OG8.9 | Stillbirth Evaluation — Summary & Reflection

KEY TAKEAWAYS

Stillbirth is defined in India as birth of a dead baby at ≥28 weeks gestation OR ≥1000 g birth weight. Classification: fresh (no maceration, likely intrapartum) vs macerated (maceration features, antepartum, ≥12–24 h since death). Causes are classified by ReCoDe (P-placenta, U-cord, F-fetus, A-amniotic fluid, M-maternal, I-intrapartum, N-neonatal, U-unexplained); 25–30% remain unexplained after full investigation. Diagnosis confirmation: real-time ultrasound (not auscultation alone). Pre-induction investigations: coagulation screen (DIC risk from retained dead fetus), blood group/crossmatch, Kleihauer-Betke, blood glucose. Complete evaluation also includes: placental histopathology, external fetal examination, karyotype (with consent), TORCH screen, thyroid function. Management: induction of labour preferred over expectant management; method varies by gestation; vaginal delivery is the goal. Bereavement care is mandatory: compassionate communication, offer to see/hold the baby, memory-making, formal counselling referral. Stillbirths ≥28 weeks must be legally registered in India. Recurrence counselling at 6 weeks: explain cause, risk, and future pregnancy plan.

REFLECT

The opening scenario presented a macerated stillbirth at 36 weeks in a multigravida who had not felt fetal movements for two days. Reduced fetal movements are the single commonest pre-warning symptom of antepartum stillbirth — and yet women often delay seeking care due to normalising the symptom, cultural beliefs, or fear. Reflect on this: how would you structure your ANC counselling at each visit to ensure a woman knows exactly when and how to seek urgent assessment for reduced movements? What institutional factors (after-hours access, attitude of staff, waiting times) might prevent a woman from acting promptly, and how might you advocate for changes? Consider also the experience of the family in the scenario. What they will remember is not your diagnosis — it is the manner in which you communicated it. Kolb reflection: in your next clinical posting, ask to observe how a senior clinician breaks bad news in an obstetric setting. Reflect on what they did well and what you would do differently.