Womens Health

Pregnancy Loss: Stillbirth

For most women, pregnancy is a source of great joy and happiness, as they prepare for motherhood and the birth of their child. That is what makes having a stillborn baby such a devastating and overwhelming occurrence for everyone involved. In the United States, some 25,000 babies each year are lost to stillbirth. And while the exact cause of stillbirth is as yet unknown, there are certain risk factors that may contribute to a pregnant woman’s risk of having a stillborn child.

What is Stillbirth?

Stillbirth refers to fetal death that occurs after 20 weeks of pregnancy (during or after the second trimester) – miscarriage is fetal death before those first 20 weeks. Stillbirth can occur in the uterus (intrauterine death) or within the birth canal during labor and delivery (intra-partum death). Most often stillbirth occurs unexpectedly, and it is important to note that it can occur in both healthy pregnancies and in those complicated by other health issues.

Risk Factors

Though any woman can experience a stillbirth, there are certain factors that increase your risk of stillbirth, including:

  • carrying multiple babies
  • having a pre-existing health condition (such as high blood pressure)
  • smoking during pregnancy
  • using illicit drugs during pregnancy
  • being over the age of 35

What Causes Stillbirth?

If you have been diagnosed with stillbirth, your doctors will take all measures necessary to determine the cause. However, for a variety of reasons, pinpointing the exact reason is not always possible. In fact, in up to 50% of stillbirth cases, a cause for death is never fully determined. However, some possible causes can include:

  • Placental Problems: Because the placenta serves as the baby’s main source of nourishment within the womb, any abnormalities can drastically impact the health of the fetus. Sometimes, the placenta can peel away from the uterus before birth, depriving the baby of oxygen and nutrients vital to his survival. Known as placental abruption, this condition is believed to be responsible for up to 16% of stillbirths. It generally occurs around the 35th week of pregnancy.
  • Birth Defects: Sometimes a fetus is created with abnormal chromosomes, leading to problems in its genetic code. This can cause a number of serious birth defects, which can make it impossible for the baby to be carried to term. Approximately 5% to 10% of stillbirths are the result of such genetic birth defects. Birth defects can also be the result of environmental toxins, such as chemical exposure or cigarette smoking.
  • Infection: Bacterial infections can significantly increase the risk of fetal death when they occur between 24 and 27 weeks of gestation. However, many times these infections will carry no apparent symptoms and may therefore go undiagnosed until they lead to serious complications, including stillbirth and preterm birth. Tests conducted on the placenta can determine whether infection was the cause of fetal death.

In addition, certain maternal health conditions can be a cause of intrauterine and intra-partum death. Women with diabetes and preeclampsia are at slightly increased risk for having a stillborn baby.

Previously doctors believed that trauma suffered during delivery (such as umbilical cord strangulation or shoulder dislocation) was a leading cause of stillbirth. Although this may occur, thanks to modern developments in childbirth techniques, this has become a very rare cause of stillbirth.

How is Stillbirth Diagnosed?

Stillbirth is usually diagnosed during your routine ultrasound scan at prenatal appointments. An ultrasound can detect whether a baby is moving and breathing normally. Fetal heart rate monitors can also determine a stillbirth. Afterwards additional blood tests will be done to help determine the cause of the stillbirth.

What Happens After the Diagnosis of a Stillbirth?

After a woman has been diagnosed with a stillbirth, she must make the decision whether or not to have labor induced. While waiting for natural labor does not pose any risks to the mother, for many pregnant women the two-week wait is too much to bear, which is why most opt to have labor induced.

To induce labor your doctor will insert suppositories into your vagina to stimulate dilation. You will also receive the hormone oxytocin to help stimulate uterine contractions. If you encounter problems delivering your baby, a cesarean section may be performed in order to prevent any serious health complications.

The good news is that the majority of couples who experience stillbirth experience healthy pregnancies in the future. However, parents with genetic defects or illness may be at increased risk for subsequent stillbirths.

Stillbirth Prevention

Thanks to developments in fetal monitoring, stillbirths are increasingly becoming a thing of the past. However, there are still things you can do to limit your risk of stillbirth even further. For example, all pregnant women should be sure to:

  • Attend all Prenatal Appointments: It is important to attend regular prenatal appointments throughout your pregnancy. During these appointments, your health care provider will be sure to check whether your baby is developing properly and your overall health is good. These appointments are also essential in identifying any additional health problems early on.
  • Monitor Their Baby’s Movements: After the 26th week of pregnancy, it is recommended that all pregnant women monitor their baby’s movements. For example, count the number of kicks that your baby makes in a day. If your baby is kicking less than ten times a day, or seems to be abnormally quiet, you should consult your health care provider.
  • Avoid Infection: Many infections responsible for stillbirth are preventable. Be sure to practice good hygiene, including regular hand washing. Also, avoid exposure to cat litter during pregnancy, and don’t eat raw or improperly cooked foods.
  • Report Any Pain or Bleeding: Monitor yourself for any abnormal bleeding or pains during your pregnancy. Report any of these symptoms to your health care professional immediately.

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