Stillbirth

Definition

A stillbirth is defined as the death of a fetus at any time after the 20th week of pregnancy. Stillbirth is also referred to as intrauterine fetal death (IUFD).

Description

It is important to distinguish between a stillbirth and other words that describe the unintentional end of a pregnancy. A pregnancy that ends before the twentieth week is called a miscarriage rather than a stillbirth, even though the death of the fetus is a common cause of mis-carriage. After the twentieth week, the unintended end of a pregnancy is called a stillbirth if the infant is dead at birth and premature delivery if it is born alive.

Factors that increase a mother's risk of stillbirth include: age over 35, malnutrition, inadequate prenatal care, smoking, and alcohol or drug abuse.

Causes

A number of different disorders can cause stillbirth. They include:

• Pre-eclampsia and eclampsia. These are disorders of late pregnancy characterized by high blood pressure, fluid retention, and protein in the urine.
• Diabetes in the mother.
• Hemorrhage.
• Abnormalities in the fetus caused by infectious diseases, including syphilis, toxoplasmosis, German measles (rubella), and influenza.
• Severe birth defects, including spina bifida. Birth defects are responsible for about 20% of stillbirths.
• Postmaturity. Postmaturity is a condition in which the pregnancy has lasted 41 weeks or longer.
• Unknown causes. These account for about one third of stillbirths.

Symptoms

In most cases the only symptom of stillbirth is that the mother notices that the baby has stopped moving. In some cases, the first sign of fetal death is premature labor. Premature labor is marked by a rush of fluid from the vagina, caused by the tearing of the membrane around the baby; and by abdominal cramps or contractions.

Diagnosis

When the mother notices that fetal movement has stopped, the doctor can use several techniques to evaluate whether the baby has died. The doctor can listen for the fetal heartbeat with a stethoscope, use Doppler ultrasound to detect the heartbeat, or give the mother an electronic fetal nonstress test. In this test, the mother lies on her back with electronic monitors attached to her abdomen. The monitors record the baby's heart rate, movements, and contractions of the uterus.

Medical

In most cases of intrauterine death, the mother will go into labor within two weeks of the baby's death. If the mother does not go into labor, the doctor will bring on (induce) labor in order to prevent the risk of hemorrhage. Labor is usually induced by giving the mother a drug (oxytocin) that cause the uterus to contract.

Follow-up therapy

Emotional support from family and friends, self-help groups, and counseling by a mental health professional can help bereaved parents cope with their loss.

Prognosis

With the exception of women with diabetes, women who have a stillbirth have as good a chance of carrying a future pregnancy to term as women who are pregnant for the first time.

Prevention

The risk of stillbirth can be lowered to some extent by good prenatal care and the mother's avoidance of exposure to infectious diseases, smoking, alcohol abuse, or drug consumption. Tests before delivery (antepartum testing), such as ultrasound, the alpha-fetoprotein blood test, and the electronic fetal nonstress test, can be used to evaluate the health of the fetus before there is a stillbirth.

BOOKS

Cunningham, F. Gary, et al. Williams Obstetrics. Stamford: Appleton & Lange, 1997.

Johnson, Robert V. Mayo Clinic Complete Book of Pregnancy and Baby's First Year. New York: William Morrow and Co., Inc.

ORGANIZATIONS

Compassionate Friends. P.O. Box 3696, Oak Brook, IL 60522. (877) 969-0010. <http://www/compassionatefriends.org>.

Hannah's Prayer. P.O. Box 5016, Auburn CA 95604. (775) 852-9202. <http://www.hannah.org>.

GriefNet. P.O. Box 3272, Ann Arbor, MI 48106. <http://rivendell.org>.

M.E.N.D. (Mommies Enduring Neonatal Death). P.O. Box 1007, Coppell, TX 75067. (972) 459-2396; (888) 695-6363. <http://www.mend.org/home_index.asp>.

Pregnancy and Infant Loss Support (SHARE). St. Joseph Health Center, 300 First Capitol Dr., St. Charles, MO63301. (800) 821-6819. <http://www.nationalshareoffice.com/index.html>.

Carol A. Turkington

KEY TERMS

Alpha-fetoprotein analysis—A blood test that can be done after the sixteenth week of pregnancy to evaluate the possibility of spina bifida and other birth defects in the fetus.

Electronic fetal nonstress test—A test in which electronic monitors attached to the mother's abdomen to detect contractions of the uterus as well as the baby's heartbeat and movements.

Miscarriage—The spontaneous end of a pregnancy before the twentieth week. The death of the fetus is a common cause of miscarriage.

Oxytocin—A drug that is given to induce labor in some cases of stillbirth.

Pre-eclampsia and eclampsia—Disorders of late pregnancy associated with high blood pressure, fluid retention, and protein in the urine. They can cause stillbirth.

Premature delivery—The birth of a live baby when a pregnancy ends spontaneously after the twentieth week.