ing testing at 32 weeks of gestation likely works as
well and may reduce the chance of false-positive
results.40 Alternatively, Doppler velocimetry, amniotic
fluid indexes, and serial ultrasonograms to
assess growth may be used to assess placental
function. Induction of labor is another common
strategy used in women with prior fetal death. As
with antenatal surveillance, many clinicians advise
delivery at a gestational age 2 weeks before the
previous loss. This recommendation should be
viewed with caution because of unproven efficacy
(with regard to stillbirth prevention) and the potential
for clinically relevant prematurity. However,
induction has tremendous emotional benefit for
many couples with prior fetal death. Accordingly,
elective induction in the setting of pulmonary maturity
and a favorable cervix may be appropriate in
well-selected cases. Indeed, a large component of
providing good care in subsequent pregnancies in
women with prior fetal death is to tend to the
patient’s emotional needs. Frequent visits, documentation
of fetal heart tones and well being and
lots of positive reinforcement are invaluable.