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Stillbirth

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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 pregnancy with more than one fetus
  • High blood pressure or other conditions in the mother
  • The mother has Rh-negative blood and fetus has Rh-positive blood—Rh incompatibility
  • The umbilical cord descends into the vagina too early and cuts of oxygen to the fetus—umbilical cord prolapse
  • A loop or knot in the umbilical cord
  • The placenta separates from the uterus before the fetus is delivered—placental abruption
  • The placenta becomes implanted near or over the cervix—placenta previa

In many cases, the cause is unknown.

Risk Factors

Stillbirth is more common in African American women, and those aged 35 years and older. Other factors that may increase your chance of stillbirth include:

  • Chronic conditions, 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 fetuses
  • 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 medications. 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, ar doctor can recommend a weight loss program. This can include a healthful diet and exercise.
  • Taking folic acid before becoming pregnant can prevent certain birth defects, and may reduce the risk of having a miscarriage or another stillbirth. Ask your doctor how much folic acid you should take each day.
  • 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 Pregnancy Association

    http://www.americanpregnancy.org

  • The American Congress of Obstetricians and Gynecologists

    http://www.acog.org

  • Health Canada

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

  • Women’s Health Matters

    http://www.womenshealthmatters.ca

  • Fetal death. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 25, 2014. Accessed September 29, 2014.

  • 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://www.cedars-sinai.edu/Education/Graduate-Medical-Education/Residency-Programs/Obstetrics-and-Gynecology/Didactic-Program/Documents/stillbirth-officepresentation-85767.pdf. Accessed September 29, 2014.

  • Stillbirth. The Children’s Hospital of Philadelphia website. Available at: http://www.chop.edu/healthinfo/stillbirth.html. Accessed September 29, 2014.

  • Stillbirth: trying to understand. American Pregnancy Association website. Available at: http://www.americanpregnancy.org/pregnancyloss/sbtryingtounderstand.html. Updated January 2014. Accessed September 29, 2014.

  • The American Congress of Obstetricians and Gynecologists. ACOG practice bulletin No. 102: Management of stillbirth. Obstet Gynecol. 2009 Mar;113(3):748-61. Reaffirmed 2012.

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

  • 8/26/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Gaskins AJ, Rich-Edwards JW, et al. Maternal prepregnancy folate intake and risk of spontaneous abortion and stillbirth. Obstet Gynecol. 2014;124(1):23-31.