Stillbirth

It occurs in 15 per 1000 in Malaysia.


There are various causes of stillbirths.

30-40% of stillbirths are caused by fetal / placental malformations.

A local report confirms this.

Pregnancy complications can cause stillbirths:
Bleeding
Feto-maternal bleeding
Hypertension of pregnancy
Obstetric cholestasis


A list of infections have been linked to stillbirths:
Listeria
Toxoplasmosis
CMV


Maternal Conditions have been linked:
Diabetes
Warfarin therapy
SLE
Kidney diseases
Thrombophilia
others

In 30% the cause cannot be identified.

The recurrence risk is five times the background risk.

A detailed analysis of of symptoms and investigation results, including the postmortem examination report, will most often reveal the cause and help prevent a recurrence in the next pregnancy.

Miscarriage

It occurs in 1 of 8 pregnancies.


60% of miscarriages occur because the pregnancies are genetically damaged.


Other causes included:
  1. major structural malformations
  2. diabetes
  3. active diseases (SLE, thyroid)
  4. abnormalities of the uterus
  5. thrombophilia
  6. weakness of the uterine cervix
  7. infections



A detailed analysis of the miscarriage and investigion results are necessary to avoid a recurrence.

Preterm Birth

It occurs in 1 of 10 pregnancies.

Prematurity is the main cause of why newborns die.

Causes include:

  1. Planned birth due to problems in pregnancy such as hypertension or fetal growth restriction
  2. Urinary infection
  3. Rarely vaginal infection
  4. Weakness of the cervix

In many the cause will not be known.

A detailed analysis of symptoms and event and results of investigations will help narrow down the most likely cause. This will help your obstetrician plan your next pregnancy.

Baby With Abnormality

4% of all babies are born with major malformations.

Most women will have no risk factors for their special child.

The causes of congenital malformations are many:
  1. diabetes
  2. epilepsy
  3. medications
  4. age
  5. familial hereditary conditions
  6. nutritional
  7. chemical exposure
  8. pollution exposure
  9. uncontrolled medical conditions

A detailed analysis of risk factors and description of the baby will help analyse a probable cause.

This will help your doctor plan your next pregnancy which should be considered a high risk one.

ANY ONE OF THE ABOVE CAN HAS HIGH RECURRENCE RATE. IT IS ADVISED THAT ALL COUPLE WHO HAVE EXPERIENCED THE ABOVE TO HAVE A CONSULTATION WITH HIGH RISK PREGNANCY EXPERTS BEFORE YOUR NEXT PREGNANCY

Care Plan For Pregnancies with past history of the above
Pre-pregnancy vitamins
See your consultant as soon as pregnant.
The following scan should be performed:
  1. Viability scan @ 6-8 weeks
  2. First trimester genetic scan at 11-14 weeks
  3. Assessment of cervical length
  4. Assessment of uterine artery blood flow doppler studies
  5. Detailed scan of fetus as early as possible



Specific care plan would depend on the condition and cause.


All women with a history of the above should be followed up as HIGH RISK PREGNANCIES.