Stillbirth

About

When children are born dead, one can only imagine the anguish of the expectant parents-to-be! The term stillbirth is used when fetal death occurs after 20 weeks of pregnancy. The prevalence is about 1 in 160 pregnancies and most of these occur before the beginning of labor. A small percentage of stillbirths occur during the time of labor or during delivery.

The exact manner in which fetal death is brought about remains unclear as fetal behavior is inconsistent. The pregnant woman can usually sense when there is a sudden lack of movement, when fetus stops kicking or moving around. A change in fetal movement and sleep-wake cycle provides indications of fetal distress or even death. Normal, healthy fetuses too can exhibit such changes so it needs to be confirmed through medical exams.

In the United States the rate of stillbirth is approximately 1 in 160 births. In third world countries, where the medical facilities are rather compromised, the rate could be much higher.

Causes

The following are some of the known causes of stillbirth -

• Birth defects: Approximately 15 to 20 percent of stillborn babies present with one or more birth defects. Down syndrome is one of the common examples.

• Placental problems: A common placental problem is placental abruption in which the placenta peels away from the uterine wall prior to delivery causing heavy bleeding. This is a life-threatening situation as the fetus can die due to oxygen deficiency. Smokers and drug abusers are most at risk.
• Poor fetal growth: Slow-growing fetuses (40%) are at risk of still birth. Babies of smokers and those with high BP are more at risk.

• Infections: Infections in mothers, fetus or placenta account for 10 - 25 percent of stillbirths.
• Chronic health conditions in the mother: Chronic health conditions such as diabetes, thrombophilia or other clotting diseases, kidney disease and pregnancy-induced high blood pressure account for 10% of still births.
• Umbilical cord accidents: These accidents which involve the umbilical cord deprive the fetus of oxygen and contribute to 2 to 4 percent of stillbirths.

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There are other uncommon causes too, such as Rh disease, motor accidents or asphyxia.

Certain risk factors also are associated with stillbirth. Some of these include :

• Maternal age over 35 years
• Maternal obesity
• Multiple gestation (twins or more)

• African-American ancestry

Diagnosis

An ultrasonography (USG) or ultrasound examination can help to confirm stillbirth. A USG would fail to detect fetal heart beat if the fetus is still born. If necessary, blood tests may be carried out on the pregnant woman to determine the cause of death. Once fetal death is confirmed then the options to deliver the still fetus may be discussed.

For some women, immediate delivery may be advised for medical reasons while others may be told to wait till the onset of labor, which usually occurs two weeks after the fetus dies in the womb. Usually no risk is involved in waiting. If the woman does not go into labor on her own it may have to be induced as there is risk of developing clots after this period.

For inducement of labor, the cervix of the woman is prepared by administering medications. The hormone oxytocin is usually administered intravenously to induce uterine contractions. Cesarean is usually avoided, unless there is a problem with normal delivery.

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Post Delivery measures

Once the fetus is delivered, placenta and umbilical cord are removed and carefully examined to determine the cause of fetal death. An autopsy and a chromosomal analysis may be recommended. These tests may provide vital clues of what is wrong, in case the couple is planning future pregnancy.

Prevention

Stillbirths have steadily declined since 1950’s due to better monitoring and treatment options for maternal high blood pressure and diabetes that contribute towards stillbirth. A pregnant woman and her baby are constantly monitored through ultrasound scans and the vital signs of both mother and child are recorded. If the mother feels that the fetal movement is slow, or if she experiences vaginal bleeding, she is advised to contact the doctor. The latter could be caused by placental abruption and, a timely cesarean could save fetal life.

Rh disease which is another important cause of stillbirth which can now be prevented by injecting an Rh-negative woman with immune globulin during her 28^th weeks of pregnancy and after the birth of her Rh-positive baby.

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A pregnant woman should never go on diet or try to lose weight, but must take care to maintain an optimum weight. She should keep away from smoking, consuming drugs or take alcohol to minimize her risk for still births.

Couple who have already experienced still births must discuss their risk rate with their health care providers. They may also consult a counselor or join a support group to cope with their grief.