|AGE More common over the age of 35||GENDER|
|LIFESTYLE Smoking and alcohol or drug abuse during pregnancy are risk factors||GENETICS Risk factors depend on the cause|
A stillbirth is the delivery of a dead fetus after week 24 of pregnancy. Before 24 weeks, it is considered a miscarriage.
The death of a fetus in the uterus or during birth is a very distressing event. Bereaved parents may experience confused feelings of anger, shock, guilt, and inadequacy, in addition to overwhelming grief. Stillbirths are extremely rare. Their incidence has decreased dramatically in developed countries during the past 50 years, and fewer than 6 in 1,000 babies are now stillborn in the UK each year. Stillbirth is slightly more common in mothers over the age of 35.
What are the causes of stillbirth?
Often, the precise cause of fetal death is unknown. The death may be caused by a decrease in the fetus's oxygen supply (see Fetal distress) due to a problem with the umbilical cord or the placenta. For example, the umbilical cord may be tangled or knotted, or the placenta may separate from the uterus before the baby is born (see Placental abruption). If the mother has very high blood pressure or poorly controlled diabetes mellitus, the risk of stillbirth is increased.
Stillbirth may also occur if the fetus has a severe genetic disorder or, rarely, if the blood groups of the mother and fetus are not compatible (see Rhesus incompatibility). Certain infectious diseases that pass from the mother to the fetus, such as listeriosis, may harm the fetus and, if they are severe, may be fatal. Women who smoke or abuse drugs or alcohol are at greater risk of a stillbirth.
What might be done?
The first sign that a fetus may have died in the uterus is the absence of movement. If, after week 20 of pregnancy, you are aware that fetal movements have decreased or ceased altogether, you should call your doctor without delay. The doctor will listen for the fetal heartbeat and then confirm his or her findings with an ultrasound scan (see Ultrasound scanning in pregnancy). In most cases, the results of the scan confirm that the fetus is well and the pregnancy is progressing normally. Rarely, if the fetus has died and labour has not started, induction of labour will probably be necessary.
If there is no immediate risk to your health, such as an infection, you may be given time to come to terms with the loss of the baby before it is delivered. A caesarean section is not usually used to deliver the baby because of the risks associated with any operation and the small risk of the scar reopening during a subsequent vaginal delivery. In the very rare event of a baby dying during labour, delivery will continue.
Parents are encouraged to see and hold their stillborn baby after the birth as part of the grieving process. After the delivery, the mother and baby undergo tests to determine the cause of death. Before leaving hospital, the mother may be given drugs to inhibit her milk production and provide pain relief.
Your doctor may recommend professional counselling to help you to recover from your loss (see Loss and bereavement). You should not be afraid to seek support from family and friends. You may also find it helpful to join a self-help group and meet people who have been through a similar experience. Some people may find comfort in a funeral ceremony. About 6 weeks after the birth, your doctor will review the results of tests and the postmortem with you and discuss the cause of the death, if it is known.
What is the prognosis?
After a stillbirth, you may feel strongly that you want to begin another pregnancy straight away. However, it may be better to wait until you are emotionally ready for a new baby and are fully recovered from your pregnancy. If you do decide on another pregnancy, your doctor will ensure that you are given extra care because you will be considered to be at high risk (see High-risk pregnancy). The risk of having a further stillbirth depends on the original cause, if one can be found, but most subsequent pregnancies are successful. As with all grief, the pain of losing a baby lessens with time.
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