Stillbirth – Causes, Diagnosis and Prevention.

What is Stillbirth?

A stillbirth is the death or loss of a baby before or during delivery. Both miscarriage and stillbirth describe pregnancy loss, but they differ according to when the loss occurs. In the United States, a miscarriage is usually defined as loss of a baby before the 20th week of pregnancy, and a stillbirth is loss of a baby at or after 20 weeks of pregnancy.

Stillbirth is further classified as either early, late, or term.

• An early stillbirth is a fetal death occurring between 20 and 27 completed weeks of pregnancy
• A late stillbirth occurs between 28 and 36 completed pregnancy weeks
• A term stillbirth occurs between 37 or more completed pregnancy weeks

What causes a baby to be stillborn?

A number of diseases and conditions as well as problems with the pregnancy or health of the mother can all be causes of stillbirth. Some causes of stillbirth include:

• Birth defects or chromosomal abnormalities in the fetus;
• Problems with the placenta, such as insufficient blood flow;
• Infections of the fetus, mother, or placenta;
• Complications of pregnancy and labor, such as preterm labor and placental abruption (separation of the placenta from the uterine wall);
• Problems with the umbilical cord; and
• High blood pressure or other health complications in the mother.

What are the risk factors for delivering a baby stillborn?

Certain conditions or factors increase the risk of having a stillborn baby. These include:

• Obesity
• Diabetes or high blood pressure
• Multiple gestation
• Age under 20 or over 35
• Black race
• Smoking
• Alcohol use
• Drug abuse
• History of stillbirth, miscarriage, or pregnancy complications

What are the symptoms of Stillbirth?

The following are the most common symptoms of stillbirth. However, each woman may experience symptoms differently. Symptoms may include:

• Stopping of fetal movement and kicks
• Spotting or bleeding
• No fetal heartbeat heard with stethoscope or Doppler
• No fetal movement or heartbeat seen on ultrasound, which makes the definitive diagnosis that a baby is stillborn. Other symptoms may or may not be linked to stillbirth.

The symptoms of stillbirth may resemble other medical conditions. Always consult your doctor for a diagnosis.

Complications

Serious Maternal Complications Associated with Hospitalization for Stillbirth Deliveries

• Disseminated Intravascular Coagulation
• Blood loss requiring transfusion
• Shock or hypotension
• Renal failure
• Respiratory failure requiring intubation
• Diabetic ketoacidosis
• Sepsis
• Uterine rupture
• Unplanned hysterectomy
• Maternal death

Diagnosis and Tests

How is the diagnosis made?

Usually, you’ll notice that your baby isn’t as active as it used to be. An ultrasound will confirm if the baby has passed.

How can I find out what caused my stillbirth?

To discover the cause, your healthcare provider will perform one or more of the following tests:

• Blood Tests. Blood tests will show if you have preeclampsia, obstetric cholestasis or diabetes.
• Examination of the umbilical cord, membranes and placenta. These tissues attach to your fetus. An abnormality could prevent your baby from receiving oxygen, blood and nutrients.
• Tests for infection. Healthcare providers will take a sample of your urine, blood, or cells from your vagina or cervix to test for infection.
• Thyroid function test. This test will determine if there’s something wrong with your thyroid gland.
• Genetic tests. Your healthcare provider will take a sample of the umbilical cord to determine if your baby had genetic problems such as Down’s syndrome.

Your healthcare provider will also review medical records and the circumstances surrounding the stillbirth. With your consent, an autopsy can be performed to determine the cause of your baby’s death. An autopsy is a surgical procedure performed by a skilled pathologist. Incisions are made carefully to avoid any disfigurement, and the incisions are surgically repaired afterward. You have the right to limit the autopsy to eliminate any incisions on your baby that are uncomfortable for you. Be sure to write these requests on the autopsy permission form.

Some hospitals do not perform autopsies, so your baby may have to be transported to another hospital. Be sure you feel comfortable with where your child is being taken. You also have the right to deny an autopsy, if that is your wish.

An autopsy may be legally required in some cases, including when:

• A baby died within 24 hours of a surgical operation.
• A healthcare provider cannot certify the cause of death.
• A baby was alive and then died suddenly.

What is the treatment for mothers of stillborn babies?

Treatment for mothers of stillborn babies includes several key components:

• Delivery of the fetus. Depending on the stage of pregnancy, the fetus may be delivered by induction of labor or by dilation and evacuation (dilation of the cervix and removal of the fetus from the womb) if the stillbirth occurs in the second trimester. Cesarean delivery may also be an option for some women.
• Examination of the fetus and search for causes of stillbirth. This can include examination of the fetus or the amniotic fluid to try to determine the reason for the stillbirth. It is important to do this to try to determine if there are conditions or factors that might place future pregnancies at risk.
• Management of risk factors. If medical reasons or risk factors are present that might put future pregnancies at risk, the mother can work with her health care team to try to minimize risk for future pregnancies.
• Coping with grief. Emotional support and grief counseling is another important part of treatment of the mother.

Preventing Stillbirth

Not all stillbirths can be prevented, but there are some things you can do to reduce your risk, such as:

• Not smoking
• Avoiding alcohol and drugs during pregnancy – these can seriously affect your baby’s development, and increase the risk of miscarriage and stillbirth
• Not going to sleep on your back after 28 weeks – don’t worry if you wake up on your back, just turn onto your side before you go back to sleep
• Attending all your antenatal appointments so that midwives can monitor the growth and well being of your baby
• Taking folic acid before pregnancy and having a flu vaccine during your pregnancy
• Limiting the amount of caffeine you consume during pregnancy