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Late Intrauterine Fetal Death and Stillbirth (Green-top Guideline No. 55)

Published: 10/11/2010

This is the first edition of this guideline.

The second edition of this guideline is currently in development.

Update February 2017: Following a review of all guidelines in December 2016, some minor editorial changes have been made to this guideline since the original publication. The version available here is the most up to date. The date on the guideline has not been changed since no amendments were made to the content.

Update December 2014: New evidence and guidance in this field were reviewed in 2014 and it was decided that revision of this guideline would be deferred to a later date. The version available on the website and app will remain valid until replaced.

Update 26 July 2011: The RCOG Green-top Guideline No. 55, Late Intrauterine Fetal Death and Stillbirth, which was published in October 2010 recommends the use of low doses of misoprostol (50 or 100 micrograms depending upon gestational age) when inducing labour.

The RCOG is aware that protocols employing much larger doses of misoprostol are still being employed in the UK, with consequent potentially associated adverse effects. Each maternity unit is advised to review their protocol for the management of induction of labour under these circumstances and to adopt the recommended misoprostol dosaging. Currently, misoprostol is only available in the form of a 200 microgram tablet; however, the required dosage of 50 or 100 micrograms can be obtained by cutting the tablet or by dilutional methods. Your hospital pharmacist will be able to assist you with this if necessary.

The purpose of this guideline is to identify evidence-based options for women (and their relatives) who have a late intrauterine fetal death (IUFD: after 24 completed weeks of pregnancy) of a singleton fetus, and to incorporate information on general care before, during and after birth, and care in future pregnancies. The guidance is primarily intended for obstetricians and midwives but might also be useful for women and their partners, general practitioners and commissioners of healthcare.

This guideline does not include the management of multiple pregnancies with a surviving fetus, stillbirth following late fetocide, late delivery of fetus papyraceous or the management of specific medical conditions associated with increased risk of late IUFD.

Recommendations about the psychological aspects of late IUFD are focused on the main principles of care to provide a framework of practice for maternity clinicians. The full psychological and social aspects of care have been reviewed by Sands (Stillbirth and neonatal death charity).

The section on postmortem examination covers clinical aspects required for obstetricians and midwives caring for women who have suffered a stillbirth.