What is a stillbirth?

Causes and Symptoms

There are many causes of stillbirth, but in many cases, the precise cause of a fetal death is not known. The causes of stillbirth can be grouped into general categories such as fetal asphyxia; hematologic, chromosomal, or developmental problems with the fetus; and maternal illness. Fetal asphyxia occurs when the blood supply to the fetus is reduced or cut off, such as in cases of umbilical cord entanglement or placenta abruptio (abnormal detachment of the placenta from the uterus caused by such factors as maternal high blood pressure or preeclampsia, trauma, or certain drugs). Hematologic causes of stillbirth include isoimmunization (in which maternal antibodies attack fetal blood cells) or thrombophilias (abnormalities in blood clotting). Maternal illnesses such as diabetes, infections (such as listeria), cholestasis, and antiphospholipid syndrome are also associated with increased risk of stillbirth.

The primary symptom of fetal demise is the absence of fetal movement. The death can be confirmed on ultrasonography or fetoscopy, which reveals the absence of a fetal heartbeat. Stillbirth may be associated with other symptoms, depending on its cause. For instance, if it results from placenta abruptio, then the woman may experience bleeding and contractions.

Treatment and Therapy

Once a stillbirth has been confirmed, treatment is directed at helping the woman and her family cope with the loss and the grieving process through psychopathology. Grief counseling is an important component of therapy. If the patient is already in labor, then minimizing obstetric trauma to the mother is of prime concern. If the patient is not in labor, then plans regarding the induction of labor are made, since prolonged retention of the dead fetus and placenta may result in disseminated intravascular coagulation (DIC), a dangerous blood condition. The patient also receives treatment aimed at controlling any maternal illnesses, such as gestational diabetes or preeclampsia. If no obvious conditions contributed to the stillbirth, then the patient may be offered an investigation into causes of the demise. This investigation may involve tests on maternal blood for abnormalities of blood clotting, infections, abruption, diabetes, and liver abnormalities. With appropriate consent, witnessed sampling, and chain of custody handling, a urine specimen may be evaluated for the maternal ingestion of toxic substances. The stillborn fetus may be sent for autopsy and karyotyping.

No effective means exist for preventing stillbirth, although with advances in medical care, by 2009 the stillbirth rate had fallen to about 18.9 per 1,000 births throughout the world, and only 3.1 per 1,000 in high-income countries. By 2011 approximately .61 percent of pregnancies in the United States resulted in a stillbirth. If a pregnant woman has conditions putting her at increased risk of fetal demise or a history of stillbirth, then increased surveillance using ultrasonography and fetal heart tone monitoring may be indicated.

Bibliography

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Kohner, Nancy, and Alix Henley. When a Baby Dies: The Experience of Late Miscarriage, Stillbirth, and Neonatal Death. Rev. ed. New York: Routledge, 2001. Print.

MacDorman, Marian F., and Sharon Kirmeyer. "The Challenge of Fetal Mortality." Centers for Disease Control and Prevention. CDC, April 2009. Web. 16 Feb. 2015.

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"Stillbirth." MedlinePlus. Natl. Lib. of Medicine, Natl. Institutes of Health, 9 Jan. 2015. Web. 16 Feb. 2015.