How should I approach the investigation of potential causes of stillbirth in a patient with a previous history of intrauterine fetal death?

The provided UK guidelines primarily focus on the management of intrauterine fetal death (IUFD) and intrapartum care, rather than detailing a specific protocol for investigating the causes of stillbirth in a patient with a previous history of IUFD ¹,²,³. However, the evaluation of stillbirth is a recognized area of clinical focus (Page and Silver, 2018).

While specific investigative steps for recurrent stillbirth are not outlined in the provided guidelines, understanding the causes of perinatal death is a critical aspect of improving maternity care. Organisations such as MBRRACE-UK conduct audits to identify the causes of maternal and perinatal death and morbidity, and to make recommendations to reduce poor outcomes ¹.

In the event of an intrauterine fetal death, it is important to offer support to women and their partners and family, along with information about specialist support ¹. If the woman is physically well, her membranes are intact, and there is no evidence of infection or bleeding, discuss the options for birth, which include expectant management, induction of labour, or caesarean birth, respecting her decision ¹. If there is evidence of ruptured membranes, infection, or bleeding, immediate induction of labour or caesarean birth should be offered ¹. For women who have had a previous caesarean birth, methods of induction should be discussed to enable an informed decision about the most appropriate choice ¹.