A stillbirth is a common and devastating pregnancy complication, occurring in 1 in 160 deliveries in the United States 2.
- The investigation of stillbirth should include medical history, postmortem examination, histopathological examination of the placenta, genetic analysis, and microbiology of fetal and placental tissues 3, 2.
- Determining the etiology of stillbirth may improve care in a subsequent pregnancy 3.
- The management of stillbirth should include emotional support, clear communication of test results, and referral to a bereavement counselor or peer support group if necessary 2, 4.
- The method and timing of delivery after a stillbirth depend on the gestational age at which the death occurred, maternal obstetric history, and maternal preference 2.
Risk Factors and Causes
- The most prevalent risk factors associated with stillbirth are non-Hispanic black race, nulliparity, advanced maternal age, obesity, preexisting diabetes, chronic hypertension, smoking, alcohol use, and past obstetric history 2.
- The causes of stillbirth can be classified into several categories, including fetal, placental, and maternal factors 5.
- A significant proportion of stillbirths remains unexplained even after a thorough evaluation 2.
Evaluation and Classification
- Evaluation of a stillbirth should include fetal autopsy, gross and histologic examination of the placenta, umbilical cord, and membranes, and genetic evaluation 2.
- The classification of stillbirth can be based on the gestational age at which the death occurred, the presence of fetal anomalies, and the presence of maternal medical conditions 5.
Support and Care
- Grieving parents want staff to demonstrate sensitivity and empathy, validate their emotions, provide clear information, and be aware that the timing of information may be distressing 4.
- Parents want support and guidance when making decisions about seeing and holding their baby 4.
- Culturally appropriate care is important and may require staff to accommodate different cultural practices 4.