Fetal Demise/Neonatal Death Algorithm

1. Fetal Demise/Neonatal Death Algorithm By, Briana Schafer

2. Clinical Definitions

3. Induced OR Spontaneous AB.Fetus < 20 weeks gestational age, or <23 weeks from LMP, or < 500g if GA and LMP not known, AND diagnosed as fetal death.

4. Stillbirth Fetus >20 weeks, LMP > 23 weeks, or > 500 g if gestational age and LMP not known AND born dead. • If YES, • Intrapartum • Fetal Death • If NO, • Antepartum • Fetal Death Was • Baby issued a Fetal Death Certificate, NO BIRTH CERTIFICATE Was fetus alive on admission with documented heart tones? • IF AUTOPSY/SPECIAL EXAM DESIRED BY MD: • MD to fill out Autopsy Consultation form and notify pathologist on call • MD to fill out Autopsy Consent form, obtain parent signature, RN witness • Form 18 filled out ONLY for Coroner’s cases. MD to call Coroner. Coroner’s cases include criminal abortions, drug abuse, gunshot/poisoning, other criminal activity (see Coroner criteria for complete listing). • UCLA Autopsy form filled out only for HIV or Creutzfeldt-Jakob Syndrome disease cases only. • Yellow AUTOPSY CASE form goes on top of chart, chart goes to Pathology. Baby goes to morgue. Charge/Primary nurse to notify Decedent Affairs. • Primary NURSE: Refer to Social Services BEFORE delivery and give • bereavement services packet “Resolve Through Sharing.” • Notify NM/HS. Notify One Legacy w/in 1 hour of delivery, fill out form with # they give you • State law requires burial or cremation of infant. Discuss plans with parents and social services. Obtain signed Release to Mortuary/Coroner form with name of mortuary selected by parents • If parents refuse to dispose of remains, obtain signed Permit to Retain and Dispose form. Parents will be billed. • Obtain weight and length of infant. If appropriate complete memory box with footprints, use digital camera for photos. • Place appropriate ID bands on baby (if neonatal death, use assigned MRN). Wrap in chux, label outside with mother’s name/MRN/delivery data & time/sex of infant/baby’s stillbirth or MRN. • Notify transport & security, bring infant to morgue, chart to Decedent Affairs (if no autopsy) IN PERSON on day of death • Send placenta to Pathology with pathology requisition including delivery date & time, notation of infant death, gestational age • Follow Policy & Procedure protocol. • Notify NM/HS. Notify One Legacy w/in 1 hour of delivery, fill out form with # they give you • State law requires burial or cremation of infant. Discuss plans with parents and social services. Obtain signed Release to Mortuary/Coroner form with name of mortuary selected by parents • If parents refuse to dispose of remains, obtain signed Permit to Retain and Dispose form. Parents will be billed. • Obtain weight and length of infant. If appropriate complete memory box with footprints, use digital camera for photos. • Place appropriate ID bands on baby (if neonatal death, use assigned MRN)). Wrap in chux, label outside with mother’s name/MRN/delivery data & time/sex of infant/baby’s stillbirth or MRN. • Bring infant to morgue, chart to Decedent Affairs (if no autopsy) IN PERSON on day of death • Send placenta to Pathology with pathology requisition including delivery data & time, notation of infant death, gestational age

