Perinatal Loss Prevention

Preconception Health
Fetal Growth Restriction
Fetal Movement
Maternal Sleep Position

Perinatal Loss

Communication
Bereavement Care
Clinical Care
Pathology

Pregnancy After Loss

Clinical Care
Psychosocial Care

Healthy pregnancies begin with a healthy mother and family. Ideally, individuals who are considering pregnancy will discuss their plans with a health professional. This provides an opportunity to screen for genetic conditions, infections, autoimmune concerns, and other risk factors. If a preconception visit has not occurred, this information should be covered during the first antenatal appointment. Screening for additional risk factors should be done at each antenatal visit. Tools for screening are available in Appendix A.

Recommended plan for preconception visits include:

  • Detailed personal and family history, including reproductive history
  • Screen for history of trauma, including reproductive trauma
  • Screen for mental health concerns using PHQ9 and GAD7
  • Screen for STIs
  • Determine TORCH immunity
  • Screen for genetic conditions/advanced karyotype screening (once)
    • SMA
    • Cystic Fibrosis
    • Tay Sachs for Jewish or French Canadian families
    • Fragile X
    • Factor V Leiden
    • MTHFR
    • Prothrombin
  • Review childhood vaccination status
  • Screen for maternal health conditions and develop a plan for management
    • Maternal weight
    • Mental health
    • Substance use
    • Thyroid function
    • Lipid profile
    • Pap smear
    • Sleep hygiene
    • Existing health conditions
  • Discuss pregnancy spacing
  • Review social determinants of health
    • Occupational situation/setting
    • Cultural traditions
    • Family dynamics
    • Exposure to racism
    • Financial considerations
    • Access to care
    • Support system
    • Stress
    • Lifestyle factors
  • Screen for risk factors for pregnancy complications
    • Advanced maternal age
    • History of poor pregnancy outcomes
    • IVF pregnancy
    • Primiparity
  • Discuss known and potential risk factors for pregnancy complications
  • Initiate prenatal vitamins with folate and DHA supplements
  • Workup for recurrent pregnancy loss if strong family history or personal history of poor pregnancy outcomes
  • Referral to specialists for management of maternal health conditions as needed

At each antenatal visit, risk factors should be reviewed and discussed with the family. Changes to the antenatal surveillance schedule should be considered with increased number or severity of risk factors. It is important to view pregnancy loss as a multifactorial condition. There may be several factors present that could lead to a poor outcome, but more commonly, it is the combination of these factors that results in poor outcomes, specifically pregnancy loss.

Recommended topics for assessment include the following risk factors:

  • Maternal Health
  • Autoimmune Disorders
  • Maternal health conditions (hypertension, diabetes, renal disorders, sickle cell disease, thyroid disorder)
  • Substance use
  • Maternal BMI (underweight or overweight)
  • Infections
  • Advanced maternal age
  • History of poor pregnancy outcome
  • Maternal sleep position and quality
  • Maternal mental health

Social Health

  • Support system
  • Financial concerns
  • Trauma
  • Stress
  • Access to care
  • Prenatal care
  • Exposure to racism

Pregnancy/Fetal Health

  • IVF pregnancy
  • Multiple gestation
  • Gestational Diabetes
  • Preeclampsia
  • Cholestasis
  • Infections
  • Primiparity
  • Placental conditions
  • Abnormal PAPP-A, inhibin A, PlGF
  • Umbilical cord abnormalities
  • Fetal growth restriction
  • Altered fetal movement
  • Oligo/polyhydramnios
  • Post-term