Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Managing a patient who has experienced a stillbirth involves both physical and emotional support, with a focus on sensitive communication and informed decision-making NICE NG207,NICE NG126.
- Physical Management:
- In the event of an intrauterine fetal death, offer support to help women and their partners and family cope with the emotional and physical consequences NICE NG207.
- If the woman is physically well, her membranes are intact, and there is no evidence of infection or bleeding, discuss options for birth, including expectant management, induction of labour, or caesarean birth, respecting her decision NICE NG207.
- If there is evidence of ruptured membranes, infection, or bleeding, offer immediate induction of labour or caesarean birth NICE NG207.
- If induced labour is chosen, provide one-to-one midwifery care during labour and birth, with monitoring of uterine contractions (preferably manual assessment) NICE NG207.
- For induced labour, offer oral mifepristone followed by vaginal dinoprostone or oral/vaginal misoprostol, or a mechanical method, based on clinical circumstances and national protocols NICE NG207.
- For women with a previous caesarean birth, discuss methods of induction to enable an informed decision NICE NG207.
- Emotional and Psychological Support:
- Offer information about specialist support NICE NG207.
- Treat all women with dignity and respect, acknowledging that reactions to pregnancy loss vary NICE NG126. Provide information and support sensitively, considering individual circumstances and emotional responses NICE NG126.
- Healthcare professionals and non-clinical staff (e.g., receptionists) should receive training in sensitive communication and breaking bad news NICE NG126.
- Provide the woman and, with her consent, her partner, specific evidence-based information in various formats throughout her care NICE NG126.
- Discuss options for seeing a photograph of the baby, having mementos, seeing the baby, or holding the baby with the woman, her partner, and family NICE CG192. This discussion should occur before delivery if the baby's death in utero is known, and continue after delivery if needed NICE CG192.
- This process should be facilitated by an experienced practitioner, and a follow-up appointment in primary or secondary care should be offered NICE CG192.
- For women who develop post-traumatic stress disorder (PTSD) resulting from a stillbirth, offer a high-intensity psychological intervention such as trauma-focused CBT or Eye Movement Desensitisation and Reprocessing (EMDR) NICE CG192.