5. Neonatal Death Fetus is any gestational age, born alive with purposeful movement &/or vital signs and then expires after delivery. • Use standard baby number • Complete standard L&D documentation • Admit and enter data into Health Connect • MD must pronounce Time of Death and document in progress note • Have parents complete birth certificate worksheet • Baby will be issued standard birth AND death certificate • IF AUTOPSY/SPECIAL EXAM DESIRED BY MD: • MD to fill out Autopsy Consultation form and notify pathologist on call • MD to fill out Autopsy Consent form, obtain parent signature, RN witness • Form 18 filled out ONLY for Coroner’s cases. MD to call Coroner. Coroner’s cases include criminal abortions, drug abuse, gunshot/poisoning, other criminal activity (see Coroner criteria for complete listing). • UCLA Autopsy form filled out only for HIV or Creutzfeldt-Jakob Syndrome disease cases only. • Yellow AUTOPSY CASE form goes on top of chart, chart goes to Pathology. Baby goes to morgue. Charge/Primary nurse to notify Decedent Affairs. • Primary NURSE: Refer to Social Services BEFORE delivery and give • bereavement services packet “Resolve Through Sharing” • Notify NM/HS. Notify One Legacy w/in 1 hour of delivery, fill out form with # they give you • State law requires burial or cremation of infant. Discuss plans with parents and social services. Obtain signed Release to Mortuary/Coroner form with name of mortuary selected by parents • If parents refuse to dispose of remains, obtain signed Permit to Retain and Dispose form. Parents will be billed. • Obtain weight and length of infant. If appropriate complete memory box with footprints, use digital camera for photos. • Place appropriate ID bands on baby (if neonatal death, use assigned MRN). Wrap in chux, label outside with mother’s name/MRN/delivery data & time/sex of infant/baby’s stillbirth or MRN. • Notify transport & security, bring infant to morgue, chart to Decedent Affairs (if no autopsy) IN PERSON on day of death • Send placenta to Pathology with pathology requisition including delivery date & time, notation of infant death, gestational age

6. Stillbirth Fetus >20 weeks, LMP > 23 weeks, or > 500 g if gestational age and LMP not known AND born dead. Induced OR Spontaneous AB. Fetus < 20 weeks gestational age, or <23 weeks from LMP, or < 500g if GA and LMP not known, AND diagnosed as fetal death. Neonatal Death Fetus is any gestational age, born alive with purposeful movement &/or vital signs and then expires after delivery. Kaiser Permanente Medical Center Perinatal ServicesFetal Demise/Neonatal Death Algorithm Was fetus alive on admission with documented heart tones? • Use standard baby number • Complete standard L&D documentation • Admit and enter data into Health Connect • MD must pronounce Time of Death and document in progress note • Have parents complete birth certificate worksheet • Baby will be issued standard birth AND death certificate • Refer to Social Services BEFORE delivery and give bereavement services packet “Resolve Through Sharing.” • Notify NM/HS. Notify One Legacy w/in 1 hour of delivery, fill out form with # they give you • State law requires burial or cremation of infant. Discuss plans with parents and social services. Obtain signed Release to Mortuary/Coroner form with name of mortuary selected by parents • If parents refuse to dispose of remains, obtain signed Permit to Retain and Dispose form. Parents will be billed • Obtain weight & length of infant. If appropriate, complete memory box with footprints, use digital camera for photos • Place appropriate ID bands on baby (if neonatal death, use assigned MRN)). Wrap in chux, label outside with mother’s name/MRN/delivery data & time/sex of infant/baby’s stillbirth or MRN • Notify transport & security, bring infant to morgue, chart to Decedent Affairs (if no autopsy) in personon day of death • Send placenta to Pathology with pathology requisition including delivery date & time, notation of infant death, gestational age • IF AUTOPSY/SPECIAL EXAM DESIRED BY MD: • MD to fill out Autopsy Consultation form and notify pathologist on call • MD to fill out Autopsy Consent form, obtain parent signature, RN witness • Form 18 filled out ONLY for Coroner’s cases. MD to call Coroner. Coroner’s cases include criminal abortions, drug abuse, gunshot/poisoning, other criminal activity (see Coroner criteria for complete listing). • UCLA Autopsy form filled out only for HIV or Creutzfeldt-Jakob Syndrome disease cases only. • Yellow AUTOPSY CASE form goes on top of chart, chart goes to Pathology. Baby goes to morgue. Charge/Primary nurse to notify Decedent Affairs.

7. Management of the Body INDUCED/SPONTANEOUS ABORTION or STILLBIRTH If fetus is 20 weeks or less (Induced/Spontaneous Abortion), parents must REQUEST cremation.

8. Management of the Body NEONATAL DEATH AFTER DELIVERY OF BABY

9. Management of the Body STILLBIRTH/NEONATAL DEATH AFTER ALL PROCEDURES ARE DONE AND FAMILY IS FINISHED VIEWING THE BABY