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Introduction Intrauterine Fetal death (IUFD) and stillbirth is common, with a rate of 1 in 200 babies born without signs

oflife(1). In response to a higher than a erage incidence of IUFD!s in 2010, we audited these cases, and those o er the following 11 months, to assess if there were an" trends in demographics or impro ements to be made in standards of care. #eassuringl", o er this time we found that our incidence of IUFD!s was comparable to the bac$ground rate. %tandards &ate Intrauterine Fetal Death and %tillbirth, #'() )reen top guideline ** (2010) + ,ational -atient %afet" .genc". %pecificall"/ 0'ompletion of in estigations to elucidate cause, including placental histolog". 01hether a post2mortem was offered 01ere there an" barriers to care that ma" ha e contributed to the outcome3 4ethods #etrospecti e re iew of all IUFD!s (e5cluding fetocides) o er an 26 month period (7anuar" 2010 to December 2011) at 1e5ham -ar$ 8ospital (1-8). 4aternit" notes, radiolog" and patholog" s"stems were re iewed and data collected using the ,ational -atient %afet" -roforma. 10,*9: deli eries occurred in the time period, along with ;9 IUFD!s. 4aternal Demographics/ <rends 0<he mean age was 2= "ears (range/ 1: 2;1 "ears) 0*>? of the women who had IUFD!s were of non2 @ritish origin. ,on2@ritish women accounted for 29? of the total deli eries at 1-8 during this period. 0>0? of women were nulliparous. ,ulliparous woman accounted for ;1? of the total deli eries at 1-8 during this time.

02=? boo$ed after 12th wee$ of pregnanc". 2 women were un2boo$ed, including a concealed pregnanc". 0> were smo$ers. 01 woman had poorl" controlled t"pe 1 diabetes, and 1 had )estational Diabetes. 0(nl" 12 were screened for gestational diabetes, and based on ethnicit" alone, 2: should ha e had the test. 06 were diagnosed with congenital anomaliesA 2 were detected at anomal" scan and1 detected in third trimester. Identifiable barriers to care 09th annual report 'B%DI reported suboptimal care as present in up to half of pregnancies affected. 0:2? did not ha e an identifiable barrier to care. 0-atient factors/ language barriers most common as reflected b" our population in %lough. 0(rganisational factors including transfer of care + freCuent non2attendance. 04aDorit" had more than 1 barrier

8ow did the IUFD!s present3 ,o intra2partum IUFD!s occurred during care at 1-8 during this audit period. 0; women presented with massi e placental abruptions, 2 of which had a fetal heartbeat heard on admission, which Cuic$l" disappeared within minutes despite immediate grade 1 caesarean section. Undefined/ 02 women deli ered at home without medical personnel, and death of the bab" was confirmed on arri al of staff. 0> women were admitted in labour and on presentation there was no fetal heartbeat auscultated.

4ode of Deli er" 09=? of IUFD!s were deli ered aginall" 0'aesarean section was performed in 2 patients with massi e abruptions, 2 for placenta prae ia and 1 for maternal reCuest (this patient had 1 pre ious caesarean and histor" of a prior mid2 trimester loss) 1hat in estigations were performed3 0Eleihauer/ 'ompleted in 9*? of patientsA one was positi e. 0<hrombophilia screen/ 'ompleted in =9? of patients + .&& ,B).<IFB. .n e5pensi e test usuall" indicated in IU)#G placental failure. 0<(#'8 screen/ 'ompleted in =>? of patients + .&& ,B).<IFB. 0. total of 12: microbiolog" swabs were ta$en, including 8igh Faginal %wab, -lacenta %wab and Fetal %wab. (nl" > cultured a pathogenic organism associated with IUD, and onl" 2 had clinical and histopathological features of chorioamnionitis. 1as placental histolog" performed3 #ecommended b" )reen top )uideline e en those declining post2mortem, as in one stud", a maDor contributor to death was found in 99? of placenta!s e5amined 8ow man" IU)# babies were pic$ed up antenatall"3 01 was diagnosed earl" and a decision made to manage conser ati el" b" parents + consultant 02 were diagnosed with fulminating -B< + IUFD on arri al 0; were boo$ed initiall" or transferred to consultant care for other reasons than IU)# (raised @4I, fibroids, late boo$er + inpatient sta" with p"elonephritis) and these IUFD!s occurred earl" at 2;, 2*, 2: + 6; wee$s respecti el". <he late boo$er had IUFD detected at the first .,'. 06 were in communit" care + these occurred at 6*, 6> + ;1 wee$s. <he ;1 wee$ pregnanc" was a late boo$er and turned up in labour with no F8. <he two former were diagnosed at -4.

.udit #ecommendations and .ction -lan 0.ntenatal care for the ulnerable/ we ha e set up a consultant led clinic specificall" for ulnerable women. 0Implementation of a specific 4aternit" <riage 0Bnsure all women who ha e ris$ factors for )D4 are screened. 0 Impro e detection rates of IU)#. 'ustomised growth charts are now being utilised, and referral to secondar" care encouraged. 0(ffer all women -4!s and placental histolog", and impro e documentation of consent process in the maternit" notes. 2 %ee more at/ http/GGwww.epostersonline.comGrcog2016G3 CHnodeG*1:+pageH29Isthash.h@)5F4&J.dpuf

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