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Question 655
Clinical Management → Clinical Practice
Classification
Question
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Foetal intrauterine death: counselling and investigation
Question Stem
Following an intrauterine foetal death, which approach best reflects the priorities of management?
Options
A
Avoid discussing possible causes because most cases are unexplained
B
Provide supportive counselling and try to establish a cause to inform advice about future pregnancies
C
Limit care to arranging delivery because bereavement support is outside clinical care
D
Assume an identifiable cause will be found in nearly every later-gestation death
E
Defer all discussion until the next pregnancy
Explanation
Intrauterine foetal death is a major disaster for families. Management should include supportive counselling by appropriately trained staff and an attempt to identify the cause so that appropriate advice can be given about future pregnancies, while recognising that many cases remain unexplained.
Option Validity
A) Although many cases remain unexplained, clinicians should still try to identify a cause so they can advise about future pregnancies.
C) Supportive counselling and appropriately trained bereavement staff are important components of care.
D) Many cases remain unexplained, particularly in later gestations; an identifiable cause is not found in nearly every case.
E) Support and investigation are part of care after the death and are not deferred until a subsequent pregnancy.
Further Reading
Saxena MRCOG-1 Basic Sciences — Principles of Clinical Practice, printed p. 7.