Stillbirth

Death of a fetus in the womb after a certain gestational age

Stillbirth
Karlsruhe Hauptfriedhof Kleinstkinder.jpg
A memorial for stillborn babies in Germany.
Synonyms	Intrauterine fetal demise, late fetal loss
Specialty	Obstetrics, Neonatology
Symptoms	Absence of fetal movement, absent fetal heartbeat, abnormal ultrasound findings
Complications	Emotional distress, postpartum complications, infection
Usual onset	Usually after 20–24 weeks of gestation
Duration	Permanent loss
Types	Early stillbirth, late stillbirth, term stillbirth
Causes	Unknown (many cases), placental issues, umbilical cord complications, infections, genetic factors
Risk factors	Advanced maternal age, obesity, smoking, hypertension, diabetes
Diagnosis	Ultrasound, absence of fetal heartbeat, Doppler scan
Differential diagnosis	Miscarriage, intrauterine growth restriction, preterm labor
Prevention	Prenatal care, managing maternal health conditions, monitoring fetal movements
Treatment	Induced labor, cesarean delivery (if necessary)
Prognosis	Emotional and physical recovery varies
Frequency	1 in 115 births (United States), higher in low-income regions

A stillbirth is the death of a fetus inside the mother's womb after 20 to 24 weeks of pregnancy (depending on country-specific definitions) or during childbirth. When the fetus is delivered, it is called stillborn. Stillbirth differs from a miscarriage, which occurs earlier in pregnancy.

Classification

Stillbirths are categorized based on gestational age:

• Early stillbirth – occurs between 20–27 weeks of pregnancy.
• Late stillbirth – occurs between 28–36 weeks of pregnancy.
• Term stillbirth – occurs at 37 weeks or later.

Causes

The exact cause of stillbirth is unknown in many cases, even after thorough investigation. However, several known factors can contribute to stillbirth, including:

1. Maternal Health Conditions

• Diabetes
• High blood pressure (preeclampsia, eclampsia)
• Obesity
• Autoimmune disorders
• Infections during pregnancy (e.g., syphilis, cytomegalovirus, listeriosis)
• Substance abuse – Smoking, alcohol, and drug use increase the risk.

2. Placental and Umbilical Cord Problems

• Placental abruption – The placenta separates from the uterus before birth.
• Insufficient placental function – Poor blood supply to the fetus.
• Umbilical cord accidents – Cord compression, knots, or prolapse.

3. Fetal Factors

• Congenital anomalies – Genetic disorders or structural abnormalities.
• Infections – Sepsis, viral infections.
• Fetal growth restriction (IUGR) – Poor fetal development.

4. Environmental and External Factors

• Exposure to radiation
• Physical trauma (e.g., accidents, domestic violence)
• Chronic stress and poor prenatal care

Occurrence

The prevalence of stillbirth varies by country, healthcare access, and socioeconomic factors.

• United States – Approximately 1 in 115 births results in stillbirth, equating to around 26,000 cases annually (one every 20 minutes).
• United Kingdom – Around 1 in 200 births results in stillbirth.
• Australia – Similar to the UK, with rates of 1 in 200 births.
• Developing Countries – Higher rates due to limited access to healthcare, malnutrition, and untreated infections.

Diagnosis

Signs and Symptoms

• Absence of fetal movements
• Lack of fetal heartbeat on ultrasound
• Cramping or pain
• Vaginal bleeding
• Abnormal fluid levels around the baby

Medical Evaluation 1. Ultrasound – Confirms the absence of fetal heartbeat. 2. Doppler scan – Checks for blood flow to the fetus. 3. Autopsy (optional) – Identifies potential causes.

Management and Treatment

Once stillbirth is diagnosed, delivery is necessary to prevent maternal complications such as infection and excessive bleeding.

Methods of Delivery

• Induced labor – Medication helps the mother deliver the baby vaginally.
• Cesarean section – Used in special cases (e.g., multiple previous C-sections).
• Expectant management – Waiting for labor to begin naturally.

Emotional and Psychological Effects

Losing a baby can cause grief, depression, anxiety, and PTSD in parents. Support includes:

• Counseling and therapy
• Support groups for grieving parents
• Medical follow-ups to monitor physical recovery

Legal Definitions of Stillbirth

Each country has different legal definitions and registration requirements for stillbirth.

United Kingdom

• Any baby born after 24 weeks of pregnancy with no signs of life is legally recorded as a stillbirth.
• A Stillbirth Certificate is issued to the family.

Australia

• A fetus weighing more than 400 grams or older than 20 weeks must be legally registered.

United States

• The U.S. does not have a national stillbirth definition.
• Classification depends on state laws, but fetal deaths over 350 grams or 19 weeks are usually reported.

Prevention

While not all stillbirths can be prevented, certain measures can reduce the risk:

• Regular prenatal checkups
• Monitoring fetal movements (kick counts)
• Managing maternal conditions (e.g., diabetes, high blood pressure)
• Avoiding alcohol, smoking, and drug use
• Sleeping on the side (after 28 weeks) – Reduces stillbirth risk by improving blood flow to the fetus.

After Stillbirth

• Families may choose to have a funeral or cremation.
• Many hospitals offer memory keepsakes such as handprints, footprints, and photographs.
• Special cemeteries exist for stillborn babies in some regions.

Research and Future Directions

Medical advancements aim to reduce stillbirth rates through:

• Improved placental monitoring via ultrasound.
• Genetic screening for early risk detection.
• Artificial womb technology – Experimental research on growing premature fetuses in artificial wombs.

See Also

• Fetal death
• Childbirth
• Pregnancy complications
• Perinatal mortality

External Links

• Pregnancy Institute – Research on umbilical cord issues.
• March of Dimes: Facts on Stillbirth
• Stillbirth Stories – A Mother's Perspective
• Wisconsin Stillbirth Service Program