Fetal Demise/Neonatal Death Algorithm

By,Briana Schafer

Clinical Definitions

Induced or Spontaneous

Abortion

Diagnosed as FETAL DEATH

Fetus <20 weeks

gestational age

<23 weeks from LMP if GA

not known

<500g if GA and LMP not

known

Stillbirth

Fetus is BORN DEAD

Fetus >20 weeks

gestational age

>23 weeks from LMP if GA

not known

>500g if GA and LMP not

known

Neonatal Death

Fetus born alive then expires after delivery

Fetus is any gestational age

Born with purposeful movement

Born with vital signs

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.

Nurse to offer memory box and pictures to parents

If burial/cremation not requested, put remains and placenta in formalin for pathology examination, send to pathology with requisition

Mortuary Release form NOT NEEDED unless family requesting burial or cremation. Family must sign form

Primary NURSE: Refer to Social Services BEFORE delivery and give bereavement services packet “Resolve Through Sharing”

Charge Nurse/Team Leader gives assignment

Inform charge nurse and arrange for LDR 9 or appropriate room at a distance from active labor patients

Was Stillbirth

Fetus >20 weeks, LMP > 23 weeks, or > 500 g if gestational age and LMP not known AND born dead.

Was fetus alive on admission with documented heart tones?

Baby issued a Fetal Death Certificate,

NO BIRTH CERTIFICATE

If YES,IntrapartumFetal Death

If NO,AntepartumFetal Death

• 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

• 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

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.

Neonatal DeathFetus 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

• 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

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.

Kaiser Permanente Medical Center Perinatal Services

Fetal Demise/Neonatal Death Algorithm

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.

StillbirthFetus >20 weeks, LMP > 23 weeks, or > 500 g if gestational age and LMP not known AND born dead.

Neonatal DeathFetus is any gestational age, born alive with purposeful movement &/or vital signs and then expires

after delivery.

Nurse to offer memory box and pictures to parents

If burial/cremation not requested, put remains and placenta in formalin for

pathology examination, send to pathology with requisition

Mortuary Release form NOT NEEDED unless family requesting burial or cremation. Family must sign form

Primary NURSE: Refer to Social Services BEFORE delivery and give bereavement

packet “Resolve Through Sharing”

Charge Nurse/Team Leader gives assignment

Inform charge nurse and arrange for LDR 9 OR appropriate room at a distance

from active labor patients

Was fetus alive on admission with documented heart tones?

Baby issued a Fetal Death

Certificate, NO BIRTH

CERTIFICATE

If YES,IntrapartumFetal Death

If NO,Antepartu

mFetal Death

• 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 person on

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.

Management of the BodyINDUCED/SPONTANEOUS ABORTION or STILLBIRTH

1.) Weigh, measure, obtain vital statistics and document on mother’s

chart

2.) Take pictures, apply footprints to card, and

give to parents

3.) Place placenta in 10% Formalin, label with

label with date, name, PF#.

4.) If spontaneous abortion, place fetus in

10% Formalin, label with patient’s name and

MRN.

5.)Generate Pathology form. Send fetus with form to Pathology. Fetus will be examined

and pathology report will be generated and sent with remains to mortuary.

If fetus is 20 weeks or less (Induced/Spontaneous Abortion), parents must REQUEST cremation.

Management of the BodyNEONATAL DEATH

1.) Wipe infant clean

especially face and hands, if condition of

body permits. 2.) Wrap infant

snugly and cover head

with stockinet.

3.) Allow parents/family to hold baby according to their wishes.

4.) Weigh and

measure infant.

5.) Document

ALL pertinent

statistics on Baby at Birth.

6.) Band infant as in regular live birth (DO NOT

BAND MOTHER). Keep mother’s ID

bracelet in her chart.

AFTER DELIVERY OF BABY

Management of the BodySTILLBIRTH/NEONATAL DEATH

#3.) Care of Remains

Wrap infant in chux, baby blanket and then place in SHROUD (located in Dirty Utility Room, upper right)

Attach THIRD luggage tag to BODY BAG

#4.) Transport

Notify Security ext. 2370 to open Morgue prior to

transport (transport staff member MUST accompany

body to morgue)

Place infant in the Crypt

Attach FOURTH luggage tag on refrigerator door

Enter infant information in morgue log

AFTER ALL PROCEDURES ARE DONE AND FAMILY IS FINISHED VIEWING THE BABY

#1.) Memory Box

Place hat on head if possible

Take pictures for parents. Location (LDR or Utility Room) depends on

condition of demise.

Take footprints with Identifier Footprint Sheet and Wipes

(located by Unit Secretary desk). Give to parents.

#2.) Labeling

Apply stamped luggage tags found in fetal demise packet,

include “Baby Boy/Girl of (mother’s name)”

Attach FIRST luggage tag to infant’s ANKLE

Attach SECOND luggage tag to infant’s WRIST

#5.) After transport, bring fetal demise packet and envelope to Decedent

Affairs

Mother’s chart stays with her

Give NKE to oncoming staff receiving mother (for

example, if patient requires autopsy)