Stillbirth is death of a fetus at 20 weeks of pregnancy or later (or after 28 weeks in some definitions).
Stillbirth may result from a problem in the woman, placenta, or fetus.
Doctors do blood tests to try to identify the cause of a stillbirth.
If the dead fetus is not expelled, the woman may be given medications to help the uterus expel its contents, or the contents are surgically removed by dilation and evacuation.
Stillbirth, by definition, involves death of the fetus. In the United States, stillbirth is defined as fetal death before or during birth at 20 weeks gestation or later. The World Health Organization defines stillbirth as fetal death after 28 weeks. There are almost 2 million stillbirths worldwide every year. Prior stillbirth increases the risk of death of the fetus in subsequent pregnancies.
If a fetus dies during late pregnancy or near term but remains in the uterus for weeks, the woman may develop a clotting disorder that can cause severe bleeding (called disseminated intravascular coagulation).
Causes of Stillbirth
Stillbirth may result from a problem in the woman, placenta, or fetus. Sometimes what causes a stillbirth is unknown.
The fetus may die when women have certain conditions, such as
Preeclampsia (a type of high blood pressure that develops during pregnancy) or eclampsia
Injuries
Blood clotting disorders such as antiphospholipid syndrome
Diabetes that is poorly controlled
A poorly controlled thyroid disorder
Severe obesity (body mass index [BMI] of 40 or higher)
Problems with the placenta may also result in death of the fetus. These problems may include the following:
Placental abruption (when the placenta detaches from the wall of the uterus too soon)
Entry of the fetus's blood into the mother's bloodstream
A prolapsed umbilical cord (when the cord comes out of the vagina before the baby)
Problems with the umbilical cord (such as umbilical cord prolapse or a knot)
Vasa previa (when membranes that contain blood vessels connecting the umbilical cord and placenta lie across or near the opening of cervix)
Conditions that reduce blood flow (and thus oxygen and nutrients) to the fetus
An infection of the membranes around the fetus (intraamniotic infection)
Sometimes the fetus dies when it has a problem, such as
Anemia (too few red blood cells)
A pregnancy with more than one baby (multiple births)
An infection
Diagnosis of Stillbirth
A doctor's evaluation
Tests to identify the cause
Doctors may suspect that the fetus is dead if the fetus stops moving, although movements often decrease as the growing fetus has less room to move. Tests to evaluate the fetus are usually done. These tests include the following:
A nonstress test: The fetus's heart rate is monitored when the fetus is lying still and as it moves. For this test, doctors use a device attached to the woman’s abdomen.
Biophysical profile: Ultrasonography is used to produce images of the fetus in real time, and the fetus is observed. This test enables doctors to evaluate the amount of amniotic fluid and check the fetus for periods of rhythmic breathing, movement, and muscle tone.
To try to identify the cause of stillbirth, doctors do genetic and blood tests (such as tests for infections, diabetes, thyroid disorders, and antiphospholipid syndrome). Doctors also recommend evaluating the fetus to look for possible causes, such as infections and chromosome abnormalities. The placenta and uterus are examined. Often, the cause cannot be determined.
Treatment of Stillbirth
If needed, medications to expel the fetus
If needed, procedures to remove any remaining tissues in the uterus
Emotional support and counseling
If any tissue from the fetus or placenta remains in the uterus, suction curettage is done to remove it. A speculum is used to spread the walls of the vagina, and the cervix is dilated. Then a flexible tube is inserted into the uterus to remove the fetus and placenta. The tube is attached to a handheld syringe or an electrical suction machine, which suctions out any remaining tissue.
The physical care for women who have had a stillbirth is the same as that usually provided after delivery of a baby (postpartum care). However, extra emotional and social support is needed.
If disseminated intravascular coagulation develops, women are given blood transfusions as needed.
Changes and emotions that occur in women after a stillbirth are similar to those that occur after a miscarriage. Women typically feel grief at the loss and require emotional support and sometimes counseling.
Whether a future pregnancy is likely to result in a stillbirth depends on the cause.
