The rise in the
number of stillbirths
has created alarm in medical circles, with the number of stillbirths far exceeding the number of deaths due to malaria, AIDS and other
chronic diseases among children below 5 years.
, the leading
medical journal is creating increased awareness about this preventable
condition, hoping for reduction in numbers.
Leading Causes of Stillbirth
1. Termination of Pregnancy
K.S. Joseph and colleagues studied data on stillbirth
numbers from British Columbia, Canada
and found that termination of pregnancy
- Was a key factor in the rise in stillbirths
- Reduction in congenital and birth defects
: Goldenberg and colleagues published a study titled "Infection-related stillbirths" in The
. The findings were:
3. Placental Lesions
- In high-income countries- 10-25% of
stillbirths are caused by infections.
- In low-income groups- 50% of
stillbirths are caused by infections.
- Syphilis is one of
the most dangerous diseases that causes stillbirth though it can be easily
detected and treated.
- Malaria causes extensive placental damage and
leads to stillbirths
- Chlamydia and Gonorrhea infections also increase the risk
even years after the disease has subsided.
: Halit Pinar and colleagues published their study titled " Placental
Findings in Singleton Stillbirths" in the Journal Obstetrics and Gynecology
In this study, placentas from stillbirths and
live births were analyzed
4. Maternal Complications
- Placental lesions were considerably
higher among stillbirths than live births:
- Retro-placental hematoma - 23.8% in
stillbirth - 4.2% live births
- Placental inflammation - 30% of stillbirths - 12.8% in live
- Single umbilical artery - 7.7% stillbirth - 1.7% live birth
- Fetal vascular thrombosis- 23% of stillbirth - 7% of live birth
: Gold KJ and colleagues studied maternal complication with
stillbirth in a study titled " Maternal complications
associated with stillbirth delivery: A cross-sectional analysis" in The Journal
Obstetrics and Gynecology
. The study found that there was a high risk of
maternal complications during childbirth and labor
that contributed to stillbirth. The following complications were found among the study population with stillbirths:
‘Working with mothers to better manage their pregnancy is a key factor in decreasing stillbirths.’
- Shoulder dystocia
- Postpartum hemorrhage
- Retained placenta
- Clinical chorioamnionitis
The maternal age also dictated if placental
complications led to stillbirth, according to the study.
5. Maternal Obesity
L and colleagues published their study titled " Risk
of stillbirth in pregnant women with obesity in the United Kingdom" in The Journal
Obstetrics Research in Clinical Practice
. This study found that obese or
overweight pregnant women had an increased risk of stillbirth in the U.K.
6. Genetic Defects in the
A large number of genetic defects contribute
7. High Blood Pressure or
Pre-Eclampsia in the Mother:
Some mothers suffer from
high blood pressure during pregnancy
and careful monitoring should be carried out to prevent stillbirth.
8. Umbilical Cord
The umbilical cord complications
include twisting of the cord around the fetus' neck which can prove to be fatal
The onus on obstetrics has been to prevent stillbirth by early delivery,
therefore the rise in the number of stillbirth cases is a cause of concern.
However, a study by MacDorman and colleagues in The Journal Obstetrics and
titled " Trends in Stillbirth by
Gestational Age in the United States, 2006-2012" found that avoiding
non-medically indicated child birth before 39 weeks did not increase U.S stillbirth rate.
This is an indication that greater awareness
and preventive strategies about stillbirth should
be created among women. The taboo associated with stillbirth in certain cultures continues to plague this condition and work against change
. Mothers, especially
young mothers are blamed solely for the stillborn leading to further maternal complications that can affect future pregnancies. Working with mothers to
better manage their pregnancy
is a key factor in decreasing stillbirths.
1. Breaking the Taboo
: The taboo associated with stillbirth should be removed by creating
better awareness about the risk factors that lead to stillbirth. This will help women step out of their situation and to seek
2. Awareness about Maternal Health
: Educating women about healthy foods that should be consumed during pregnancy
will aid in pro-active steps towards preventing stillbirth. Maternal health awareness should not be restricted to healthy food alone but includes a number of other factors like:
- Birth control strategies
- Sexual health
- Consumption of alcohol
- Drug abuse
- Adequate exercise
: Many women who have delivered a
stillborn baby suffer from psychological disturbances which are often unnoticed
by family members. This can affect how well they look after themselves during
subsequent pregnancies. There are plenty of support groups that women can
enroll themselves into to find solace and strategies for coping with stillbirth.
Women who have had stillbirths are normally devastated as they have waited long months for their
baby's birth. Many hospitals and birth registries encourage parents to register
their stillborn child so they get a chance to name their baby. This helps
parents find closure and gives them the pleasure of having done something for
4. Encourage Midwives
Midwives play a vital role in monitoring maternal and fetal health during
pregnancy. They bring in years of experience and training which will help
immensely during childbirth and labor. This dwindling paramedical support group
should be actively encouraged as a conscious means to bring down stillbirth numbers.
Fetal movement should be closely monitored by
mothers and reduction or absence in movements should be reported immediately to
the gynecologist or the midwife. Though there is no need for paranoia, getting
regular checkups during your pregnancy
will help avoid unnecessary stillbirth incidents. Conducting an autopsy for stillbirths will aid in understanding the reasons behind the stillbirth, preventing future untoward incidences during a subsequent pregnancy.
There are active steps that need to be taken
to lower incidences of stillbirth. The
reassuring factor in this regard is the aim by World Health Assembly to reduce stillbirth by 2035
3. K.S. Joseph,
Kinniburgh, Jennifer A.
Mehrabadi, Melanie Basso,
RN and Lily Lee
"Determinants of increases in
stillbirth rates from 2000 to 2010", CMAJ, May 2014
4. Jacob L,
" Risk of stillbirth in pregnant women
with obesity in the United Kingdom"; Obstetric Research in Clinical Practice,
5. MacDorman MF,
" Trends in Stillbirth by Gestational
Age in the United States, 2006-2012."; Obstetrics and Gynaecology, December
6. Gold KJ,
EL, Puder KS,
"Maternal complications associated with
stillbirth delivery: A cross-sectional analysis."; Journal of Obstetrics and
Gynaecology; Oct 2015
7. Halit Pinar,
Goldenberg, Matthew A.
Heim-Hall, Hal K.
Hawkins, Bahig Shehata,
Abramowsky, Corette B.
Parker, Donald J.
Dudley, Robert M.
Silver; "Placental Findings
in Singleton Stillbirths"; Obstetrics and Gynaecology, 2014
8. Goldenberg RL1,