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QOD: If I’ve had a stillbirth, how is my next pregnancy managed?

There is no consensus on what is the best way to monitor a future pregnancy, so this is usually individualized.

When it comes to pregnancies after a stillbirth, there is little evidence on how to monitor the baby to try and prevent a recurrent stillbirth from happening. Doctors and midwives vary their practice when it comes to this.

Doing consistent kick counts starting at 28 weeks is recommended to all pregnant women, and certainly in women who’ve had a previous pregnancy loss. Some providers may recommend more frequent growth ultrasounds or fetal monitoring, despite their proven benefit as an attempt to prevent another catastrophic event. It must be kept in mind that an increase in testing may lead to unnecessary interventions (such as hospital admissions and preterm delivery), so the risks and benefits always need to be considered. If a medical complication such as high blood pressure was the cause of the previous stillbirth, these should be appropriately managed prior to conception and throughout future pregnancies.

Early delivery may be recommended, but this should not be done before 39 weeks gestation unless the baby’s lungs have been proven mature by an amniocentesis, and even then this does not guarantee that the baby will be free of other early term complications.

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