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Stillbirth

Definition

Stillbirth refers to the death of fetus after 20 weeks of pregnancy. Stillbirths usually happen before a woman goes into labor.

Causes

Stillbirth may be caused by:

  • Chromosomal disorders
  • Poor fetal growth
  • Infection
  • Complications of multiple gestation—being pregnant with more than one fetus
  • High blood pressure or other conditions in the mother
  • Rh incompatibility , which occurs when the mother has Rh-negative blood and fetus has Rh-positive blood
  • Umbilical cord prolapse , which occurs when the umbilical cord descends into the vagina too early and cuts of oxygen to the fetus
  • A loop or knot in the umbilical cord
  • Placental abruption , which occurs when the placenta that nourishes the fetus separates from the uterus before the fetus is delivered
  • Placenta previa , which occurs when the placenta becomes implanted near or over the cervix

In many cases, the cause is unknown.

Risk Factors

Many factors may increase the risk of stillbirth. Risk factors in the mother include:

  • Ethnicity: African American
  • Age: 35 years of age or older
  • Chronic condition, such as obesity , diabetes, high blood pressure , thyroid disease, kidney disease, heart disease, blood clotting disorder, or asthma
  • Infection
  • Smoking , drinking, or using drugs during pregnancy
  • Multiple gestation
  • First pregnancy
  • History of stillbirth or miscarriage in a previous pregnancy
  • Poor prenatal care
  • Trauma , such as a car accident

Symptoms

Symptoms include:

  • No movement by the fetus
  • Vaginal bleeding in the mother

Diagnosis

An ultrasound exam may be done. This will allow the doctor to examine the fetus and confirm that the heartbeat has stopped. During this exam, the doctor may be able to find out what caused the stillbirth.

Abdominal Ultrasound
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After the woman has given birth, the doctor will further examine the fetus, placenta, and umbilical cord. An autopsy may be done if the parents request it. Tests can be ordered to find out if an infection or genetic disorder caused the baby’s death.

Treatment

After the doctor has confirmed that the fetus has died, the parents will be involved in the decision of timing delivery. Usually, planning a vaginal delivery is the safest approach. Sometimes, a cesarean section is necessary. If there are surviving fetuses in a mother giving birth to more than one baby, no intervention may be needed. The mother may choose to have labor induced by taking medicines. Labor is usually induced by medications given vaginally, orally, or by IV.

While there is no immediate danger of waiting to deliver the baby, there is a risk of infection or a serious bleeding complication for the mother if delivery is postponed for weeks.

Therapy

Having a stillborn baby is a traumatic experience for the parents. They need time to grieve the loss of their child. Emotions like shock, anger, and sadness may feel overwhelming at times. A therapist who specializes in pregnancy loss can provide support, helping parents work through their grief. Joining a support group for parents who have also suffered a pregnancy loss can be another source of support.

Prevention

While there are no definite ways to prevent stillbirth, there are steps that couples can take to have a healthy pregnancy:

Before Becoming Pregnant

  • Women should have a preconception visit with their doctor. Conditions like diabetes or high blood pressure should be treated and controlled.
  • If a woman is overweight, her doctor can recommend a weight loss program. This can include a healthy diet and exercise .
  • If a couple has a genetic trait, they can work with a genetic counselor who can help determine the chance that their child may inherit that condition.

During Pregnancy

  • Go to all prenatal care visits.
  • If a woman has had a prior stillborn baby, the doctor may do additional testing during the current pregnancy. Tests will be done to track how the fetus is developing. Some doctors may recommend that women monitor kick counts closely during their pregnancy.
  • Smoking, drinking, and using drugs should be avoided during pregnancy.
  • Women should call their doctor right away if they notice decreased fetal movement or have vaginal bleeding.

Revision Information

  • American Academy of Pediatrics

    http://www.healthychildren.org

  • American Pregnancy Association

    http://www.americanpregnancy.org

  • Health Canada

    http://www.hc-sc.gc.ca

  • Women’s Health Matters

    http://www.womenshealthmatters.ca

  • The American Congress of Obstetricians and Gynecologists. ACOG practice bulletin No. 102: Management of stillbirth. Obstet Gynecol . 2009 Mar;113(3):748-61.

  • Fetal death. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated February 7, 2013. Accessed March 12, 2013.

  • Kent DR, West J. Obstetrics and gynecology: a modern approach to the management of intrauterine fetal death. West J Med. 1977;126(4):298-299.

  • Ogunyemi D. Stillbirths. Cedars-Sinai website. Available at: http://cedars-sinai.edu/Medical-Professionals/Graduate-Medical-Education/Residency-Programs/Obstetrics-and-Gynecology/Didactic-Program/Documents/stillbirth-officepresentation-85767.pdf . Accessed March 12, 2013.

  • Stillbirth. The Children’s Hospital of Philadelphia website. Available at: http://www.chop.edu/healthinfo/stillbirth.html . Accessed March 12, 2013.

  • Stillbirth: trying to understand. American Pregnancy Association website. Available at: http://www.americanpregnancy.org/pregnancyloss/sbtryingtounderstand.html . Updated January 2013. Accessed March 12, 2013.

  • 12/30/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Stillbirth Collaborative Research Network Writing Group. Association between stillbirth and risk factors known at pregnancy confirmation. JAMA. 2011;306(22):2469-2479.

  • 12/30/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Stillbirth Collaborative Research Network Writing Group. Causes of death among stillbirths. JAMA. 2011;306(22):2459-2468.